| Objective:We analyzed the clinical manifestations,characteristics of episodic headache,autonomic and non-autonomic symptoms of patients with cluster headache in headache clinics.The article aims to provide clinical data support for cluster headache diagnosis and treatment,improve the correct diagnosis rate,and avoid misdiagnosis and misdiagnosis.Methods:We collected the cases of the patients with cluster headache at the headache clinics in the Department of Neurology of the Second Norman Bethune Hospital of Jilin University from February 2018 to October 2022.Patients’ general clinical data including age,gender,time of first onset,disease duration,delay of diagnosis,pain intensity assessed by visual analogue score(VAS),smoking and drinking history,family history of headache,characteristics of single headache attack,autonomic and non-autonomic symptoms,characteristics of cluster phase,acute phase,transition phase,preventive treatment regimen and treatment effect were recorded.Statistical analysis was performed using SPSS 27,and the measurement data that conformed to normal distribution were presented as mean ± standard deviation,the measurement data that skewed distribution were presented as median and quartile,and the analysis of difference between groups was performed using t-test or non-parametric rank sum test;Count data were expressed as frequency or rate,and differences between groups were analyzed by chi square test.P<0.05 was considered statistically significant.Results:1.Forty three patients with cluster headache were included,38 were male,with a male to female ratio of 7.6:1,age at presentation ranged from 19 to 70 years,age at first onset ranged from 10 to 52 years,disease duration ranged from 0 to 31 years,median diagnostic delay was 8.0(3.0,13.3)years,median pain intensity score was 8.5(7.8,9.0)points,55.81% of patients had a history of smoking,46.51% of patients had a history of drinking,41.46% of patients had a family history of headache,76.47% of the patients’ families were first-degree relatives.2.Single headache characteristics were as follows.The best headache site was the orbital region,followed by the temporal region,forehead,back of the eyeball,posterior occipital,head,teeth,cheeks,neck,other sites.Headache nature frequent from highest to lowest was: flatulence,jumping pain,needle tie like pain,sulking pain,drilling pain,burning pain,other pain,soreness,electricity like pain.The median duration of a single headache attack was 90(45,120)minutes.The most frequent seizure frequency within the cluster period was = 1 episode/day,followed by > 2 episodes/day.The most common daily frequency of attacks during the cluster period was = 1 attack/day,followed by >2 attacks/day.81.40% of patients with CH had no pain awakening during sleep and 18.60% of patients had pain awakening during sleep.All patients were strictly unilateral pain during the same cluster period,and strictly right-sided pain was the most common side of pain during different cluster periods,followed by strictly left-sided,left-right alternation.The daily onset time of headache was clear in 83.72% of patients.3.Lacrimation was the most common autonomic symptom,followed by conjunctival hyperemia,ptosis,rhinorrhea,facial sweating,nasal obstruction,and eyelid edema.Restlessness was the most common non-autonomic symptom,followed by nausea,vomiting,phonophobia,photophobia,agitation,reduced pain after activities(e.g.walking),and sniffing.4.Cluster time characteristics included frequent clusters episodes per year and a long cluster time,the most common cluster episode frequency was <1 episode/year.The median length of the clustering period was 30 days,and the most common cluster episodes were > 15 and ≤ 30 days.The season and month of seizure onset were well defined in 86.0% of patients,and the month of most frequent cluster episodes was August.5.Treatment of cluster headache were as follows.During the acute phase,34.8% of patients were treated with nonpharmacological(mask high flow oxygen inhalation,acupuncture),with mask high flow oxygen inhalation being the most effective nonpharmacological treatment modality;Medication was used by 27.9% of patients;No treatment was performed in 48.8% of patients.Hormonal therapy was used in 46.7%(7/ 15)of patients during the transition period.During prophylactic treatment,11.6% of patients were treated with prophylactic medication.Conclusions:1.Patients with cluster headache were more often male,the most common site of pain was the right orbit,the most common painful nature was flatulence,the most common autonomic symptom was tearing,the most common non autonomic symptom was restlessness,and the median duration of single pain was 90 minutes.2.The most common cluster episode frequency was <1 episode/year.The most common cluster episodes were > 15 and ≤ 30 days and the median length of the clustering period was 30 days.3.In the acute phase treatment a small number of patients were treated with nonpharmacologic therapy,with mask high flow oxygen the most effective nonpharmacologic treatment modality.Most patients were not prescribed treatment during the acute phase,transitional phase,and prophylactic setting. |
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