Cluster headache presentations differ in men and women

By Melanie Hinze

Awareness of the significant differences in cluster headache presentation between males and females is important so that clinicians can offer the most effective treatment as fast as possible, new Swedish research concludes.

The study, published in Neurology, included 874 patients (66% male) with a verified cluster headache diagnosis who were identified by screening medical records from hospitals and neurology clinics in Sweden from 2014 to 2020.

The researchers found that females were more likely to be diagnosed with the chronic cluster headache subtype than males (18% vs 9%, respectively). Females also reported longer bouts of cluster headaches than males and used prophylactic treatment more often  (60% vs 48%). Females experienced both ptosis and restlessness more often than males (61% vs 47%, and 54% vs 46%, respectively), and females were also more likely to have a positive family history for cluster headaches (15% vs 7%).

Triggers also differed between males and females, with more women reporting lack of sleep as a trigger, and more men reporting alcohol as a trigger for their attacks. 

Commenting on the study, Professor Richard Stark, Neurologist at Alfred Health, and Adjunct Clinical Professor in the Department of Neuroscience at Monash University, Melbourne, said that it was helpful to see that there were differences in the way that cluster headache presented in men and women.

‘The most important thing is the percentage who have chronic cluster headache,’ he said. ‘It is relatively uncommon compared with episodic cluster headache, but the finding from the Swedish study is that chronic cluster headache is a bit more common in women than in men.’ 

Professor Stark told Medicine Today that chronic cluster headache occurred without periods of remission.

The diagnosis of cluster headaches may be missed in women, he said, partly because we were expecting it to be in men, but also because the presentation was a little different.

Discussing the characteristics of cluster headaches, Professor Stark said that even if the headaches were not occurring in clusters, they were strictly one-sided, the pain was very severe and usually around the eye, and the episodes of pain typically lasted from about 20 minutes to  90 minutes. There were also autonomic features, including tearing, red eye, droopy eyelid and running from the nose.

‘So there are not many headaches that behave like that,’ he said. ‘It does raise a lot of questions about the biology of cluster headaches and why it is that it behaves in different ways in different populations and between men and women.’ 

Professor Stark added, ‘Cluster headache is a condition where we understand bits and pieces of its pathophysiology, but not as much as we’d like to.’

Neurology 2022; doi: 10.1212/WNL.0000000000201688.