TY - JOUR

T1 - Transition of cluster headache phenotype

T2 - An interview-based study

AU - Søborg, Marie Louise Kulas

AU - Petersen, Anja Sofie

AU - Lund, Nunu

AU - Wandall-Holm, Malthe Faurschou

AU - Jensen, Rigmor Højland

AU - Barloese, Mads

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2023

Y1 - 2023

N2 - Background Cluster headache exists diagnostically in a chronic and episodic variant between which patients can convert. We aimed to describe how many patients change phenotype, elucidate possible factors associated with this transition and identify differences in clinical features between primary and secondary phenotypes. Methods 540 well-defined cluster headache patients according to current ICHD-criteria completed a cross-sectional semi-structured interview. Results Total transition-incidence for the cohort was 20.7%. Conversion from chronic to episodic was reported by 6.3% and transition from episodic to chronic by 14.4% with attack side shift as a possible predictor (p = 0.007). Compared to primary chronic patients, secondary chronic patients had more frequent (60 vs 34 per month, p = 0.0487), but shorter (60 vs 90 minutes, p = 0.041) attacks. Secondary episodic patients experienced shorter remission periods than primary episodic patients (6 vs 11 months, p = 0.010). Treatment response was poor in all groups and only one third had effective prevention. Conclusion Cluster headache is a fluctuating disorder with a fifth of our cohort having experienced at least one phenotype change during course of disease. Apart from attack side shifts, no predictors for transition were identified. Severity differed between primary and secondary subtypes. Overall, there is an urgent need for better understanding of cluster headache.

AB - Background Cluster headache exists diagnostically in a chronic and episodic variant between which patients can convert. We aimed to describe how many patients change phenotype, elucidate possible factors associated with this transition and identify differences in clinical features between primary and secondary phenotypes. Methods 540 well-defined cluster headache patients according to current ICHD-criteria completed a cross-sectional semi-structured interview. Results Total transition-incidence for the cohort was 20.7%. Conversion from chronic to episodic was reported by 6.3% and transition from episodic to chronic by 14.4% with attack side shift as a possible predictor (p = 0.007). Compared to primary chronic patients, secondary chronic patients had more frequent (60 vs 34 per month, p = 0.0487), but shorter (60 vs 90 minutes, p = 0.041) attacks. Secondary episodic patients experienced shorter remission periods than primary episodic patients (6 vs 11 months, p = 0.010). Treatment response was poor in all groups and only one third had effective prevention. Conclusion Cluster headache is a fluctuating disorder with a fifth of our cohort having experienced at least one phenotype change during course of disease. Apart from attack side shifts, no predictors for transition were identified. Severity differed between primary and secondary subtypes. Overall, there is an urgent need for better understanding of cluster headache.

KW - chronic cluster headache

KW - episodic cluster headache

KW - Natural history

KW - predictors

U2 - 10.1177/03331024221128287

DO - 10.1177/03331024221128287

M3 - Journal article

C2 - 36587291

AN - SCOPUS:85145425008

VL - 43

JO - Cephalalgia

JF - Cephalalgia

SN - 0800-1952

IS - 1

ER -