Abstract
The criterion for the remission period of chronic cluster headache (CCH) was recently revised from < 1 month to < 3 months in the third edition of the International Classification of Headache Disorders (ICHD-3). However, information on the clinical features of CCH based on the ICHD-3 criteria is currently limited. The present study aimed to investigate the clinical features of CCH based on ICHD-3 using data from the Korean Cluster Headache Registry (KCHR). The KCHR is a multicentre prospective registry of patients with cluster headache (CH) from 15 hospitals. Among the 250 participants with CH, 12 and 176 participants were classified as having CCH and episodic cluster headache (ECH), respectively. Among 12 participants with CCH, 6 (50%) had remission periods of < 1 month, and the remaining 6 (50%) had a remission period of 1-3 months. Six participants had CCH from the time of onset of CH, and in the other 6 participants, CCH evolved from ECH. CCH subjects had later age of onset of CH, developed the condition after a longer interval after CH onset, and had more migraine and less nasal congestion and/or rhinorrhoea than ECH subjects. Clinical features of CCH with remission periods < 1 month were not significantly different from those of CCH with remission periods of 1-3 months, except for the total number of bouts. More current smoking and less diurnal rhythmicity were observed in participants with CCH evolved from ECH compared to those with ECH. In conclusion, the number of subjects with CCH doubled when the revised ICHD-3 criteria were used. Most of clinical characteristics of CCH did not differ when the previous and current version of ICHD was applied and compared. Some clinical features of CCH were different from those of ECH, and smoking may have a role in CH chronification.
Highlights
Chronic cluster headache (CCH) and episodic cluster headache (ECH) are subtypes of cluster headache (CH) [1, 2]
CCH is defined as CH attacks that typically occur for one year or longer without remission, or with remission periods lasting less than three months
Clinical features of chronic cluster headache of the remission period criterion in ICHD-3; 2) Some clinical features of CCH were different from those of ECH including total number of bouts, number of years after the onset of CH, age of onset of CH, nasal congestion and/or rhinorrhoea during CH attacks, and presence of migraine; 3) Approximately one-tenth of the participants with PCH experienced PCH attacks lasting more than one year with remission period < 3 months
Summary
Chronic cluster headache (CCH) and episodic cluster headache (ECH) are subtypes of cluster headache (CH) [1, 2]. CCH is defined as CH attacks that typically occur for one year or longer without remission, or with remission periods lasting less than three months. Owing to the severe pain and accompanying symptoms with long-lasting attacks without remission or short remission periods, individuals with CCH experience a high degree of impairment [3]. The criterion for the remission period of CCH was recently revised in the third edition of the International Classification of Headache Disorders (ICHD-3) from < 1 month to < 3 months [2]. The clinical features of CCH according to ICHD-3 have only been briefly reported [4]. CCH can begin as CCH from the onset (primary CCH), or can evolve from ECH (secondary CH) [5]
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