TY - JOUR

T1 - Real-life treatment of cluster headache in a tertiary headache center – results from the Danish Cluster Headache Survey

AU - Petersen, Anja Sofie

AU - Lund, Nunu

AU - Jensen, Rigmor Højland

AU - Barloese, Mads

N1 - Publisher Copyright: © International Headache Society 2020.

PY - 2021

Y1 - 2021

N2 - Background: Pharmacological treatment of cluster headache constitutes the core of clinical management, but evidence is sparse. We aimed to generate insight in the existing treatment and identify associations between clinical features and treatment response. Methods: Patients aged 18–65 diagnosed with cluster headache according to the ICHD-2 completed a questionnaire followed by a structured interview. Multiple logistic regression was used to identify associations. Results: The population consisted of 400 patients with an episodic: chronic ratio of 1.7:1. Episodic patients were more likely to respond to triptans (odds ratio = 1.77, confidence interval: 1.08–2.91, p = 0.023) and oxygen (odds ratio = 1.64, confidence interval: 1.05–2.57, p = 0.031) than chronic. Oxygen response was less likely if pain intensity was very severe (odds ratio = 0.53, confidence interval: 0.33–2.57, p = 0.006) and the risk of a poor response increased with disease duration (odds ratio = 0.79, confidence interval: 0.65–0.96, p = 0.016). Among current users of sumatriptan injection and oxygen, the proportion achieving 100% relief was higher with sumatriptan injection (p > 0.001) than with oxygen. No associations were identified regarding verapamil. Only 57% of current users of preventive medication responded at a 50% level. Conclusion: Episodic cluster headache is more responsive to acute therapy than chronic. Further, sumatriptan injection was more effective than oxygen and the responder-rate was limited with verapamil. More effective acute and preventive therapies are needed for cluster headache patients.

AB - Background: Pharmacological treatment of cluster headache constitutes the core of clinical management, but evidence is sparse. We aimed to generate insight in the existing treatment and identify associations between clinical features and treatment response. Methods: Patients aged 18–65 diagnosed with cluster headache according to the ICHD-2 completed a questionnaire followed by a structured interview. Multiple logistic regression was used to identify associations. Results: The population consisted of 400 patients with an episodic: chronic ratio of 1.7:1. Episodic patients were more likely to respond to triptans (odds ratio = 1.77, confidence interval: 1.08–2.91, p = 0.023) and oxygen (odds ratio = 1.64, confidence interval: 1.05–2.57, p = 0.031) than chronic. Oxygen response was less likely if pain intensity was very severe (odds ratio = 0.53, confidence interval: 0.33–2.57, p = 0.006) and the risk of a poor response increased with disease duration (odds ratio = 0.79, confidence interval: 0.65–0.96, p = 0.016). Among current users of sumatriptan injection and oxygen, the proportion achieving 100% relief was higher with sumatriptan injection (p > 0.001) than with oxygen. No associations were identified regarding verapamil. Only 57% of current users of preventive medication responded at a 50% level. Conclusion: Episodic cluster headache is more responsive to acute therapy than chronic. Further, sumatriptan injection was more effective than oxygen and the responder-rate was limited with verapamil. More effective acute and preventive therapies are needed for cluster headache patients.

KW - Cluster headache

KW - cross sectional study

KW - episodic

KW - refractory

KW - therapy

U2 - 10.1177/0333102420970455

DO - 10.1177/0333102420970455

M3 - Journal article

C2 - 33203216

AN - SCOPUS:85096222082

VL - 41

SP - 525

EP - 534

JO - Cephalalgia

JF - Cephalalgia

SN - 0800-1952

IS - 5

ER -