Most patients with frequent cluster headaches can predict an upcoming battle

Patients with episodic cluster headache (eCH) often have pre-cluster symptoms that predict impending cluster headache attacks. These results of a retrospective cross-sectional study were published in Cephalalgia.

Patients (N = 100) with frequent eCH were recruited from January 2019 to April 2020 at the Danish Headache Center to participate in this study. During a semi-structured interview, researchers rated patients for 9 specific local symptoms and 15 general signs or symptoms.

The patients had an average age of 42.2 years (interquartile range) [IQR], 34-51) the male to female ratio was 3.8 to 1, the patients had CH (IQR, 6-20) for an average of 15 years, and 10% had comorbid migraines.

Most patients (86%) had 1 or more pre-cluster symptoms averaging 6.8 days (IQR, 3-14) prior to their CH. The most commonly reported symptoms before the cluster were dull or painful sensations (62%; mean 5.8 days; IQR 3-13), shadow attacks (60%; mean 6.5 days; IQR 4-14), and neck pain (41% ; Mean value 4.8 days; IQR 2-7). Shadow attacks are those that do not require abortive treatment.

Almost a third of the patients (29%) had an average of 4.5 days (IQR, 2-10) before the CH fight at least 1 cranial autonomic symptom such as lacrimation, ptosis, nasal congestion or red eyes. They frequently reported symptoms of fatigue (37%; mean 5.3 days; IQR 2-10), irritability (33%; mean 5.2; IQR 3-7 days), and insomnia (19%; mean 5.3 days) ); IQR, 3-7).

Most patients (57%) stated that they could predict an attack of CH on average 4.6 days (IQR, 2-7) before onset. Of the patients who were able to predict their CH fight, 32% said that more than 95% of the upcoming fight were safe.

Patients who could predict the start of their fight had more seizures (P = 0.046), more symptoms (6.7 vs. 3.8 symptoms) and shadow attacks (odds ratio) [OR]3.06; 1.19-7.88; P = 0.020).

During the periods of remission, 58% of patients still experienced symptoms, and 19% of these patients were able to distinguish between combat-related precluster symptoms and symptoms of remission. The patients who could distinguish them said symptoms of remission were milder, shorter, or fewer than the symptoms before the cluster, or they were associated with the wrong time of year.

This study likely contained some level of recall bias as patients were asked to self-report previous symptoms, in some cases over a period of more than a year.

These data showed that most patients with eCH were able to predict coming CH seizures days or even weeks before they started. Additional studies are needed to determine whether these predictions allow the effective application of early or preventive interventions.

Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of details, see the original article.


Pedersen AS, Snoer A, Barloese M, Petersen A, Jensen RH. Prevalence of Pre-Cluster Symptoms in Episodic Cluster Headache: Is It Possible to Predict an Impending Battle? Cephalalgia. Published online January 20, 2021. doi: 10.1177 / 0333102421989255

This article originally appeared on Clinical Pain Advisor

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