Department of Neurology, Hull Royal Infirmary, Hull, UK.
Hull York Medical School, University of Hull, Hull, UK.
Neurol Sci. 2019 Jan;40(1):25-39. doi: 10.1007/s10072-018-3598-5. Epub 2018 Oct 10.
Patients with cluster headache (CH), the most common trigeminal autonomic cephalalgia, often face delayed diagnosis, misdiagnosis and mismanagement.
To identify, appraise and synthesise clinical studies on the delays in diagnosis and misdiagnosis of CH in order to determine its causes and help the management of this condition.
The systematic review was prepared, conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis. It was registered with International Prospective Register of Systematic Reviews. A systematic search of different electronic databases (Medline, EMBASE, PsycINFO, PubMed, CINAHL, BNI, HMIC, AMED, HBE and Cochrane Library) was carried out in May 2017. Reference lists of relevant articles were hand searched.
The search identified 201 unique studies. Fifteen studies met the inclusion criteria of which 13 case series studies and two survey studies. Nine studies assessed the delays in diagnosis and misdiagnosis of CH, five studies the delays in diagnosis and one study the misdiagnosis of CH. The studies included 4661 patients. Delays in diagnosis, misdiagnosis and mismanagement have been reported in many European countries, Japan and in the USA with well-developed health services. The patients with CH often visited many different clinicians, surgeons and dentists and received multiple diagnosis prior to being correctly diagnosed.
This systematic review shows that the delays in the diagnosis of CH are a widespread problem, the time to diagnosis still vary from country to country and both patients and physicians are responsible for the delays in diagnosis.
丛集性头痛（CH）是最常见的三叉神经自主神经性头痛，患者经常面临诊断延迟、误诊和治疗不当的问题。
确定、评估和综合有关 CH 诊断延迟和误诊的临床研究，以确定其原因，并帮助管理这种疾病。
系统评价按照系统评价和荟萃分析的首选报告项目进行准备、进行和报告，并在国际前瞻性系统评价注册库中进行了注册。于 2017 年 5 月对不同电子数据库（Medline、EMBASE、PsycINFO、PubMed、CINAHL、BNI、HMIC、AMED、HBE 和 Cochrane Library）进行了系统搜索，并对相关文章的参考文献进行了手工搜索。
搜索共确定了 201 项独特的研究。15 项研究符合纳入标准，其中包括 13 项病例系列研究和 2 项调查研究。9 项研究评估了 CH 的诊断延迟和误诊，5 项研究评估了 CH 的诊断延迟，1 项研究评估了 CH 的误诊。这些研究共纳入了 4661 名患者。在拥有发达医疗服务的许多欧洲国家、日本和美国，均有报道 CH 存在诊断延迟、误诊和治疗不当的情况。CH 患者经常就诊于许多不同的临床医生、外科医生和牙医，并在得到正确诊断之前接受了多次诊断。
这项系统评价表明，CH 的诊断延迟是一个普遍存在的问题，诊断时间仍因国家而异，患者和医生都对诊断延迟负有责任。
