New findings about cluster headaches

Date:
December 8, 2021
Source:
University of Texas Health Science Center at Houston
Summary:
Debilitating cluster headaches commonly begin in childhood,
but patients are not typically diagnosed until they are adults,
according to new research.



FULL STORY ========================================================================== Debilitating cluster headaches commonly begin in childhood, but patients
are not typically diagnosed until they are adults, according to research
from The University of Texas Health Science Center at Houston (UTHealth Houston).


==========================================================================
A team of researchers led by Mark Burish, MD, PhD, assistant professor
in the Vivian L. Smith Department of Neurosurgery with McGovern Medical
School at UTHealth Houston, conducted the Cluster Headache Questionnaire,
an international, internet-based survey of 1,604 participants with cluster headache. Results from the survey were recently published in Headache:
The Journal of Head and Face Pain.

Cluster headache is a rare headache disorder, occurring in about one in
every 1,000 individuals. They are extremely painful and occur in cyclical patterns known as cluster periods, with most attacks taking place at the
same time each day. Cluster headache is diagnosed as "episodic" when the attacks occur in periods lasting between seven days and one year and are separated by pain-free periods lasting three months or longer. Meanwhile,
in "chronic" cluster headache, attacks occur for more than one year
without remission or with remissions lasting less than three months.

The headaches are similar to migraines, but there are some key
differences.

Unlike migraines, which can last an entire day or potentially several
days if left untreated, cluster headaches typically last anywhere from
15 to 180 minutes. While it's uncommon to have more than one migraine
a day, it is possible for someone to have up to eight cluster headaches
over a 24-hour period. Moreover, migraine pain can vary in location; by contrast, cluster headaches involve only one side of the head, typically
at the temple or around the eye. Lastly, people who have migraines tend
to rest in a quiet, dark room, whereas people who have cluster headaches
tend to become restless and often pace around the room.

There is extremely limited information on several characteristics of
cluster headache, namely pediatric-onset cluster headache and comparative effectiveness of cluster headache treatments.

"I hope that this study will change the traditional thinking that cluster headache only affects adult men," said Burish, who is also with The
University of Texas MD Anderson Cancer Center UTHealth Graduate School
of Biomedical Sciences. "Our study shows that it commonly starts in
childhood, and that many children go years without the correct diagnosis, presumably suffering the entire time because they don't have the correct treatments." Significantly, pediatric onset was found in 27.5% of survey participants, but only 15.2% of participants with pediatric onset were diagnosed before the age of 18.



========================================================================== While the reasons behind this trend remain unknown, Burish has
come up with several theories based on conversations with pediatric neurologists, patients, and their parents. Family members and doctors
are not recognizing it because it is rare, and patients are not being
referred to the appropriate specialists.

Also, features of cluster headache in children could be different than
they are in adults, considering that there are small differences between children and adults in other headaches like migraine.

Burish said the study also revealed that women who have cluster headaches report higher pain intensity, more nausea, and higher depression scores
than men.

Other key survey findings include:
* While previous studies have shown that women are more likely to have
migraines between ages 10 and 50, the inverse is true for cluster
headaches: Men were more likely to have episodic cluster headache
between ages 10 and 50. The sex ratio was approximately equal for
other ages.

* An overwhelming majority of respondents had at least one symptom
featuring a reaction of the autonomic nervous system, like red eye
or nasal congestion (99.0%) and had restlessness (96.6%), but many
also had prototypical migraine features, including sensitivity
to light and sound (50.1%), pain aggravated by physical activity
(31.4%), or nausea and vomiting (27.5%).

* Interestingly, the first-line medications for acute treatment
(oxygen)
and preventive treatment (calcium channel blockers) were perceived
as significantly less effective in chronic cluster headache compared
with episodic cluster headache.

In addition to this epidemiological data, Burish said the study unearthed
some smaller tidbits of information worthy of future research.

"Cluster headache seems to start at a younger age in patients with
a family history of cluster headache, compared to an older age
in patients without a family history," Burish said. "In genetics,
this is called 'anticipation,' which suggests there may be a gene or
genes involved. Identifying those genes could be a huge breakthrough
for cluster headache." Other researchers included Hongyu Miao, PhD,
associate professor in the Department of Biostatistics and Data Science
at UTHealth School of Public Health; co-first authors Larry I. Schor,
PhD, and Stuart M. Pearson, MA, with the University of West Georgia; and
Robert E. Shapiro, MD, PhD, with the University of Vermont. Wei Zhang,
PhD, formerly an assistant professor in the Department of Biostatistics
and Data Science at UTHealth School of Public Health, was also part of
the research team.

The study received funding support from Autonomic Technologies, Inc. and Clusterbusters.

========================================================================== Story Source: Materials provided by University_of_Texas_Health_Science_Center_at_Houston.

Original written by Caitie Barkley. Note: Content may be edited for
style and length.


========================================================================== Journal Reference:
1. Larry I. Schor, Stuart M. Pearson, Robert E. Shapiro, Wei Zhang,
Hongyu
Miao, Mark J. Burish. Cluster headache epidemiology including
pediatric onset, sex, and ICHD criteria: Results from the
International Cluster Headache Questionnaire. Headache: The Journal
of Head and Face Pain, 2021; DOI: 10.1111/head.14237 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211208110314.htm

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