Cluster headaches though diagnosed during adulthood have pediatric onset

Cluster headaches have significant limitations, including a paucity of large non-clinic-based research. There is also a scarcity of data on certain features of cluster headache, such as pediatric occurrence.

Cluster headaches are common in the pediatric population, according to a recent study conducted by Larry I. Schor and colleagues, although they are often not identified until adulthood.

The goal of this study was to confirm diagnoses and explore epidemiological data from a worldwide, non-clinic-based, large (n = 1604) survey of cluster headache participants.

The findings of this study were published in the Headache - Journal of Head and face pain on November 28th, 2021.

The International Cluster Headache Questionnaire was an internet-based survey that asked about cluster headache demographics, International Classification of Headache Disorders (ICHD) criteria, and medicines.

The key findings of this work are:

1. A total of 3251 people took part in the study, with 1604 of them meeting the ICHD criteria for cluster headache. Researchers interviewed a random sample of 5% of participants for validation and verified the diagnosis of cluster headache in 97.5%.

2. Only 27.5% of individuals had pediatric onset, and only 15.2% of those with pediatric onset were diagnosed before the age of 18.

3. Men were more prevalent than women to suffer episodic cluster headache between the ages of 10 and 50, while the sex ratio was almost similar at other ages.

4. The vast majority of responders reported at least one autonomic characteristic and restlessness, but many also reported stereotypical migrainous symptoms such as photophobia or phonophobia, pain increased by physical exercise, or nausea and vomiting.

5. Interestingly, as compared to episodic cluster headache, the first-line drugs for acute treatment (oxygen) and preventative treatment (calcium channel blockers) were evaluated as much less effective in chronic cluster headache.

In conclusion, the start of cluster headache is the inverse of that of migraine; with migraine, women are more likely to suffer migraine between the ages of 10 and 50, but otherwise the sex ratio is almost similar. Prototypical migrainous characteristics are ineffective in distinguishing cluster headache from migraine. Data from a major worldwide trial further reveal that persistent cluster headache is less sensitive not just to novel therapies (such as noninvasive vagus nerve stimulation and galcanezumab), but also to standard first-line medications.

Reference:

Schor LI, Pearson SM, Shapiro RE, Zhang W, Miao H, Burish MJ. Cluster headache epidemiology including pediatric onset, sex, and ICHD criteria: Results from the International Cluster Headache Questionnaire. Headache. 2021 Nov 28. doi: 10.1111/head.14237. Epub ahead of print. PMID: 34841518.