A new study conducted by the Kiel Pain Clinic on 825 patients with cluster headaches shows that cluster headaches can present with considerable clinical variability. The inter- and intra-individual variability of the phenotype can contribute to the fact that the clinical headache phenotype is not captured by overly strict diagnostic criteria, thus delaying diagnosis and effective treatment.
In a recent study by the Department of Neurology at the University of Lübeck and the Pain Clinic in Kiel, the severity of clinical symptoms of episodic and chronic cluster headaches was analyzed with regard to their variability and compared with the specifications of the criteria of the International Headache Classification ICHD-3.
A large proportion of patients with cluster headaches exhibit clinical features that are reflected in the ICHD-3 diagnostic criteria. However, due to the variability of symptoms, a significant number of clinical presentations are not covered by the ICHD-3 criteria for cluster headaches. Additionally, sequential side-to-side changes, pain localization, and persistent pain between attacks are observed, which are not currently addressed in the ICHD-3 criteria. Psychological complications, such as depression, sleep disturbances, and anxiety, are the most prevalent comorbidities.
The variability of the cluster headache phenotype can, if diagnostic criteria are too strict, exclude some patients from a correct diagnosis and delay effective therapy. The occurrence of persistent pain between attacks should also be diagnostically evaluated in light of its high frequency and intensity, as well as its impact on patient suffering. The care of patients with cluster headaches should thoroughly consider psychological complications.
Link to the complete study:
https://link.springer.com/article/10.1007/s40122-021-00267-8
I have severe cluster headaches 6 to 8 times a day. The pain usually starts in my eye, radiates across my temple, and up to the upper right corner of my head. My eye and cheekbone swell so much that my eye is almost completely closed. My eyelid also swells and droops. The pain spreads to the entire right side of my head, from my eye and nose to my carotid artery, teeth, and shoulder. Everything tenses up in pain. I'm afraid of getting vaccinated with AstraZeneca, because I'm worried that the cluster headaches will become completely uncontrollable afterward. I already don't know how I'm supposed to live with this.