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Sanayama H, Namekawa M, Sakiyama Y, Sugawara H. Herpes Zoster Ophthalmicus Initially Diagnosed As Cluster Headache, Complicated by Delayed Eruption. Cureus 2024; 16:e56698. [PMID: 38646210 PMCID: PMC11032512 DOI: 10.7759/cureus.56698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Herpes zoster ophthalmicus (HZO) manifests as a consequence of the reactivation of the Varicella-zoster virus (VZV) and primarily affects the ophthalmic division of the trigeminal nerve. Identification of the vesicular eruption is central to the diagnostic process; however, the delayed manifestation of this cutaneous phenomenon poses a challenge to timely and accurate diagnosis. This report elucidates the case of a 61-year-old Japanese male with painful trigeminal neuropathy attributed to VZV that was initially diagnosed as cluster headache, mainly due to the delayed cutaneous eruption. Contrary to the expected pattern of cluster headache presentations, there was no discernible fluctuation in headache severity. The transient improvement of symptoms following interventions tailored for cluster headache management, including pure oxygen inhalation and subcutaneous sumatriptan injection, inadvertently contributed to a delay in accurate diagnosis. The importance of distinguishing HZO from cluster headache is emphasized, particularly in cases involving elderly patients or those with persistent cephalo-ophthalmalgia without the characteristic fluctuation of symptoms. In cases where clinical suspicion of HZO is raised, cerebrospinal fluid analysis should be performed. This approach is consistent with the overall goal of facilitating a prompt and accurate diagnosis.
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Affiliation(s)
- Hidenori Sanayama
- Department of Comprehensive Medicine 1, Division of General Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JPN
| | - Michito Namekawa
- Department of Health and Social Services, Graduate School, Saitama Prefectural University, Saitama, JPN
| | - Yoshio Sakiyama
- Department of Comprehensive Medicine 1, Division of Neurology, Saitama Medical Center, Jichi Medical University, Saitama, JPN
| | - Hitoshi Sugawara
- Department of Comprehensive Medicine 1, Division of General Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JPN
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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; 61:1511-1520. [PMID: 34841518 DOI: 10.1111/head.14237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the diagnoses and to investigate epidemiological data from an international, non-clinic-based, and large (n = 1604) survey of participants with cluster headache. BACKGROUND There are several limitations in current epidemiological data in cluster headache including a lack of large non-clinic-based studies. There is also limited information on several aspects of cluster headache, such as pediatric incidence. METHODS The International Cluster Headache Questionnaire was an internet-based survey that included questions on cluster headache demographics, criteria from the International Classification of Headache Disorders (ICHD), and medications. RESULTS A total of 3251 subjects participated in the survey, and 1604 respondents met ICHD criteria for cluster headache. For validation, we interviewed a random sample of 5% (81/1604) of participants and confirmed the diagnosis of cluster headache in 97.5% (79/81). Pediatric onset was found in 27.5% (341/1583) of participants, and only 15.2% (52/341) of participants with pediatric onset were diagnosed before the age of 18. Men were more likely to have episodic cluster headache between ages 10 and 50, but the sex ratio was approximately equal for other ages. An overwhelming majority of respondents had at least one autonomic feature (99.0%, 1588/1604) and had restlessness (96.6%, 1550/1604), but many also had prototypical migrainous features including photophobia or phonophobia (50.1%, 804/1604), pain aggravated by physical activity (31.4%, 503/1604), or nausea and vomiting (27.5%, 441/1604). 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 (3.2 ± 1.1 and 2.1 ± 1.0 respectively on a 5-point ordinal scale) compared with episodic cluster headache (3.5 ± 1.0 and 2.4 ± 1.1, respectively, p < 0.001 for both comparisons). CONCLUSIONS Cluster headache often occurs in the pediatric population, although they are typically not diagnosed until adulthood. The onset of cluster headache is the inverse of that in migraine; in migraine women are more likely to have migraine between ages 10 and 50 but the sex ratio is approximately equal otherwise. Prototypical migrainous features are not useful in differentiating cluster headache from migraine. Participant data from a large international study also suggest that chronic cluster headache is not only less responsive to newer treatments (like noninvasive vagus nerve stimulation and galcanezumab), but to traditional first-line treatments as well.
