Women May be More Seriously Affected by Cluster Headaches, Suggests New Research

Although cluster headache may be more common in men, the disorder may be more severe in women, suggests a recent study published in Neurology, the medical journal of the American Academy of Neurology (AAN).

“Cluster headache is still often misdiagnosed in women, perhaps because some aspects can be similar to migraine,” said study author Andrea C. Belin, PhD, of the Karolinska Institute in Stockholm, Sweden, in an AAN press release. “It is important for physicians to be aware of how the disorder manifests differently in men and women so the most effective treatment can be given as fast as possible.”

The study authors note that past studies on sex differences in this headache type have yielded conflicting results. To gain insight into sex-specific characteristics of cluster headache, Belin and colleagues screened medical records from 2014-2020 from hospitals and neurology clinics across Sweden and identified 874 individuals (66% men) with a verified cluster headache diagnosis to be included in the study. Each participant answered a detailed questionnaire about symptoms, medications, headache triggers, and lifestyle habits and all variables were compared with regards to sex.

Investigators found that more women than men were diagnosed with chronic cluster headache (18% vs 9%; P=.0002), defined for the purpose of the study as recurring cluster headache attacks for ≥1 year without interruption, or with short intermissions with no symptoms that last <3 months.

Investigators also noted that attacks lasted longer among women than men. For example, 8% of women said headache bouts lasted an average of 4-7 months, compared with 5% of men, and 26% of women said bouts on average lasted less than 1 month, compared with 30% of men. Furthermore, women used prophylactic treatment more often than men (60% vs 48%, P=.0005), according to study results.

Regarding associated symptoms, women experienced ptosis (61% vs 47%, P=.0002) and restlessness (54% vs 46%, P=.02) more frequently than men. More women also had a positive family history for cluster headache (15% vs 7%, P=.0002) and reported diurnal rhythmicity of their attacks more often compared with men (74% vs 63%, P=.002).

Alcohol as a trigger for cluster headache occurred more frequently in men than women (54% vs 48%, P=.01), while lack of sleep triggering an attack was more common in women (31% vs 20%, P=.001).

“This is the largest study on sex differences in verified cluster headache patients to date which may help to increase our understanding in which manner the disorder manifests differently in males and females,” concluded Belin and colleagues. “Cluster headache is still often misdiagnosed in females, perhaps because certain features of the disease in female patients resemble a migraine-like phenotype. It is therefore of utmost importance for physicians to be aware of these sex differences when working in the clinic and meeting headache patients to be able to give the most effective treatment as fast as possible.”

A limitation to the study was all data was self-reported, which could introduce recall bias in relation to, for example, use of medication or the progress of a specific headache. In addition, the study’s observational design makes it difficult to infer causality from the associations reported.

Reference: Belin AC, Fourier C, Ran C, et al. Sex differences in clinical features, treatment, and lifestyle factors in patients with cluster headache. Neurology. Published online December 21, 2022. doi:10.1212/WNL.0000000000201688.