Cluster Headache Sufferers Research Articles

Demoralization predicts suicidality in patients with cluster headache

ObjectiveTo determine the frequency of suicidal ideation and assess suicide risk in cluster headache (CH) patients compared to matched controls without CH in this observational case-control study.BackgroundCH is characterized by recurrent intolerable attacks of unilateral retro-orbital pain, which can cause disability, depression, and desperation. CH has been linked to suicide since its early descriptions by B.T. Horton; however, there is relatively little empiric data showing the association between suicidality and CH, especially in the context of other psychological phenomena, such as depression and demoralization.MethodsCH and control participants were recruited through community and CH patient group advertisements. CH diagnosis was confirmed using the International Classification of Headache Disorders, 3rd edition diagnostic criteria for CH. Lifetime suicidal ideation and suicide risk were assessed using the Suicidal Behavior Questionnaire-revised and the Columbia Suicide Severity Rating Scale. The Brief Lifetime Depression Scale evaluated lifetime depression. Demoralization was assessed using the Diagnostic Criteria for use in Psychosomatic Research – Demoralization and the Kissane Demoralization Scale. Forward stepwise logistic regression determined the odds of suicidal ideation.ResultsOne hundred CH and 135 control participants were comparable for age, sex, race, income, and marital status. Significantly more CH than control participants had lifetime active suicidal ideation (47.0% vs. 26.7%; p = 0.001), high suicide risk (38.0% vs. 18.5%; p = 0.0009), lifetime depression history (67.0%% vs. 32.6%; p < 0.00001), and demoralization (28.0% vs. 15.6%; p = 0.02). The odds of lifetime suicidal ideation were higher in those with CH (odds [95% confidence interval]; 2.04 [1.08,3.85]), even after accounting for depression and demoralization. In CH, suicidal ideation was associated with demoralization (6.66 [1.56,28.49]) but not depression (1.89 [0.66,5.46]).ConclusionsLifetime suicidal ideation and high suicide risk are prevalent in CH sufferers, and its likelihood is dependent on the presence of demoralization.

OnabotulinumtoxinA in the treatment of refractory chronic cluster headache

BackgroundCluster headache (CH) is a clinically well-defined primary headache disorder, approximately 20% of cluster headache sufferers experience recurrent attacks without periods of significant remission. For the treatment of chronic cluster headache (CCH) only limited therapeutic options are available.MethodsA potential refractory CCH patient group was identified according to the clinical definition of rCCH based on the consensus statement of the European Headache Federation (EHF). Treatment with OnabotulinumtoxinA (BoNT-A; Botox®, 150 Allergan IU) was done according to the PREEMPT study protocol. A standardized headache diary was used for recording frequency, duration of attacks and pain intensity. To assess personal burden the HIT-6 and the Hospital Anxiety and Depression scale was used. Primary outcome measure was a > 50% reduction in headache minutes.ResultsSeventeen male patients suffering from rCCH, aged 32 ± 11 (mean ± SD) years, presenting a mean disease duration of 6.6 years completed the study of 28 weeks. The cut-off point of > 50% reduction in headache minutes as positive result was reached in 58.8%, 29.4% experienced an improvement of 30–50%. Mean frequency of headache days dropped from 28.2 to 11.8 days at week 24 (p = 0.0001; 95% CI -21.33 to − 11.61;). Intensity of remaining attacks was also reduced significantly. Headache disability scores showed a trend to improvement after BoNT-A.ConclusionsEncouraging results for the treatment with BoNT-A in rCCH patients were observed in our study population.

Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco-Exposed: Results from the United States Cluster Headache Survey.

