Cluster Headache in Kuwait: A Hospital-Based Study

Jasem Al-Hashel 1 2, Ismail Ibrahim 1, Doaa Youssry 1 3, Samar Farouk Ahmed 1 4, Peter Goadsby 5

Affiliations

04 June 2019

-

doi: 10.3389/fneur.2019.00573

Abstract

Background: Cluster headache (CH) is a relatively uncommon primary headache disorder. Few studies in our region described CH. We aimed to study demographics, clinical characteristics and treatment modalities of CH patients referred to Headache Clinic in Kuwait. 

Materials and Methods: This cross-sectional study included all CH patients who are referred to headache clinic. The diagnosis of CH based on the CH diagnostic criteria of the Headache Classification Committee of the IHS, 3rd edition (beta version) (ICHD-3-beta). The demographics, clinical characteristics and treatment modalities of CH patients were recorded. 

Results: Forty six patients were diagnosed with CH which constituted 1.7% of all headache patients and 0.1% of all visits to Neurology clinic. Male:Female ratio was 15.3:1. Mean age was 40.1 ± 10.7 years and mean age at onset was 29 years (20-49). Family history was positive in 6.5%. Smoking was seen in 63.0% of patients while 6.5 % reported alcohol intake. CH was episodic in 84.4% and chronic in 15.2%. Seasonal predilection was seen in all patients; the most frequent season was Autumn 47.8%. The mean duration of the cluster bouts was 6 weeks (2-12 weeks). The mean duration of the attack was 60 min (15-180 min). Number of attacks per day ranged from 2 to 10 attacks with a mean of 5 attacks/day. The median of attack severity by Visual Analog Scale (VAS) was 8.5 (7-10). The time taken to diagnose the patients ranged from <1 year to 12 years with a mean of 4 years. Chronic CH have a statically significant relation with smoking (P = 0.036), older age (P = 0.027), and longer time taken to diagnosis (P = 0.026) compared to episodic CH. 

Conclusion: Our results reported that there is higher proportion of males compared to females and less positive family history. Smoking was a significant risk factor for chronicity in addition to advanced age, higher age at disease onset and a longer time taken till diagnosis.

Keywords: Kuwait; cluster headache; demographics; hospital study; trigeminal autonomic cephalalgias.

Figures

Figure 1 Distribution of headache cases in outpatient population (n = 2,782).

Figure 1 Distribution of headache cases in outpatient population (n = 2,782).

Figure 2 Distribution of the studied cases according to month (n = 46).

Figure 2 Distribution of the studied cases according to month (n = 46).

Similar articles

Evaluating the IHS criteria for cluster headache--a comparison between patients meeting all criteria and patients failing one criterion.

van Vliet JA, Eekers PJ, Haan J, Ferrari MD; Dutch RUSSH Study Group.Cephalalgia. 2006 Mar;26(3):241-5. doi: 10.1111/j.1468-2982.2006.00932.x.PMID: 16472329

Diagnostic Delay and Its Predictors in Cluster Headache.

Kim BS, Chung PW, Kim BK, Lee MJ, Chu MK, Ahn JY, Bae DW, Song TJ, Sohn JH, Oh K, Kim D, Kim JM, Park JW, Chung JM, Moon HS, Cho S, Seo JG, Kim SK, Choi YJ, Park KY, Chung CS, Cho SJ.Front Neurol. 2022 Feb 10;13:827734. doi: 10.3389/fneur.2022.827734. eCollection 2022.PMID: 35222255 Free PMC article.

Clinical features of cluster headache: an outpatient clinic study from China.

Xie Q, Huang Q, Wang J, Li N, Tan G, Zhou J.Pain Med. 2013 Jun;14(6):802-7. doi: 10.1111/pme.12101. Epub 2013 Apr 30.PMID: 23631424

Trigeminal autonomic cephalalgias.

