The specific headache phenotype, accompanying symptoms, and psychological impact that lead to hospital admission of patients with cluster headaches are currently unknown. Therefore, the aim of this study from the Kiel Pain Clinic was to analyze the characteristics of patients admitted to our tertiary headache center for cluster headaches in 2018, 2019, and 2020.

A total of 207 patients with cluster headache, admitted in 2018, 2019, and 2020, were examined. A retrospective cohort study was conducted to analyze the phenotype and psychosocial impact of cluster headache using standardized methods. Data were collected using the standardized Kiel Headache Questionnaire, the Migraine Disability Assessment (MIDAS) questionnaire, and the World Health Organization (WHO) Disability Assessment Schedule (WHODAS 2.0).

Most patients had a long-standing chronic illness history, with 71.5% having experienced the condition for more than five years. Cluster headache attacks of severe to very severe intensity occurred in 98.6% of patients, and more than 78% experienced three or more attacks per day. The nocturnal attacks led to severe sleep disturbances with exhaustion, lack of energy, and inability to work. Persistent, chronic pain in this area also contributed to inability to work in 31.4% of patients. Overall, 94.7% of patients had a MIDAS score of grade 4, corresponding to very severe disability. Analysis of the WHODAS 2.0 score revealed that 92.7% of patients with cluster headaches had severe limitations in their health and functioning. These patients were particularly affected by the psychological symptoms and psychosocial impact of cluster headaches. The severely debilitating complications of cluster headaches were particularly evident in the high frequency of suicidal thoughts in more than 40% of the patients studied. This serious illness affected almost all areas of professional, social, and family life, causing immense suffering.

The results show a pronounced, severe symptom complex in patients with cluster headaches that extends far beyond purely diagnostic criteria. The psychosocial impact of cluster headaches should be given special consideration in the care of these patients.

Source:

Göbel CH, Koch B, Heinze-Kuhn K, Heinze A, Cirkel A, Göbel H. Headache Phenotype and the Psychosocial Burden of Cluster Headaches: An Analysis of Patients Prior to Hospitalization. Pain Ther. 2025 Feb 24. doi: 10.1007/s40122-025-00715-9. Epub ahead of print. PMID: 39994092.

https://link.springer.com/article/10.1007/S40122-025-00715-9