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Affiliation(s)
- Larry I Schor
- Department of Psychology, University of West Georgia, Carrollton, Georgia, USA
| | - Stuart M Pearson
- Department of Psychology, University of West Georgia, Carrollton, Georgia, USA
| | - Robert E Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont, USA
| | - Wei Zhang
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Hongyu Miao
- Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
| | - Mark J Burish
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
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3
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Lloyd J, Biloshytska M, Andreou AP, Lambru G. Noninvasive Neuromodulation in Headache: An Update. Neurol India 2021; 69:S183-S193. [PMID: 34003164 DOI: 10.4103/0028-3886.315998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and preventative treatments. The promising concept of neuromodulation of relevant neuronal targets in a noninvasive fashion for the treatment of primary headache disorders has led to the trial of numerous devices over the years. Objective We aimed to review the evidence on current neuromodulation treatments available for the management of primary headache disorders. Methods Randomized controlled trial as well as open-label and real-world studies on central and peripheral cephalic and noncephalic neuromodulation modalities in primary headaches were critically reviewed. Results The current evidence suggests a role of single-pulse transcranial magnetic stimulation, supraorbital nerve stimulation, and remote noncephalic electrical stimulation as migraine abortive treatments, with stronger evidence in episodic rather than in chronic migraine. Single-pulse transcranial magnetic stimulation and supraorbital nerve stimulation also hold promising evidence in episodic migraine prevention and initial positive evidence in chronic migraine prevention. More evidence should clarify the therapeutic role of the external vagus nerve stimulation and transcranial direct current stimulation in migraine. However, external vagus nerve stimulation may be effective in the acute treatment of episodic but not chronic cluster headache, in the prevention of hemicrania continua and paroxysmal hemicrania but not of short-lasting neuralgiform headache attacks. The difficulty in setting up sham-controlled studies has thus far prevented the publication of robust trials. This limitation along with the cost of these therapies has meant that their use is limited in most countries. Conclusion Neuromodulation is a promising nonpharmacological treatment approach for primary headaches. More studies with appropriate blinding strategies and reduction of device cost may allow more widespread approval of these treatments and in turn increase clinician's experience in neuromodulation.
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Affiliation(s)
- Joseph Lloyd
- Headache Research-Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Maryna Biloshytska
- Headache Research-Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Anna P Andreou
- Department of Functional Neurosurgery and Neuromodulation, Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; The Headache Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Giorgio Lambru
- The Headache Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Donnet A. Algia vascolare del volto. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Peng KP, Takizawa T, Lee MJ. Cluster headache in Asian populations: Similarities, disparities, and a narrative review of the mechanisms of the chronic subtype. Cephalalgia 2020; 40:1104-1112. [PMID: 32397739 PMCID: PMC7457455 DOI: 10.1177/0333102420923646] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Headache disorders like migraine show geographic and ethnic differences between Asian and European/North American countries. In cluster headache, these differences are rarely mentioned and discussed. This article aimed to review the characteristics of cluster headache in Asian countries and compare the clinical features to those in European and North American populations. METHODS We conducted a narrative literature review on the demographics, clinical presentations, and treatments of cluster headache in Asian countries. RESULTS Patients with cluster headache in Asian populations showed a stronger male predominance compared to European and North American populations. Chronic cluster headache was rare in Asian countries. The clinical presentation of restlessness was not as common in Asian as it was in European and North American countries, and Asian patients with aura were extremely rare. Patients in Asian countries may have a lower circadian rhythmicity of cluster headache and a lower headache load, as demonstrated by lower attack frequencies per day, bout frequencies, and bout durations. CONCLUSIONS Regional differences in the presentation of cluster headache exist. Greater awareness for cluster headache should be raised in Asian regions, and further studies are warranted to elucidate the mechanisms behind observed differences.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chung P, Lee MJ, Park J, Sohn J, Kim B, Chu MK, Chung JM, Ahn J, Choi Y, Kim S, Bae D, Kim D, Moon H, Chung C, Cho S. Differences of Cluster Headache on the Basis of Sex in the Korean Cluster Headache Registry. Headache 2019; 59:1722-1730. [DOI: 10.1111/head.13637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Pil‐Wook Chung
