Distinct Gender Differences Noted Among Individuals With Cluster Headache

Woman holds hand up to pain behind eye
Woman holds hand up to pain behind eye
Investigators have found data that show there is phenotypical similarity between cluster headache and migraine in women.

Distinct gender-related differences in the presence of cluster headache (CH) have been reported, with additional novel information available that supports the hypothesis of a closer phenotypical similarity between CH and migraine among women. A cross-sectional evaluation of consecutive patients with CH who were followed regularly at the tertiary Headache Science Center of the IRCSS Mondino Foundation of Pavia, Italy, was conducted. Results of the analysis were published in the journal Frontiers in Neurology.

The investigators sought to carefully evaluate the women to men distribution of typical migraine-linked symptoms and other symptoms of the disorder in a large, well-characterized clinical population of individuals with CH. Patients who were seen at the Headache Science Center for a CH between September 2016 and October 2018 were enrolled in the study. All patients needed to fill out a semistructured questionnaire designed specifically for the analysis. This questionnaire focused on the presence of such migraine-associated symptoms as nausea, vomiting, photophobia, phonophobia, and osmophobia; familiarity with migraine; and with respect to women, the relationship between onset of CH with such reproductive events as menarche, menstrual cycle, duration of menstruation, number of pregnancies, menopause, and use of contraceptive pills.

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During the participants’ visit, the investigators also compiled data on the characteristics of the migraine attacks, including frequency, severity, duration, related symptoms, and response to preventive therapies, as well as features of the most recent bouts, including frequency, response to preventive treatments, and duration of attacks. These data were compared with those available from the same patients in the investigators’ clinical database to minimize recall biases. The clinical database, which is updated continuously at each patient visit, contains demographic information (ie, age, sex, occupation, lifestyle factors); information with respect to type of CH, characteristics, and recurrence of attacks; acute and preventive treatments received and their effect; and documentation of concomitant diseases.

The primary study outcome was the gender distribution of individuals who met criterion D in the third edition of the International Classification of Headache Disorders for migraine-associated symptoms. Secondary study outcomes included gender distribution of individual migraine-associated symptoms and other features of the disease included in the clinical database and/or the questionnaire.

Data were obtained from 163 men (mean age, 41.46 ± 10.37 years) and 87 women (mean age, 42.24 ± 11/95 years) who were experiencing CH. No significant distribution was observed between the sexes with regard to the primary outcome measure (women: 73.6%; men: 65.6%; P =.200). When the occurrence of individual symptoms was evaluated, however, nausea and osmophobia were reported significantly more often among women (P =.048 and P =.037, respectively) than among men. Ptosis and nasal congestion were also reported significantly more frequently in women (P =.017 and P =.01, respectively), whereas enlarged temporal artery was reported significantly more often in men (P =.001).

The distribution of pain across the head had a tendency to be larger in women, extending significantly more often to the zygomatic (P =.050), parietal (P =.049), and frontal (P =.037) regions. Additionally, women had a significantly longer mean duration of untreated CH attacks compared with men (P =.004). Furthermore, in women with CH, the onset of their disease often corresponded with moments of important changes in the levels of sexual hormones, including postpartum, menarche, and menopause. Concomitant psychiatric disorders and thyroid diseases were reported more often among women, whereas smoking and snoring were both reported among a higher percentage of men.

The investigators concluded that the observations gleaned from this study are relevant to advancing our knowledge about the pathophysiology of CH, resulting in a more refined diagnostic process and improved disease management.

Allena M, De Icco R, Sances G, et al. Gender differences in the clinical presentation of cluster headache: a role for sexual hormones?Front Neurol. 2019;10:1220.