Göbel Carl H, Karstedt Sarah, Heinze Axel, Koch Britta, Göbel Hartmut
Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Kiel Migraine and Headache Centre, Kiel, Germany.
Pain Ther. 2021 Dec;10(2):1121-1137. doi: 10.1007/s40122-021-00267-8. Epub 2021 May 4.
Cluster headaches can occur with considerable clinical variability. The inter- and intra-individual variability could contribute to the fact that the clinical headache phenotype is not captured by too strict diagnostic criteria, and that the diagnosis and the effective therapy are thereby delayed. The aim of the study was to analyze the severity and extent of the clinical symptoms of episodic and chronic cluster headaches with regard to their variability and to compare them with the requirements of the International Classification of Headache Disorders 3rd edition (ICHD-3) diagnostic criteria.
The study was carried out as a cross-sectional analysis of 825 patients who had been diagnosed with cluster headaches by their physician. Using an online questionnaire, standardized questions on sociodemographic variables, clinical features of the cluster headache according to ICHD-3, and accompanying clinical symptoms were recorded.
The majority of patients with cluster headaches have clinical features that are mapped by the diagnostic criteria of ICHD-3. However, due to the variability of the symptoms, there is a significant proportion of clinical phenotypes that are not captured by the ICHD-3 criteria for cluster headaches. In addition, change in the side of the pain between the cluster episodes, pain location, as well as persisting pain between the attacks is not addressed in the ICHD-3 criteria. In the foreground of the comorbidities are psychological consequences in the form of depression, sleep disorders, and anxiety.
The variability of the phenotype of cluster headaches can preclude some patients from receiving an appropriate diagnosis and effective therapy if the diagnostic criteria applied are too strict. The occurrence of persisting pain between attacks should also be diagnostically evaluated due to its high prevalence and severity as well as psychological strain. When treating patients with cluster headaches, accompanying psychological illnesses should carefully be taken into account.
丛集性头痛的临床表现具有相当大的变异性。个体间和个体内的变异性可能导致过于严格的诊断标准无法涵盖临床头痛表型，从而延误诊断和有效治疗。本研究的目的是分析发作性和慢性丛集性头痛临床症状的严重程度和范围及其变异性，并将其与《国际头痛疾病分类》第三版（ICHD-3）诊断标准的要求进行比较。
本研究对825例经医生诊断为丛集性头痛的患者进行了横断面分析。通过在线问卷，记录了关于社会人口统计学变量、根据ICHD-3的丛集性头痛临床特征以及伴随临床症状的标准化问题。
大多数丛集性头痛患者的临床特征符合ICHD-3的诊断标准。然而，由于症状的变异性，有相当一部分临床表型未被ICHD-3的丛集性头痛标准所涵盖。此外，ICHD-3标准未涉及丛集发作之间疼痛部位的变化、疼痛位置以及发作之间持续存在的疼痛。在合并症中，以抑郁、睡眠障碍和焦虑形式出现的心理后果最为突出。
如果应用的诊断标准过于严格，丛集性头痛表型的变异性可能会使一些患者无法得到适当的诊断和有效治疗。发作之间持续疼痛的情况因其高发生率、严重程度以及心理压力，也应进行诊断评估。在治疗丛集性头痛患者时，应仔细考虑伴随的心理疾病。