- Department of Neurology Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul South Korea
| | - Mi Ji Lee
- Department of Neurology Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul South Korea
| | - Jeong‐Wook Park
- Department of Neurology Uijeongbu St. Mary’s Hospital Uijeongbu South Korea
| | - Jong‐Hee Sohn
- Department of Neurology Chuncheon Sacred Heart Hospital, Hallym University College of Medicine Chuncheon South Korea
| | - Byung‐Kun Kim
- Department of Neurology Eulji Hospital, Eulji University Seoul South Korea
| | - Min Kyung Chu
- Department of Neurology Severance hospital Seoul South Korea
| | - Jae Myun Chung
- Department of Neurology Inje University College of Medicine Seoul South Korea
| | - Jin‐Young Ahn
- Department of Neurology Seoul Medical Center Seoul South Korea
| | - Yun‐Ju Choi
- Department of Neurology Presbyterian Medical Center Jeonju South Korea
| | - Soo‐Kyoung Kim
- Department of Neurology Gyeongsang National University College of Medicine Jinju South Korea
| | - Dae‐Woong Bae
- Department of Neurology College of Medicine, The Catholic University of Korea Suwon Korea
| | - Daeyoung Kim
- Department of Neurology Chungnam National University College of Medicine Daejeon Korea
| | - Heui‐Soo Moon
- Department of Neurology Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul South Korea
| | - Chin‐Sang Chung
- Department of Neurology Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul South Korea
| | - Soo‐Jin Cho
- Department of Neurology Dongtan Sacred Heart Hospital, Hallym University College of Medicine Hwaseong South Korea
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Manzoni GC, Camarda C, Genovese A, Quintana S, Rausa F, Taga A, Torelli P. Cluster headache in relation to different age groups. Neurol Sci 2019; 40:9-13. [PMID: 30796624 DOI: 10.1007/s10072-019-03767-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cluster headache (CH) has always been considered a type of primary headache affecting predominantly male subjects in early and medium adulthood. However, recent studies carried out in large case series of patients with CH show that not infrequently it may set in also after age 50; by contrast, onset before adolescence is very rare. Additionally, when onset occurs before age 14 or from the sixth decade of life onward, male predominance decreases to the point that in chronic forms CH predominantly affects the female sex. This particular pattern of the gender ratio in relation to onset in different age groups suggests that hormonal factors may actually play a role in the genesis of CH. In particular, future studies should be aimed at investigating the possible protective role of estrogen.
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Affiliation(s)
| | - Cecilia Camarda
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Antonio Genovese
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Simone Quintana
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Rausa
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Arens Taga
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Schindler EA, Wright DA, Weil MJ, Gottschalk CH, Pittman BP, Sico JJ. Survey Analysis of the Use, Effectiveness, and Patient-Reported Tolerability of Inhaled Oxygen Compared With Injectable Sumatriptan for the Acute Treatment of Cluster Headache. Headache 2018; 58:1568-1578. [DOI: 10.1111/head.13405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Emmanuelle A.D. Schindler
- Department of Neurology; Yale School of Medicine; New Haven CT USA
- Neurology Service, VA Connecticut Healthcare System; West Haven CT USA
| | | | | | | | - Brian P. Pittman
- Department of Psychiatry; Yale School of Medicine; New Haven CT USA
| | - Jason J. Sico
- Department of Neurology; Yale School of Medicine; New Haven CT USA
- Neurology Service, VA Connecticut Healthcare System; West Haven CT USA
- Department of Internal Medicine; Yale School of Medicine; New Haven CT USA
- Center for Neuroepidemiology and Clinical Research; Yale School of Medicine; New Haven CT USA
- Pain Research, Informatics, Medical Comorbidities and Education (PRIME) Center of Innovation (COIN); VA Connecticut Healthcare System; West Haven CT USA. Clinical Epidemiology Research Center (CERC); VA Connecticut Healthcare System; West Haven CT USA
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9