To present results from the United States Cluster Headache Survey comparing the clinical presentation of tobacco nonexposed and tobacco-exposed cluster headache patients. Cluster headache is uniquely tied to a personal history of tobacco usage/cigarette smoking and, if the individual cluster headache sufferer did not smoke, it has been shown that their parent(s) typically did and that individual had significant secondary smoke exposure as a child. The true nontobacco exposed (no personal or secondary exposure) cluster headache sufferer has never been fully studied. The United States Cluster Headache Survey consisted of 187 multiple choice questions related to cluster headache including: patient demographics, clinical headache characteristics, family history, triggers, smoking history (personal and secondary), and headache-related disability. The survey was placed on a website from October through December 2008. One thousand one hundred thirty-four individuals completed the survey. One hundred thirty-three subjects or 12% of the surveyed population had no personal smoking/tobacco use history and no secondary smoke exposure as an infant/child, thus a nontobacco exposed population. In the nonexposed population, there were 87 males and 46 females with a gender ratio of 1.9:1. Episodic cluster headache occurred in 80% of nonexposed subjects. One thousand and one survey responders or 88% were tobacco-exposed (729 males and 272 females) with a gender ratio of 2.7:1. Eighty-three percent had a personal smoking history, while only 17% just had parents who smoked with secondary smoke exposure. Eighty-five percent of smokers had double exposure with a personal smoking history and secondary exposure as a child. Nonexposed cluster headache subjects are significantly more likely to develop cluster headache at ages 40 years and younger, while the exposed sufferers are significantly more likely to develop cluster headache at 40 years of age and older. Nonexposed patients have a statistically significant higher frequency of a migraine family history. The exposed population is statistically significantly more likely to have a history of head trauma 19% vs the nonexposed population 10% (P = .02). Tobacco exposed are significantly more likely to transition from episodic to chronic cluster headache (23% vs 14%, P = .02). Cranial autonomic symptoms as well as agitation are more common in tobacco exposed. Nonexposed are less likely to have specific cluster headache triggers. Exposed are significantly more likely to be triggered by alcohol. Tobacco exposed are significantly heavier caffeine users than nonexposed. Nonexposed are significantly more likely to have cluster headache cycles that vary throughout the year than exposed (52% vs 40%, P = .02). Exposed are much more likely to develop cluster headache from 12 am to 6 am than non exposed. Exposed experience significantly more frequent attacks per day and longer duration cycles than nonexposed. A significantly larger percent of the exposed population (57%) has suicidal ideations with their syndrome than nonexposed (43%) (P = .003). In regard to disability, both subtypes are disabled by their headaches, but exposed have more work related disability and lost home-days from headache. Both subgroups have a poor overall response to preventive and abortive medication outside of inhaled oxygen and injectable sumatriptan. Cluster headache sufferers who were never exposed to tobacco (personal or secondary as a child) appear to present uniquely compared to the tobacco exposed subgroup. The tobacco exposed clinical phenotype appears to have a more severe syndrome based on attack frequency, cycle duration, and headache related disability. Tobacco exposure is associated with cluster headache chronification. The nonexposed subtype appears to have an earlier age of onset, higher rate of familial migraine, and less circadian periodicity and daytime entrainment, suggesting a possible different underlying pathology than in the tobacco exposed sub-form.

Influences on headache trigger beliefs and perceptions.

Background Previous headache trigger studies have primarily utilized checklists to measure beliefs about triggers. While this work has defined the diversity of beliefs across headache sufferers, the strength of association and the frequency at which these triggers are encountered remain unexplored. Objective To measure the strength of association, frequency of encounter, and influences on trigger beliefs and perceptions using a laboratory assessment task. Methods This cross-sectional observational study, part of the HACOGS project, included adult current migraine, tension-type, or cluster headache sufferers. Participants rated the chances they would experience a headache if they were to encounter a specific trigger and the number of days per month they experience that trigger for 33 common triggers. Results All 300 participants contributed data on all triggers, with little missing data (1.2%). All triggers exhibited a high degree of inter-individual variability on the strength of association and encounter perceptions. Many triggers were perceived to be encountered daily (e.g., caffeine, air conditioning), and a full range of perceptions were observed for each trigger. Stress (75% chance of headache), missing a meal (60%), and dehydration (60%) were the triggers with the greatest potency beliefs. Only 8-15% of these beliefs were related to individual differences and 26-27% to the triggers themselves. Conclusions Participants expressed diverse beliefs and perceptions about the strength of many common headache triggers. Variation in these beliefs was not associated with individual differences or the triggers themselves. This finding supports the importance of measuring more than just the presence-absence of trigger beliefs.

Cluster Headache With Accompanying Migraine-Like Features: A Possible Clinical Phenotype.