Eller M, Goadsby PJ.Oral Dis. 2016 Jan;22(1):1-8. doi: 10.1111/odi.12263. Epub 2014 Aug 8.PMID: 24888770 Review.

Classification of Trigeminal Autonomic Cephalalgia: What has Changed in International Classification of Headache Disorders-3 Beta?

Ravishankar K.Ann Indian Acad Neurol. 2018 Apr;21(Suppl 1):S45-S50. doi: 10.4103/aian.AIAN_350_17.PMID: 29720818 Free PMC article. Review.

Cited by

Cluster Analysis Revealed Two Hidden Phenotypes of Cluster Headache.

Yalinay Dikmen P, Ari C, Sahin E, Ertas M, Mayda Domac F, Ilgaz Aydinlar E, Sahin A, Ozge A, Ozguner H, Karadas O, Shafiyev J, Vuralli D, Aktan C, Oguz-Akarsu E, Karli N, Zarifoglu M, Bolay H, Ekizoglu E, Kocasoy Orhan E, Tasdelen B, Baykan B.Front Neurol. 2022 May 20;13:898022. doi: 10.3389/fneur.2022.898022. eCollection 2022.PMID: 35669872 Free PMC article.

Cluster Headache and Associated Risk Factors: A Systemic Review and Meta-Analysis.