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Jay GW, Barkin RL. Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias. Dis Mon 2017; 63:308-338. [DOI: 10.1016/j.disamonth.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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Steinberg A, Fourier C, Ran C, Waldenlind E, Sjöstrand C, Belin AC. Cluster headache - clinical pattern and a new severity scale in a Swedish cohort. Cephalalgia 2017; 38:1286-1295. [PMID: 28906127 DOI: 10.1177/0333102417731773] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background The aim of this study was to investigate clinical features of a cluster headache cohort in Sweden and to construct and test a new scale for grading severity. Methods Subjects were identified by screening medical records for the ICD 10 code G44.0, that is, cluster headache. Five hundred participating research subjects filled in a questionnaire including personal, demographic and medical aspects. We constructed a novel scale for grading cluster headache in this cohort: The Cluster Headache Severity Scale, which included number of attacks per day, attack and period duration. The lowest total score was three and the highest 12, and we used the Cluster Headache Severity Scale to grade subjects suffering from cluster headache. We further implemented the scale by defining a cluster headache maximum severity subgroup with a high Cluster Headache Severity Scale score ≥ 9. Results A majority (66.7%) of the patients reported that attacks appear at certain time intervals. In addition, cluster headache patients who were current tobacco users or had a history of tobacco consumption had a later age of disease onset (31.7 years) compared to non-tobacco users (28.5 years). The Cluster Headache Severity Scale score was higher in the patient group reporting sporadic or no alcohol intake than in the groups reporting an alcohol consumption of three to four standard units per week or more. Maximum severity cluster headache patients were characterised by higher age at disease onset, greater use of prophylactic medication, reduced hours of sleep, and lower alcohol consumption compared to the non-cluster headache maximum severity group. Conclusion There was a wide variation of severity grade among cluster headache patients, with a very marked impact on daily living for the most profoundly affected.
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Affiliation(s)
- Anna Steinberg
- 1 Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Carmen Fourier
- 2 Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ran
- 2 Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Waldenlind
- 1 Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Christina Sjöstrand
- 1 Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
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Jürgens TP. Comment: Sex-specific differences in cluster headache—. Neurology 2017; 88:1074. [DOI: 10.1212/wnl.0000000000003723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/11/2017] [Indexed: 11/15/2022] Open
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Moon HS, Park JW, Lee KS, Chung CS, Kim BK, Kim JM, Sohn JH, Chu MK, Oh K, Cho SJ. Clinical Features of Cluster Headache Patients in Korea. J Korean Med Sci 2017; 32:502-506. [PMID: 28145655 PMCID: PMC5290111 DOI: 10.3346/jkms.2017.32.3.502] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/03/2016] [Indexed: 01/03/2023] Open
Abstract
Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19-60 years) and the average age of onset was 30.7 ± 10.3 years (range 10-57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1-25) bouts over 7.3 ± 6.7 (range 1-30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.
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Affiliation(s)
- Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kwang Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin Sang Chung
- Department of Neurology, Seoul Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Kyung Chu
- Department of Neurology, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Manzoni GC, Taga A, Russo M, Torelli P. Age of onset of episodic and chronic cluster headache - a review of a large case series from a single headache centre. J Headache Pain 2016; 17:44. [PMID: 27102121 PMCID: PMC4840133 DOI: 10.1186/s10194-016-0626-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/07/2016] [Indexed: 01/03/2023] Open
Abstract
Background In the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 and 31.6 years. Differences in onset age based on gender and subtype diagnosis are reported, while there are only few data on patients with childhood and elderly onset. We therefore deemed it useful to review our own large case series of CH patients. Methods The age of onset of cluster headache was investigated in a consecutive case series of 808 patients (585 men and 223 women), including 686 (503 men and 183 women) with episodic cluster headache (ECH), 103 (66 men and 37 women) with chronic cluster headache (CCH), and 19 with an indeterminate form of CH (16 men and three women). Results The mean age of onset was 30.2 ± 13.8 years (30.1 ± 13.0 in men and 30.4 ± 15.7 in women). The women with primary CCH had a mean onset age of 42.8 ± 21.7 years, while the women with secondary CCH did not differ much from those with ECH. Distribution of the study subjects by decades of onset age showed a peak in the third decade both in men and in women, but when only CCH patients were considered it displayed a more marked bimodal pattern in women (with peaks in the second and the sixth decade) than men (with peaks in the third and the fifth decade). The clear male predominance in cases with onset in the central age groups became attenuated in the extreme age groups. In patients with onset between ≤ 15 years and ≥ 50 years, the traditional male-to-female ratio was actually inverted in CCH. Conclusions Based on these epidemiological findings, it would be important to investigate the possible role, causative or protective, played by hormonal factors in CH pathogenesis.
