Cluster Headache and Other Medical Conditions

Key Points

Cluster Headache (CH) patients:

  1. Are more likely than people without CH to smoke and misuse alcohol.
  2. Are more likely to suffer from depression and think about suicide.
  3. Have a higher number of office and emergency department visits than non-CH suffers.
  4. Wait a long time for a correct diagnosis.

Introduction

Cluster headache (CH) belongs to a group of headache disorders called the trigeminal autonomic cephalalgias. This is a rare disorder, and it is one of the worst pain known to headache. CH is typically described as a severe, unilateral, orbital pain. Associated symptoms may include red or teary eyes, swollen or drooping eye lid, nasal congestion or runny nose. CH patients are usually restless during an attack, unlike migraine patients who prefer to remain still. These attacks last about 15-180 minutes and there may be a seasonal pattern.

CH is more common in men than women. It generally begins when people are in their twenties. In medical literature, the “classic” CH patient is depicted as more likely to smoke, use or misuse alcohol, marijuana, and more likely to suffer from depression.

Co-morbidity is another word for other medical conditions or diseases. Not much is known about how common other medical problems are in patients with CH.
I performed a study that looked at other medical conditions of people who received a diagnosis of CH from experts and compared them to people of the same age and sex without CH.

Why study cluster headache and co-morbidity?

-Medicine used for CH treatment might interact with medications used for other conditions.
-Might provide a clue to the underlying cause of CH and help improve treatment.

Study findings

  • Eighty percent of the CH patients were men.
  • CH patients are more likely to use medical resources such as the emergency department and have frequent office visits compared to people of the same age and sex who did not have CH.
  • The average age of onset of CH was about 29 years of age.
  • The average patient was not diagnosed with CH until 13 years had passed. Previous studies have also reported a delay in diagnosis of CH. This is an important area to study because the burden of disease may be great, and if CH can be diagnosed early unnecessary tests and suffering may be avoided.
  • CH patients had a prevalence of depression almost double that of the control group. There was no difference in the prevalence of anxiety.  A web-based study indicated that about 50 % of the CH patients had suicidal thoughts.1
  • Sixty four percent of the CH patients were smokers, compared to 31 % in the control group.
  • Cardiovascular disease profile was not much different compared to the control. This is an interesting finding because one would assume that higher smoking would lead to higher heart disease. Although the numbers were low, the prevalence of obesity and diabetes were lower in CH. It is possible that this may counter-balance the effects of smoking, since obesity and diabetes are also risk factors for cardiovascular disease.

If you have cluster headache you should:

  • Tell your doctor about your other medical conditions
  • Tell your doctor about all of the other medications you are taking for other conditions
  • If you smoke, discuss with your doctor different methods for quitting2

1. Rozen TD, Fishman RS. Cluster Headache in the United States of America: Demographics, Clinical Characteristics, Triggers, Suicidality, and Personal Burden. Headache. 2012 Jan; 52(1):99-113.
2. http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/resources/index.htm
Shivang Joshi MD, MPH, RPh, Headache Fellow, Department of Neurology, Brigham and Women’s Hospital, Graham Headache Center, Boston, MA.
New Investigator and Trainee Section of the American Headache Society