Natural course of untreated cluster headache: A retrospective cohort study

Authors: Mi Ji Lee, Hyun Ah Choi, Jong Hwa Shin, Hea Ree Park and Chin-Sang Chung
Source: Neurology, April 18, 2017 vol. 88 no. 16 Supplement P1.185


Objective: To determine the temporal changes of headache characteristics and the pattern of remission in cluster headache.

Background: There is little knowledge about the natural course of cluster headache, especially the age, pattern and characteristics of remission.

Design/Methods: We screened patients who were diagnosed with CH in Samsung Medical Center between 1997 and 2010. Patients who 1) have agreed to collect personal information, and 2) lost follow-up at least for 5 years were considered eligible for the study. Eligible patients were contacted via telephone or cellular phone. Headache characteristics and temporal changes during the disease course were interviewed.

Remission was defined with two of the followings: 1) symptom-free for more than twice of the longest interval of bouts, and 2) symptom-free for the past 5 years.

Results: Finally, 42 patients were included in the analysis. Strictly unilateral location was reported in 40 (95.0%) at initial visit, but decreased to 22 (77.8%) during the disease course. Circadian and circannual rhythmicity was present in 23 (62.2%) and 23 (63.9%) at baseline, but decreased to 15 (40.5%) and 17 (48.6%) during the disease course. Autonomic symptom was prominent in 35 (100%) at initial visit, but 27 (77.1%) at the follow-up. Final course was determined as active (n=28, 66.7%) and remission (n=14, 33.3%), while no chronification was identified. In remitted patients, their last bouts occurred at median age of 38 (range, 36–52) years. Patients with remission were older and had a shorter disease duration than the active group. Remitted patients had less prominent circannual and circadian rhythmicity at baseline. There were no uniform pattern of remission.

Conclusions: Distinct features of cluster headache decrease with time. Although there was no single predictor of remission, patients with remission had less circadian and circannual rhythmicities and suffered less bouts in a reduced disease course. Pattern of remission was diverse.

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