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Affiliation(s)
- Gian Camillo Manzoni
- Centro Cefalee, Dipartimento di Emergenza-Urgenza e Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Padiglione Barbieri 3° piano, Via Gramsci 14, 43126, Parma, Italy.
| | - Arens Taga
- Centro Cefalee, Dipartimento di Emergenza-Urgenza e Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Padiglione Barbieri 3° piano, Via Gramsci 14, 43126, Parma, Italy
| | - Marco Russo
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Parma, Parma, Italy
| | - Paola Torelli
- Centro Cefalee, Dipartimento di Emergenza-Urgenza e Area Medica Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Padiglione Barbieri 3° piano, Via Gramsci 14, 43126, Parma, Italy
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Lanteri-Minet M. [Epidemiology, clinical presentation, diagnosis, natural history and screening of cluster headache]. Presse Med 2015; 44:1176-9. [PMID: 26476753 DOI: 10.1016/j.lpm.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/22/2015] [Indexed: 12/28/2022] Open
Abstract
This review is focused on the essential data about epidemiology, clinical presentation, diagnosis, natural history and screening for cluster headache.
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Affiliation(s)
- Michel Lanteri-Minet
- CHU de Nice, hôpital Cimiez, pôle neurosciences cliniques, département évaluation et traitement douleur, 4, avenue Reine-Victoria, 06003 Nice, France.
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Donnet A, Demarquay G, Ducros A, Geraud G, Giraud P, Guegan-Massardier E, Lucas C, Navez M, Valade D, Lanteri-Minet M. Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.douler.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Donnet A, Demarquay G, Ducros A, Geraud G, Giraud P, Guegan-Massardier E, Lucas C, Navez M, Valade D, Lanteri-Minet M. Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face. Rev Neurol (Paris) 2014; 170:653-70. [DOI: 10.1016/j.neurol.2014.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 12/24/2022]
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Abstract
Chronic pain impairs the quality of life for millions of individuals and therefore presents a serious ongoing challenge to clinicians and researchers. Debilitating chronic pain syndromes cost the US economy more than $600 billion per year. This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data.
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Zidverc-Trajkovic J, Markovic K, Radojicic A, Podgorac A, Sternic N. Cluster headache: Is age of onset important for clinical presentation? Cephalalgia 2014; 34:664-670. [PMID: 24445197 DOI: 10.1177/0333102413520085] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The age of onset of cluster headache (CH) attacks most commonly is between 20 and 40 years old, although CH has been reported in all age groups. There is increasing evidence of CH with early or late onset and a different course of the disorder. The aim of the study was to analyze the influence of the age of onset on clinical features, disorder course, and therapy effectiveness in CH patients. METHODS A retrospective and cross-sectional analysis was performed on 182 CH patients divided into three groups according to the age of onset. The first group consisted of patients with the first CH attack before 20 years of age, the second group was patients with age of onset between 20 and 40 years of age, and the third group was patients with age of onset after 40 years of age. Demographic data, features of CH periods and attacks, and the response to standardized treatment were compared among the groups. RESULTS Patients with CH onset after 40 years of age reported a lower number of autonomic features and less frequently had conjunctival injection and nasal congestion/rhinorrhea phenomena during their attacks. Diagnostic delay was the longest in the patients with CH onset before 20 years of age. CONCLUSION The influence of the age of onset of CH is intriguing for further studies and could possibly extend the knowledge about CH pathophysiology. From a clinical point of view, the differences in CH presentation are insufficient to preclude a correct diagnosis and treatment because the same criteria could be applied regardless of patient age.
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Affiliation(s)
- Jasna Zidverc-Trajkovic
- Neurology Clinic, Clinical Center of Serbia, Serbia Faculty of Medicine, University of Belgrade, Serbia
| | | | | | - Ana Podgorac
- Faculty of Medicine, University of Belgrade, Serbia
| | - Nadezda Sternic
- Neurology Clinic, Clinical Center of Serbia, Serbia Faculty of Medicine, University of Belgrade, Serbia
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