Abstract
BackgroundCluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients.MethodsOur study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors.ResultsThe sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average “diagnostic delay” was 5.3 ± 6.4 years and the condition was diagnosed approximately (“doctor delay”: one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases.ConclusionsOur results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.
Highlights
Cluster headache (CH) is a severe, disabling form of headache
Cluster headache (CH) is a primary headache disorder that, in the International Headache Society (IHS) diagnostic criteria [1], is classified together with similar conditions known as the trigeminal autonomic cephalalgias
The results were assembled in a database and analyzed using Microsoft Excel. Demographic data This is a multicenter, hospital-based study in which 116 CH patients were recruited from Italian headache centers (90 from northern, 10 from southern and 16 from central Italy) and 28 CH patients were interviewed in Moldova, Ukraine or Bulgaria
Summary
Cluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. Cluster headache (CH) is a primary headache disorder that, in the IHS diagnostic criteria [1], is classified together with similar conditions known as the trigeminal autonomic cephalalgias. It is a rare but very disabling condition. The disease has a typical and recognizable clinical picture: it is characterized by recurrent attacks of unilateral pain, usually involving the orbital and periorbital. The intensity of the attacks and the consequent disability are such that patients require rapid diagnosis and appropriate treatment. Effective options for both abortive and preventive treatment are currently available. These options are supported by updated international therapeutic guidelines [2]
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