Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi- Pai Rd, Taipei, 11217, Taiwan.
College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Headache Pain. 2024 Oct 8;25(1):174. doi: 10.1186/s10194-024-01862-8.
Pre-cluster symptoms (PCSs) are symptoms preceding cluster bouts and might have implications for the treatment of cluster headache (CH). This study investigated the prevalence of PCSs, and their utility in predicting upcoming bouts as well as the associations with therapeutic efficacy.
We prospectively collected data from patients with CH. Each patient received a structured interview and completed questionnaire surveys during CH bouts. In sub-study 1, we cross-sectionally analyzed the prevalence, symptomatology, and predictability of upcoming bouts. Overall, 34 PCSs, divided into seven categories, were queried, including head and neck pain, cranial autonomic symptoms, restlessness, fatigue or mood changes, sleep alterations, constitutional symptoms, and generalized pain. In sub-study 2, we recorded the weekly frequency of CH attacks after the initiation of verapamil concurrently with a 14-day transitional therapy based on the patients' headache diary. A responder to verapamil was defined as a patient who have a reduction from baseline of at least 50% in the weekly frequency of CH attacks 4 weeks after the initiation of verapamil.
A total of 168 CH patients (women/men: 39/129) completed the study. In sub-study 1, we found 149 (88.7%) experienced PCSs, with a median of 24 (IQR 18 to 72) hours before the bouts. Up to 57.7% of patients with PCS reported that they could predict upcoming bouts. Among the seven categories of PCSs, head and neck pain was the most common (81.0%) and was associated with a higher predictability of upcoming bouts (odds ratio [OR] = 4.0; 95% confidence interval [CI] 1.7-9.6). In sub-study 2, we found two categories of PCSs were associated with the response to verapamil: sleep alteration (OR = 2.5 [95% CI = 1.3-4.8], p = 0.004) and ≥ 1 cranial autonomic symptoms (OR = 2.7 [95% CI = 1.4-5.1], p = 0.003).
PCSs were very common in CH and could be used to predict upcoming bouts. Different symptom categories of PCSs may have different clinical implications.
集群前症状（PCSs）是集群发作前的症状，可能对偏头痛的治疗有影响。本研究调查了 PCSs 的发生率，及其对即将到来的发作的预测价值，以及与治疗效果的关系。
我们前瞻性地收集偏头痛患者的数据。每位患者在偏头痛发作期间接受了结构化访谈和问卷调查。在子研究 1 中，我们分析了即将发作的 PCSs 的患病率、症状和可预测性。总体而言，我们询问了 34 种 PCSs，分为 7 类，包括头颈部疼痛、颅自主症状、不安、疲劳或情绪变化、睡眠改变、全身症状和全身疼痛。在子研究 2 中，我们记录了维拉帕米治疗开始后每周偏头痛发作的频率，并根据患者的头痛日记进行了为期 14 天的过渡治疗。维拉帕米治疗的反应者定义为维拉帕米治疗开始后 4 周，偏头痛发作频率至少降低 50%的患者。
共有 168 例偏头痛患者（女性/男性：39/129）完成了研究。在子研究 1 中，我们发现 149 例（88.7%）患者出现了 PCSs，在发作前中位数为 24 小时（IQR 18 至 72 小时）。多达 57.7%的有 PCSs 的患者报告说他们可以预测即将到来的发作。在 7 类 PCSs 中，头颈部疼痛最常见（81.0%），与即将发作的更高可预测性相关（优势比[OR] = 4.0；95%置信区间[CI] 1.7-9.6）。在子研究 2 中，我们发现两类 PCSs 与维拉帕米的反应有关：睡眠改变（OR = 2.5 [95%CI 1.3-4.8]，p = 0.004）和≥1 种颅自主症状（OR = 2.7 [95%CI 1.4-5.1]，p = 0.003）。
PCSs 在偏头痛中非常常见，可以用来预测即将到来的发作。不同的 PCSs 症状类别可能有不同的临床意义。