There are limited literature data on migraine-like accompanying features (MLF) in patients with cluster headache (CH). These symptoms are frequently reported by patients and may delay CH diagnosis. The aim of the present study was to investigate the occurrence of migraine-like symptoms in an Italian case series of CH patients and to determine whether these features influence the clinical phenotype of CH. A cross-sectional study was performed in all consecutive patients referred to the Parma Headache Centre between 1975 and 2013 affected by CH; the cases were subsequently reviewed applying the ICHD3-beta criteria. Our initial study sample consisted of 785 subjects, 569 men (72.5%) and 216 women (27.5%). We then identified those patients who reported at least one of the migraine accompanying symptoms (ie, nausea or vomiting or photophobia and phonophobia). We found 362 patients (46%) with MLF, 250 men (43.9% of the initial male sample) and 112 women (51.9% of the initial female sample), and 423 patients (54%) without MLF, 319 men (56.1% of the initial male sample) and 104 women (48.1% of the initial female sample). Multiple logistic regression analysis highlighted some demographic and clinical features that significantly characterized patients with MLF after adjusting for confounding: they were more frequently female (OR 1.78, CI 1.11-2.80), with a relatively younger age of onset (OR 1.82, CI 1.06-2.91) than expected, attacks were longer in duration (OR 1.85, CI 1.04-2.46) and accompanied by a more frequent ptosis (OR 1.67, CI 1.04-2.34), sweating (OR 1.63, CI 1.02-2.21), and miosis (OR 1.54, CI 1.12-1.93); osmophobia was also more frequently reported (OR 1.76, CI 1.28-2.46). Our study confirms the high proportion of CH patients with MLF, which is reported in literature. The presence of MLF seems to relate to some peculiar demographic and clinical characteristics of CH sufferers. Whether these features influence the response to therapy remains to be determined.

The development and validation of the Cluster Headache Quality of life scale (CHQ).

BackgroundCluster headache (CH) is a rare, excruciating and highly disabling primary headache disorder. Using non cluster headache specific measures, previous studies have shown that CH has a significant negative impact on patients’ quality of life (QoL), but a CH-specific QoL scale is currently unavailable. Thus, the objective of this study was to develop and validate a CH-specific QoL scale.MethodsBased on a literature review, semi-structured patient interviews and expert panel consultation, we produced a 54-item questionnaire, which was pre-tested in a sample of CH patients and subsequently reduced to 47 items. The revised scale was then administered to CH sufferers attending a tertiary headache clinic and those registered with a patient group. A total of 406 completed questionnaires were received. To assess test-retest reliability, a subsample (N = 56) completed the scale on a second occasion, two weeks after the first. Standard statistical methods were used to analyse the data for validity and reliability.ResultsItem reduction and exploratory factor analysis led to 28-items, grouped into four subscales labelled “restriction of activities of daily living”, “impact on mood and interpersonal relationships”, “pain and anxiety”, and “lack of vitality”. The final CH-specific QoL scale, the CHQ, demonstrated satisfactory internal consistency (Cronbach’s alpha > 0.9) and test-retest reliability (intraclass correlation coefficient > 0.8), with good internal construct validity between subscales (range 0.52–0.75) and convergent validity with other QoL measures.ConclusionsWe have developed and validated the first patient-reported outcome measure of QoL specifically for CH sufferers, which may be used to monitor QoL in clinical care and research.

Cluster headache.

Cluster headache.

A Survey of Cluster Headache (CH) Sufferers Using Vitamin D3 as a CH Preventative (P1.256)

OBJECTIVE: To present survey results of 110 CH sufferers (CH9ers) using a daily anti-inflammatory regimen of vitamin and mineral supplements including 10,000 IU/d vitamin D3, (cholecalciferol) and Omega-3 fish oil as a CH preventative. BACKGROUND: Cluster headache is one of the most painful and disabling headache disorders known to man. Results from an informal survey CH’ers using the anti-inflammatory regimen as a CH preventative indicated a surprisingly high efficacy. A survey was needed to qualify and quantify the efficacy of this regimen. DESIGN/METHODS: A questionnaire was developed to capture efficacy, 25(OH)D lab results along with essential demographic and epidemiological information. Participants were advised to consult with their PCP or neurologist before starting this regimen and to ask for the 25(OH)D lab tests before and after 蠅30 days of use or a favorable response. RESULTS: 80% of CH9ers reported significant reductions in frequency, severity and duration of their CH. 60% reported remaining substantially PF. Average starting 25(OH)D was 23.4 ng/mL. Average 25(OH)D response after 蠅30 days or favorable response was 76 ng/mL. Regimen appears equally effective for both ECH and CCH, although ECH9ers enjoy a slightly higher efficacy of 85% vs. 70% for CCH. A stress test of 25(OH)D reserves after 13 mo. PF, resulted in a return of CH after 8 days without vitamin D3. 33% reported comorbidities. There were no major adverse events reported. CONCLUSIONS: Empirical data suggest a possible causal relationship between a vitamin D3 insufficiency/deficiency and cluster headache. At Disclosure: Dr. Batcheller has nothing to disclose.

