Søborg Marie-Louise Kulas, Petersen Anja Sofie, Lund Nunu, Wandall-Holm Malthe Faurschou, Jensen Rigmor Højland, Barloese Mads
The Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark.
The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark.
Cephalalgia. 2023 Jan;43(1):3331024221128287. doi: 10.1177/03331024221128287.
Cluster headache exists diagnostically in a chronic and episodic variant between which patients can convert. We aimed to describe how many patients change phenotype, elucidate possible factors associated with this transition and identify differences in clinical features between primary and secondary phenotypes. 540 well-defined cluster headache patients according to current ICHD-criteria completed a cross-sectional semi-structured interview. Total transition-incidence for the cohort was 20.7%. Conversion from chronic to episodic was reported by 6.3% and transition from episodic to chronic by 14.4% with attack side shift as a possible predictor (p = 0.007). Compared to primary chronic patients, secondary chronic patients had more frequent (60 vs 34 per month, p = 0.0487), but shorter (60 vs 90 minutes, p = 0.041) attacks. Secondary episodic patients experienced shorter remission periods than primary episodic patients (6 vs 11 months, p = 0.010). Treatment response was poor in all groups and only one third had effective prevention. Cluster headache is a fluctuating disorder with a fifth of our cohort having experienced at least one phenotype change during course of disease. Apart from attack side shifts, no predictors for transition were identified. Severity differed between primary and secondary subtypes. Overall, there is an urgent need for better understanding of cluster headache.
丛集性头痛在诊断上存在慢性和发作性两种变体，患者可能会在这两种变体之间转变。我们旨在描述有多少患者会改变表型，阐明与这种转变相关的可能因素，并确定原发性和继发性表型在临床特征上的差异。根据当前的国际头痛疾病分类（ICHD）标准，540例明确诊断的丛集性头痛患者完成了一项横断面半结构化访谈。该队列的总转变发生率为20.7%。报告从慢性转变为发作性的比例为6.3%，从发作性转变为慢性的比例为14.4%，发作侧改变可能是一个预测因素（p = 0.007）。与原发性慢性患者相比，继发性慢性患者发作更频繁（每月60次对34次，p = 0.0487），但发作持续时间更短（60分钟对90分钟，p = 0.041）。继发性发作性患者的缓解期比原发性发作性患者短（6个月对11个月，p = 0.010）。所有组的治疗反应都很差，只有三分之一的患者有有效的预防措施。丛集性头痛是一种波动的疾病，我们队列中有五分之一的患者在疾病过程中经历了至少一次表型变化。除了发作侧改变外，未发现转变的预测因素。原发性和继发性亚型之间的严重程度有所不同。总体而言，迫切需要更好地了解丛集性头痛。
