Sex Differences in Clinical Characteristics, Treatment and Lifestyle Factors in Cluster Headache Patients Summary Background and objectives: Cluster headache is considered a predominantly male disorder, but we previously suggested that women may display a more severe phenotype. Studies on sex differences in cluster headache have been conflicting, so this study, with the largest currently validated cluster headache material, provides more information on the sex-specific characteristics of the disease. The aim of this study was to describe sex differences in patient demographics, clinical phenotype, chronobiology, triggers, treatment and lifestyle in a Swedish cluster headache population. Methods: Study participants were identified by screening medical records from 2014 to 2020, requested from hospitals and neurology clinics in Sweden for International Classification of Diseases 10 code G44.0 for cluster headache. Each study participant answered a detailed questionnaire on clinical information and lifestyle, and all variables were compared with respect to sex. Results: 874 study participants with a verified diagnosis of cluster headache were included . 575 (66%) were men and 299 (34%) were women, and biological sex matched self-reported sex for all. Women were diagnosed at a higher rate with the chronic cluster headache subtype compared to men (18% vs. 9%, P = 0.0002) . Consistent with this observation, female participants report longer episodes than male participants (P = 0.003) and use prophylactic treatment more frequently (60% vs. 48%, P = 0.0005). In terms of associated symptoms, women experienced ptosis (61% vs 47%, p=0.0002) and restlessness (54% vs 46%, p=0.02) more frequently compared to men. More female than male study participants had a positive family history of cluster headache (15% vs. 7%, P = 0.0002). Furthermore, females reported diurnal rhythmicity of their attacks more frequently than males (74% vs 63%, P=0.002). Alcohol as a trigger occurred more frequently in men (54% vs. 48%, P=0.01), while lack of sleep triggering an attack was more common in women (31% vs. 20%, P=0.01). 0.001). Discussion: With this in-depth analysis of a well-characterized cluster headache population, we were able to demonstrate that there are significant differences between men and women with cluster headache that should be taken into account at the time of diagnosis and when choosing treatment options. Data suggest that, in general, women may be more severely affected by cluster headache than men. |
Comments
While cluster headache is more common in men than women, a new study suggests the disorder may be more severe for women. The study is published in the issue in Neurology ®, the medical journal of the American Academy of Neurology.
Cluster headaches are short but extremely painful headaches that can occur many days, or even weeks, in a row. Headaches can last anywhere from 15 minutes to three hours.
"Cluster headache is still misdiagnosed in women, perhaps because some aspects can be similar to migraine," said study author Andrea C. Belin, PhD, of Karolinska Institutet in Stockholm, Sweden. “It is important for doctors to be aware of how the disorder manifests differently in men and women so that the most effective treatment can be administered as quickly as possible.”
The study involved 874 people diagnosed with cluster headache, with 66% men and 34% women. Participants answered a detailed questionnaire about their symptoms, medications, headache triggers, and lifestyle habits.
Women were more likely to be diagnosed with chronic cluster headache than men. Chronic cluster headache is defined as recurrent attacks of cluster headache for a year or more without interruption, or with brief symptom-free intervals lasting less than three months. 18% of women were diagnosed with chronic cluster headache, compared to 9% of men.
The attacks also lasted longer for women than for men. For example, 8% of women said headache episodes lasted an average of four to seven months, compared with 5% of men, while 26% of women said episodes lasted average less than a month, compared to 30% of men.
Women were also more likely to report that their attacks occurred at various times during the day than men, 74% to 63%. Women were more likely to have a family member with a history of cluster headache, between 15% and 7%.
“While the ratio of men and women with cluster headache has been changing over the years, it is still primarily considered a male disorder, making it more difficult for women with milder symptoms to be diagnosed with it.” cluster headache than men,” Belin said. "It is possible that this may contribute to the higher rate of chronic cluster headache in women."
One limitation of the study was that participants self-reported the information, so they may not have remembered everything correctly.
The study was supported by the Swedish Brain Foundation, the Mellby Gård Foundation, the Swedish Research Council, the Stockholm Region and the Karolinska Institutet.