A Survey of Cluster Headache (CH) Sufferers Using Vitamin D3 as a CH Preventative (P1.256)

A Survey of Cluster Headache (CH) Sufferers Using Vitamin D3 as a CH Preventative (P1.256)

Cluster-like headache attacks triggered by nitrofurantoin intake

Sir,A wide spectrum of drugs can induce headache, which is infact one of the most common adverse drug events [1, 2].Although headache is usually a nonserious, unwanted effect,itcould bedifficult toquickly and correctly diagnose, leadingto repeated medical consultations, prescription of laboratoryor instrumental examinations, and even hospitalization [1].The International Headache Classification (IHC), inChapter 8, includes these secondary headaches as adversereactions to drugs [3]. Whereas some drug-related headachesare well characterized, others lack specific and accuratedefinition [1]. We present a patient experiencing cluster-likeattacks after nitrofurantoin consumption.A previously healthy 42-year-old man with no personal orfamily history of migraine, tension, or cluster headachepresented to the emergency room (ER) complaining of asevere unilateral left-sided headache. The pain was describedas lancinating, centered on the left eye and extending toperiorbital, supraorbital, and temporal regions. It wasaccompanied by conjunctival injection, lacrimation, eyelidedema, facial swelling, nasal congestion, and rhinorrhea ontheaffectedside.Theattackquicklyworsened,peakingwithin5–10 min, with a duration of about 60 min; both pain and theaccompanying autonomic signs spontaneously resolved. Theheadache began about 1 h after he took a tablet ofnitrofurantoin (50 mg) for a urinary tract infection. The daybefore, just after the first-ever consumption of nitrofurantoin,he had a headache attack with the same clinical presentation,the same latency between drug consumption and pain onset,and the same duration. Physical and neurologicalexaminations were normal, as were routine hematologicaltests and brain magnetic resonance imaging. As both attacksfollowed the intake of nitrofurantoin, the patient was advisedto stop taking the drug, which was replaced with a differentantibiotic agent (ciprofloxacin 500 mg twice daily).Thereafter, he experienced no further headache attacks.During a 2-year follow-up, he remained headache free.Theclosetemporalassociationbetweenthedrugintakeandthe appearance of headache on two occasions suggests acausal relationship. Nitrofurantoin is a widely used drug fortreating and preventing urinary tract infections. Headache is awell-known and one of the most common adverse effects,occurring in about 4–6 % of users [4, 5]; others side effectsinclude immune-mediated liver and lung reactions andpulmonary fibrosis. Nitrofurantoin-induced headache isusually described as severe to moderate; no specific featureshave been reported, and the pathogenetic mechanisms are notfully elucidated. Some authors [1] have categorized thisheadache as type C reactions arising from chronic use [6].Nitrofurantoin is usually included in the list of drugs that caninducebenignintracranialhypertension[7]andthenheadacherelated to raised intracranial pressure [2]. Our patient,however, had cluster-like attacks in close association withdrug intake. Several studies have demonstrated thatnitrofurans can release nitric oxide (NO) [8, 9], which is animportant neurotransmitter and regulates the vascular tone,acting as a potent vasodilator by diffusing into vascularsmooth-muscle cells. Moreover, NO is thought to play a rolein processing sensory information and pain sensitization [10].NO donors induce an immediate headache in healthyindividuals and in headache sufferers, with a delayedheadache with the characteristics of migraine, tension-type,orclusterheadacheinpatientssufferingfromtheseheadaches[10, 11]. In particular, cluster headache sufferers develop

Elucidating the molecular genetic basis of cluster headache: delineation of the genetic architecture by exome sequencing

A genetic predisposition to cluster headache (CH) has long been debated. Genetic epidemiological studies have reported an increased risk of CH in relatives of CH sufferers. The familial clustering supports a model of autosomal dominant inheritance with reduced penetrance. Some candidate gene studies have been performed, detecting associations with HCRTR2 and ADH4, but these have been limited by small sample size. We have established a large cohort of CH families in which we have previously reported a genome-wide linkage scan, isolating a number of putative linkage loci[1]. Despite this, a single causative gene is yet to be identified, largely due to substantial genetic heterogeneity.

