Cluster headache in women.

Abstract

75 patients with cluster headache (63 men and 12 women) and 939 with migraine headache were seen among 1260 new patients at the Princess Margaret Migraine Clinic of Charing Cross Hospital (London, England) over a 16-month period. 3 points of interest emerged from this analysis. The age of onset in women, unlike the men, appeared to be bimodal. Approximately half of the women developed the condition in early adult life, and the remainder at about the time of the menopause. These distributions were significantly different. This was not noted in Ekbom's earlier series nor in that of Pearce, although Ekbom did record a disproportionate number of old women at presentation. Atypical cases seemed more common among women and especially among those women who developed headaches later in life. There were no satisfactory criteria for the classification of less typical cases, e.g., patients with single weekly attacks typical in site and duration, or patients with bout up to 12 attacks daily but with long headache free intervals that would appear to exclude the diagnosis of chronic paroxysmal hemicrania. 6 of the 7 typical premenstrual cases had been on oral contraceptives (OCs), and 4 of these associated breaks from contraception with the start of clusters. They could not abort a cluster by immediately restarting OC. In 1 case there was a temporal association with a change from Ovulen 50 to Ovranette, and the headaches settled when she was changed back to Ovulen 50 3 months later. They recurred when she stopped the Ovulen 50 again after 4 months, and she conceived during the cluster, which ceased in the 4th week of pregnancy. She had another cluster, lasting 6 weeks, which started when she was 11 weeks pregnant but none later in the pregnancy. She had a further cluster 7 months postpartum, and hormonal treatment has been contraindicated by a postpartum thrombosis. The anecdotal nature of this observation cannot be denied, but a large scale trial is not feasible. Longterm OC use, possibly with a 50 mcg estrogen preparation, might be helpful in occasional patients. This phenomenon is the opposite of that found in migraine, emphasizing the distinction between the 2 conditions.