Cluster Headache Severity: Study Identifies Several Predictors

Tobacco use, alcohol consumption, age at disease onset, and sleep quality are predictors of cluster headache severity.

Tobacco use, alcohol consumption, age at disease onset, and sleep quality are predictors of cluster headache severity, according to findings from a questionnaire-based study published in the journal Cephalalgia.

For this study, investigators used the International Statistical Classification of Diseases and Related Health Problems (ICD) 10 code G44.0 to identify Swedish patients with a cluster headache diagnosis (n=500). Participants were administered questionnaires that assessed demographic data and medical history. In addition, the investigators used The Cluster Headache Severity Scale to rate the severity of cluster headaches in this cohort.

Over half of all individuals (66.7%) included in this study reported headache attacks occurring at specific time periods throughout the day. The highest cluster headache severity was found in patients who were older at disease onset, had fewer hours of sleep, consumed fewer alcoholic beverages, and used a larger amount of prophylactic medications.

Compared with non-tobacco users, patients who had a history of tobacco use or who were current tobacco users were slightly older when cluster headaches first appeared (28.5 vs 31.7). In addition, the severity of cluster headaches was greater in patients who consumed little to no alcohol compared with patients who consumed ≥3 to 4 glasses of alcohol per week.

According to the investigators, patients experiencing cluster headaches with the most severe symptoms often have a greater need and desire to seek specialist help, which could have introduced selection bias into the study population. Also, the subjective nature of the questionnaires used in this study reduces the ability to generalize the study findings across all patients with a cluster headache diagnosis.

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While low alcohol intake and higher cluster headache severity appear to be contradictory, the investigators explain that “higher disease burden appears to be connected with lower alcohol intake…[and] is in line with earlier reports of cluster headache patients reducing their alcohol consumption during CH periods.”

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Steinberg A, Fourier C, Ran C, et al. Cluster headache – clinical pattern and a new severity scale in a Swedish cohort. Cephalalgia [published online January 1, 2017]. doi:10.1177/0333102417731773