Use of cannabis among 139 cluster headache sufferers

A case report suggested the efficacy of cannabis to treat cluster headache (CH) attacks. Our aims were to study the frequency of cannabis use in CH patients, and the reported effects on attacks. A total of 139 patients with CH attending two French headache centers filled out questionnaires. Sixty-three of the 139 patients (45.3%) had a history of cannabis use. As compared to nonusers, cannabis users were more likely to be younger (p < 0.001), male (p = 0.002) and tobacco smokers (p < 0.001). Among the 27 patients (19.4% of the total cohort) who had tried cannabis to treat CH attacks, 25.9% reported some efficacy, 51.8% variable or uncertain effects, and 22.3% negative effects. Cannabis use is very frequent in CH patients, but its efficacy for the treatment of the attacks is limited. Less than one third of self-reported users mention a relief of their attacks following inhalation. Cannabis should not be recommended for CH unless controlled trials with synthetic selective cannabinoids show a more convincing therapeutic benefit.

Female cluster headache in the United States of America: What are the gender differences?: Results from the United States Cluster Headache Survey

ObjectiveTo present results from the United States Cluster Headache Survey regarding gender differences in cluster headache demographics, clinical characteristics, diagnostic delay, triggers, treatment response and personal burden. BackgroundVery few studies have looked at the gender differences in cluster headache presentation. The United States Cluster Headache Survey is the largest study of cluster headache sufferers ever completed in the United States and it is also the largest study of female cluster headache patients ever presented. MethodsThe total survey consisted of 187 multiple choice questions which dealt with various issues related to cluster headache including: demographics, clinical characteristics, concomitant medical conditions, family history, triggers, smoking history, diagnosis, treatment response and personal burden. A group of questions were specifically targeted to female cluster headache patients. The survey was placed on a website from October to December 2008. For all survey responders the diagnosis of cluster headache needed to be made by a neurologist but there was no validation of the headache diagnosis by the authors. Results1134 individuals completed the survey (816 male, 318 female).Key Points that define the differences between female and male cluster headache include:a.Age of onset: women develop cluster headache at an earlier age than men and are more likely to develop a second peak of cluster headache onset after 50years of age.b.Family history: woman cluster headache sufferers are more likely to have a family history of both cluster headache and migraine and have an increased familial risk of Parkinson's disease.c.Comorbid conditions: female cluster headaches sufferers are significantly more likely to experience depression and have asthma than males.d.Aura issues: aura with cluster headache is equally common in both sexes, but aura duration is shorter in women. Women are much more likely to experience sensory, language and brainstem auras.e.Pain location: cluster headache pain is typically retro-orbital in location in both sexes but women are significantly more likely to experience cluster headache pain in the jaw, cheek and ear than men.f.Associated symptoms: women with cluster headache develop more “migrainous” associated symptoms than men, especially nausea and they are also more likely to have self-injurious behavior than men.g.Triggers: women with cluster headache are much less likely to have alcohol trigger a headache, but are significantly more likely to have “migrainous” triggers for their cluster headaches than men.h.Smoking issues: women are much less likely to have a smoking history than male cluster headache sufferers, more likely to have never smoked prior to cluster headache onset.i.Cycle issues: spring and fall are the most common time to start a cluster headache cycle in both sexes. Women are statistically significantly less likely to start a cluster headache cycle in the months of October–December than men. Women have more attacks per day and higher pain intensity nighttime attacks than men.j.Treatment: in regard to acute treatment women statistically were less response to sumatriptan injectable and nasal spray than men, but statistically more likely to respond to inhaled lidocaine. There was equal efficacy in the sexes to inhaled oxygen but slower response in women. For preventive treatment no significant gender differences were noted, but overall women were less responsive to almost all preventives than men.k.Diagnostic delay: there remains a significant diagnostic delay for cluster headache patients in both sexes but women were more likely to be diagnosed after 10years of symptom onset than males and significantly fewer women were diagnosed correctly at an initial physician visit than men.l.Female specific issues: cluster headache does not appear to be influenced by menses or menopause but 50% of the survey responders stated their headaches improved with pregnancy. Cluster headache does not appear to alter fertility rates in female cluster headache sufferers.m.Personal burden: cluster headache causes significantly more personal burden in women than men with more loss of employment and/or need of disability, as well as more homebound days. ConclusionOverall women and men with cluster headache have a similar presentation but there are some distinct differences that have been suggested in smaller studies of female cluster headache that we have now verified, while some of our study conclusions have not been shown previously. One major limitation to the study is a lack of validation of diagnosis. A substantial false positive cluster headache diagnosis rate, especially in females, cannot be excluded by the study methods utilized.

