Age of onset of episodic and chronic cluster headache - a review of a large case series from a single headache centre.

Gian Camillo Manzoni,Arens Taga,Marco Russo,Paola Torelli

doi:10.1186/s10194-016-0626-9

Gian Camillo Manzoni, Arens Taga + Show 2 more

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https://doi.org/10.1186/s10194-016-0626-9

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Abstract

BackgroundIn the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 and 31.6 years. Differences in onset age based on gender and subtype diagnosis are reported, while there are only few data on patients with childhood and elderly onset. We therefore deemed it useful to review our own large case series of CH patients.MethodsThe age of onset of cluster headache was investigated in a consecutive case series of 808 patients (585 men and 223 women), including 686 (503 men and 183 women) with episodic cluster headache (ECH), 103 (66 men and 37 women) with chronic cluster headache (CCH), and 19 with an indeterminate form of CH (16 men and three women).ResultsThe mean age of onset was 30.2 ± 13.8 years (30.1 ± 13.0 in men and 30.4 ± 15.7 in women). The women with primary CCH had a mean onset age of 42.8 ± 21.7 years, while the women with secondary CCH did not differ much from those with ECH. Distribution of the study subjects by decades of onset age showed a peak in the third decade both in men and in women, but when only CCH patients were considered it displayed a more marked bimodal pattern in women (with peaks in the second and the sixth decade) than men (with peaks in the third and the fifth decade). The clear male predominance in cases with onset in the central age groups became attenuated in the extreme age groups. In patients with onset between ≤ 15 years and ≥ 50 years, the traditional male-to-female ratio was actually inverted in CCH.ConclusionsBased on these epidemiological findings, it would be important to investigate the possible role, causative or protective, played by hormonal factors in CH pathogenesis.

Highlights

In the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 and 31.6 years
As already reported by Horton in 1964, chronic CH (CCH) is likely to occur at a later age [6]; all subsequent literature indicates [1–3, 7, 8] a mean age of CCH onset varying between 33.4 [1] and 39.0 years [7] versus between 28.4 [7] and 30.5 years [3] for episodic CH (ECH)
For CCH cases, we considered separately those with primary CCH, i.e. chronic ab initio, and those with secondary CCH, i.e. evolving from ECH [14, 15]; this distinction is not present in the current International Headache Society (IHS) classification [16], but we think it could be of clinical interest

Summary

Introduction

In the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 and 31.6 years. Differences in onset age based on gender and subtype diagnosis are reported, while there are only few data on patients with childhood and elderly onset. We deemed it useful to review our own large case series of CH patients. In the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 [1], 30.7 [2] and 31.6 years [3], namely between 29.7 [4] and 31.3 years [5] in men and between 29.4 [5] and 32.8 years in women [3]. In order to exactly define them, a different distribution, based not on decades but on more restricted age groups, would be needed, which obviously requires very large cases series

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