Elbadawi ASA, Albalawi AFA, Alghannami AK, Alsuhaymi FS, Alruwaili AM, Almaleki FA, Almutairi MF, Almubaddil KH, Qashqari MI.Cureus. 2021 Nov 5;13(11):e19294. doi: 10.7759/cureus.19294. eCollection 2021 Nov.PMID: 34877226 Free PMC article. Review.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Headache Classification Committee of the International Headache Society (IHS) The International classification of headache disorders, 3rd edition (beta version). Cephalalgia. (2013) 33:629–808. 10.1177/0333102413485658 - DOI - PubMed
  2.  
    1. Nesbitt AD, Goadsby PJ. Cluster headache. BMJ. (2012) 344:e2407. 10.1136/bmj.e2407 - DOI - PubMed
  3.  
    1. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. (2017) 17:75–83. 10.1016/S1474-4422(17)30405-2 - DOI - PubMed
  4.  
    1. Newman LC. Trigeminal autonomic cephalalgias. CONTINUUM. (2015) 21(4 Headache):1041–57. 10.1212/CON.0000000000000190 - DOI - PubMed
  5.  
    1. Barloese M, Lund N, Petersen A, Rasmussen M, Jennum P, Jensen R. Sleep and chronobiology in cluster headache. Cephalalgia. (2015) 35:969–78. 10.1177/0333102414564892 - DOI - PubMed
  6.  
    1. Barloese MC. Neurobiology and sleep disorders in cluster headache. J Headache Pain. (2015) 16:78. 10.1186/s10194-015-0562-0 - DOI - PMC - PubMed
  7.  
    1. Wilbrink LA, Louter MA, Teernstra OP, van Zwet EW, Huygen FJ, Haan J, et al. . Allodynia in cluster headache. Pain. (2017) 158:1113–7. 10.1097/j.pain.0000000000000891 - DOI - PubMed
  8.  
    1. Schor LI. Cluster headache: investigating severity of pain, suicidality, personal burden, access to effective treatment, and demographics among a large International survey sample. Cephalalgia. (2017) 37:172 10.1177/0333102417719574 - DOI - PubMed
  9.  
    1. Choi YJ, Kim BK, Chung PW, Lee MJ, Park JW, Chu MK, et al. . Impact of cluster headache on employment status and job burden: a prospective cross-sectional multicenter study. J Headache Pain. (2018) 19:78. 10.1186/s10194-018-0911-x - DOI - PMC - PubMed
  10.  
    1. Benamer HTS, Deleu D, Grosset D. Epidemiology of headache in Arab countries. J Headache Pain. (2010) 11:1–3. 10.1007/s10194-009-0173-8 - DOI - PMC - PubMed
  11.  
    1. Al-Hashel JY, Ahmed SF, Alroughani R. Prevalence of primary headache disorders in Kuwait. Neuroepidemiology. (2017) 48:138–46. 10.1159/000478892 - DOI - PubMed
  12.  
    1. Hayes MHS, Paterson DG. Experimental development of the graphic rating method. Psychol Bull. (1921) 18:98–9.
  13.  
    1. Haefeli M, Elfering A. Pain assessment. Eur Spine J. (2006) 15:S17–24. 10.1007/s00586-005-1044-x - DOI - PMC - PubMed
  14.  
    1. El-Sherbiny NA, Masoud M, Shalaby NM, Shehata HS. Prevalence of primary headache disorders in Fayoum Governorate, Egypt. J Headache Pain. (2015) 16:85. 10.1186/s10194-015-0569-6 - DOI - PMC - PubMed
  15.  
    1. Xie Q, Huang Q, Wang J, Li N, Tan G, Zhou J. Clinical features of cluster headache: an outpatient clinic study from China. Pain Med. (2013) 14:802–7. 10.1111/pme.12101 - DOI - PubMed
  16.  
    1. Murtaza M, Kisat M, Daniel H, Sonawalla AB. Classification and clinical features of headache disorders in Pakistan: a retrospective review of clinical data. PLoS ONE. (2009) 4:e5827. 10.1371/journal.pone.0005827 - DOI - PMC - PubMed
  17.  
    1. Haimanot RT, Seraw B, Forsgren L, Ekbom K, Ekstedt J. Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community. Cephalalgia. (1995) 15:482–8. 10.1046/j.1468-2982.1995.1506482.x - DOI - PubMed
  18.  
    1. Wei DY, Ong JJ, Goadsby PJ. Cluster headache: epidemiology, pathophysiology, clinical features, and diagnosis. Ann Indian Acad Neurol. (2018) 21(Suppl 1):S3. 10.4103/aian.AIAN_349_17 - DOI - PMC - PubMed
  19.  
    1. Torelli P, Beghi E, Manzoni GC. Cluster headache prevalence in the Italian general population. Neurology. (2005) 64:469–74. 10.1212/01.WNL.0000150901.47293.BC - DOI - PubMed
  20.  
    1. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia. (2008) 28:614–8. 10.1111/j.1468-2982.2008.01592.x - DOI - PubMed
  21.  
    1. Lin KH, Wang PJ, Fuh JL, Lu SR, Chung CT, Tsou HK, et al. Cluster headache in the Taiwanese—a clinic-based study. Cephalalgia. (2004) 24:631–8. 10.1111/j.1468-2982.2003.00721.x - DOI - PubMed