Cluster Headache in the United States of America: Demographics, Clinical Characteristics, Triggers, Suicidality, and Personal Burden*

To present results from the United States (US) Cluster Headache Survey including data on cluster headache demographics, clinical characteristics, suicidality, diagnostic delay, triggers, and personal burden. There are few large-scale studies looking at cluster headache patients and none from the USA. This manuscript will present data from The US Cluster Headache Survey, the largest survey ever completed of cluster headache patients living in the USA. The total survey was composed of 187 multiple-choice questions that dealt with issues related to cluster headache including demographics, clinical characteristics, comorbid medical conditions, family history, triggers, smoking history, and personal burden. The survey was placed on a Web site from October through December 2008. A total of 1134 individuals completed the survey (816 male, 318 female). Some key highlights from the survey include the following: (1) diagnostic delay: there remains a significant diagnostic delay for cluster headache patients on average 5+ years with only 21% receiving a correct diagnosis at time of initial presentation. (2) Suicidality: suicidal ideations are substantial, occurring in 55%. (3) Eye color: the predominant eye color in cluster headache patients is brown and blue, not hazel as suggested in previous descriptions. (4) Laterality: cluster headache has a right-sided predominance. (5) Attack profile: in US cluster headache sufferers, most attacks occur between early evening and early morning hours with peak time of headache onset between midnight and 3 am; the circadian periodicity for cluster headache is present but is not as predominant in the population as previously thought. (6) Triggers: beer is the most common type of alcohol trigger in US cluster headache patients; noted migraine triggers such as weather changes and smells are also very common cluster headache triggers. (7) Medical comorbidities: peptic ulcer disease does not have a high prevalence in US cluster headache patients as suggested by previous literature; cluster headache is associated with a low prevalence of cardiac disease as well as cerebrovascular disease even though the majority of patients are chronic heavy smokers. In US cluster headache sufferers, there appears to be comorbidity with restless leg syndrome, and this has not been demonstrated in non-US cluster headache populations. (8) Personal burden: cluster headache is disabling to the individual as almost 20% of cluster headache patients have lost a job secondary to cluster headache, while another 8% are out of work or on disability secondary to their headaches. Some findings from the US Cluster Headache Survey expound on what is currently known about cluster headache, while some of the results contradict what has been previously written, while other information is completely new about this fascinating headache disorder.

Cluster Headache with Aura

Aura was not recognized as a clinical symptom of cluster headache until fairly recently, but studies now have indicated that upwards of 20% of patients with cluster headache may have aura, the same percentage of migraine sufferers who have aura. This paper looks at the epidemiology of cluster headache with aura, suggests possible roles of cortical spreading depression in cluster headache pathogenesis, and looks at the clinical/diagnostic implications of aura in cluster headache sufferers.

Inhaled Oxygen and Cluster Headache Sufferers in the United States: Use, Efficacy and Economics: Results From the United States Cluster Headache Survey

To present results from the United States Cluster Headache Survey concerning the use of inhaled oxygen as acute treatment for cluster headache (CH). Several small clinic and community-based investigations have indicated that more than 50% of CH patients have never used oxygen for the treatment of their headaches. This statistic is alarming and the reasons why they have not tried oxygen have not been determined. The United States Cluster Headache Survey is the largest study ever completed looking at CH sufferers living in the United States. The total survey consisted of 187 multiple choice questions, 84 questions dealt with oxygen use, efficacy and economics. The survey was placed on a website from October to December 2008. A total of 1134 individuals completed the survey (816 male, 318 female). Among them 868 patients had episodic CH while 266 had chronic CH. Ninety-three percent of survey responders were aware of oxygen as a CH therapy; however, 34% had never tried oxygen. Forty-four percent of patients had to suggest oxygen to their physicians to get prescribed. Twelve percent of physicians refused to prescribe oxygen. Fifty percent using oxygen never received training on proper use. Forty-five percent had to find their own source for oxygen. On prescriptions only 45% specified flow rate, 50% stated CH as diagnosis and 28% indicated mask type. Seventy percent of the surveyed population felt oxygen was effective but only 25% was presently using oxygen. Potential reasons for this finding include: oxygen is slow to onset; prescribed oxygen flow rates are too low for efficacy and most CH patients need to raise flow rates during attacks to achieve response. The efficacy of oxygen does not vary by the age of the patient, gender, the number of CH attacks per day, and smoking history. Episodic CH responds better and faster to inhaled oxygen than chronic CH. Oxygen plus a triptan may be more efficacious and faster at aborting a CH than a triptan alone. Sixteen percent of CH patients state that oxygen is unaffordable while 12% are getting welder grade oxygen because of costs of medical grade oxygen, and this form of oxygen could be potentially dangerous to the individual user. Oxygen is underutilized by CH patients living in the United States. Current recommended oxygen treatment regime is not meeting the needs of many CH patients. Prescribed oxygen flow rates are too low for efficacy. Oxygen can be expensive and very difficult to obtain. Physicians need to be better educated on the use of inhaled oxygen for CH.

Familial Cluster Headache: Demographic Patterns in Affected and Nonaffected

Smoking has been claimed to be more common in cluster headache (CH) sufferers than in nonaffected subjects. Other demographic information such as handedness, body mass index, eye color, education, occupation, and alcohol use has been described as being different in CH patients compared with a control population. The aim of this study was to get more detailed information in CH patients with a positive family history and their nonaffected relatives, assuming that there would be demographic differences between the groups. Affected CH patients and nonaffected first- and second-degree relatives (n = 114) received a posted questionnaire. Information from 83 subjects (42 affected and 41 first- and/or second-degree relatives) from 23 families was received. P < .05 was chosen to be significant. Parental cigarette smoking during childhood and adolescence of patients and controls and current or former smoking was significantly more common in CH patients. Frequent alcohol intake (2-3 times/week or more) was significantly more common in the affected group of CH patients. There were significant differences as regards the life history of head trauma, but some of the affected had had the trauma after the age of onset of CH. Interestingly, CH patients worked more full-time than nonaffected. Formerly described demographic relationships in CH regarding cigarette smoking, alcohol consumption, and head trauma were also seen in our CH patients and their nonaffected relatives. These findings might represent a gene environment interaction in affected CH patients or it could be personality-lifestyle-related phenomena or a combination of these mechanisms.

Cluster Headache As the Result of Secondhand Cigarette Smoke Exposure During Childhood

Unique to cluster headache (CH) compared with all other primary headache conditions is its association with a personal history of cigarette smoking. Studies have indicated that greater than 80% of CH patients have a prolonged history of tobacco usage prior to CH onset. How tobacco exposure can lead to CH has not yet been elucidated. As secondhand smoke exposure during childhood has been linked to multiple medical illnesses could CH also be the result of childhood exposure to tobacco smoke? The United States Cluster Headache survey is the largest survey ever done of CH sufferers living in the United States. The survey addressed various clinical, epidemiologic, and economic issues related to CH. Several survey questions dealt with the issue of personal and parental smoking history. Results from the survey suggest that CH can result from secondhand cigarette smoke exposure during childhood as greater than 60% of non-smoking CH patients had parents who smoked. Strengthening the probable association between secondhand smoke exposure and the development of CH is the fact that double the number of survey responders developed CH at or before 20 years of age if during their childhood they lived with a parent who smoked cigarettes.

Alcohol and Cluster Headaches

Alcohol and Cluster Headaches

Cluster headache and the heart

Cluster headache is a rare but debilitating recurrent headache disorder. It is most common in middle-aged and older men, a group with a high prevalence of cardiovascular disease. This article reviews available information regarding the association of cluster headache and the heart in three selected areas: 1) the known effects of cluster headache on cardiovascular parameters such as heart rate and rhythm and blood pressure; 2) the prevalence of cardiac risk factors in subjects with cluster headache; and 3) the connection between patent foramen ovale and cluster headache. Some evidence suggests that cardiovascular risk factors, especially cigarette smoking, may be more common in cluster headache sufferers. There also is evidence that disturbances of autonomic function or certain structural cardiac anomalies may be more common in cluster headache sufferers. In addition, a number of important treatment options for cluster headache have effects on cardiovascular function that must be considered in planning therapy. The implications of these findings for clinical practice are discussed.