  22.  
    1. Imai N, Yagi N, Kuroda R, Konishi T, Serizawa M, Kobari M. Clinical profile of cluster headaches in Japan: low prevalence of chronic cluster headache, and uncoupling of sense and behaviour of restlessness. Cephalalgia. (2011) 31:628–33. 10.1177/0333102410391486 - DOI - PubMed
  23.  
    1. Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. (2012) 52:99–113. 10.1111/j.1526-4610.2011.02028.x - DOI - PubMed
  24.  
    1. Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology. (2002) 58:354–61. 10.1212/WNL.58.3.354 - DOI - PubMed
  25.  
    1. El Amrani M, Ducros A, Boulan P, Aidi S, Crassard I, Visy JM, et al. . Familial cluster headache: a series of 186 index patients. Headache. (2002) 42:974–7. 10.1046/j.1526-4610.2002.02226.x - DOI - PubMed
  26.  
    1. Schürks M, Kurth T, De Jesus J, Jonjic M, Rosskopf D, Diener HC. Cluster headache: clinical presentation, lifestyle features, and medical treatment. Headache. (2006) 46:1246–54. 10.1111/j.1526-4610.2006.00534.x - DOI - PubMed
  27.  
    1. D'Alessandro R, Gamberini G, Benassi G, Morganti G, Cortelli P, Lugaresi E. Cluster headache in the Republic of San Marino. Cephalalgia. (1986) 6:159–62. 10.1046/j.1468-2982.1986.0603159.x - DOI - PubMed
  28.  
    1. Sjaastad O, Bakketeig LS. Cluster headache prevalence. Vågå study of headache epidemiology. Cephalalgia. (2003) 23:528–33. 10.1046/j.1468-2982.2003.00585.x - DOI - PubMed
  29.  
    1. Schürks M, Diener HC. Cluster headache and lifestyle habits. Current pain and headache reports. (2008) 12:115–21. 10.1007/s11916-008-0022-5 - DOI - PubMed
  30.  
    1. Tiraferri I, Righi F, Zappaterra M, Ciccarese M, Pini LA, Ferrari A, et al. Can cigarette smoking worsen the clinical course of cluster headache? J Headache Pain. (2013) 14(S1):P54 10.1186/1129-2377-14-S1-P54 - DOI
  31.  
    1. Russell MB. Epidemiology and genetics of cluster headache. Lancet Neurol. (2004) 3:279–83. 10.1016/S1474-4422(04)00735-5 - DOI - PubMed
  32.  
    1. Ekbom K. Patterns of cluster headache with a note on the relations to angina pectoris and pepticulcer. Acta Neurol Scand. (1970) 46:225–237. - PubMed
  33.  
    1. Kudrow L. The cyclic relationship of natural illumination to cluster period frequency. Cephalalgia. (1987) 7(6_suppl):76–8. 10.1177/03331024870070S623 - DOI - PubMed
  34.  
    1. Lai TH, Fuh JL, Wang SJ. Cranial autonomic symptoms in migraine: characteristics and comparison with cluster headache. J Neurol Neurosurg Psychiatry. (2009) 80:1116–9. 10.1136/jnnp.2008.157743 - DOI - PubMed
  35.  
    1. Irimia P, Cittadini E, Paemeleire K, Cohen AS, Goadsby PJ. Unilateral photophobia or phonophobia in migraine compared with trigeminal autonomic cephalalgias. Cephalalgia. (2008) 28:626–30. 10.1111/j.1468-2982.2008.01565.x - DOI - PubMed
  36.  
    1. Van Vliet JA, Eekers PJ, Haan J, Ferrari MD. Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry. (2003) 74:1123–5. 10.1136/jnnp.74.8.1123 - DOI - PMC - PubMed
  37.  
    1. Klapper JA, Klapper A, Voss T. The misdiagnosis of cluster headache: a nonclinic, population-based, Internet survey. Headache. (2000) 40:730–5. 10.1046/j.1526-4610.2000.00127.x - DOI - PubMed
  38.  
    1. Voiticovschi-Iosob C, Allena M, De Cillis I, Nappi G, Sjaastad O, Antonaci F. Diagnostic and therapeutic errors in cluster headache: a hospital-based study. J Headache Pain. (2014) 15:56. 10.1186/1129-2377-15-56 - DOI - PMC - PubMed
  39.  
    1. Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD. Greater occipital nerve blockade for cluster headache. Cephalalgia. (2002) 22:520–2. 10.1046/j.1468-2982.2002.00410.x - DOI - PubMed
  40.  
    1. Busch V, Jakob W, Juergens T, Schulte-Mattler W, Kaube H, May A. Occipital nerve blockade in chronic cluster headache patients and functional connectivity between trigeminal and occipital nerves. Cephalalgia. (2007) 27:1206–14. 10.1111/j.1468-2982.2007.01424.x - DOI - PubMed
  41.  
    1. Gaul C, Roguski J, Shanib H, Totzeck A, Görlinger K, Diener HC, et al. Efficacy and safety of occipital nerve blocks in cluster headache: a prospective observational study. J Headache Pain. (2013) 14(S1):P60 10.1186/1129-2377-14-S1-P60 - DOI

Page Navigation