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The sex divide in cluster headache severity: study

The sex divide in cluster headache severity: study

A new study published in Neurology suggests that while cluster headache is common in men, their symptoms are quite severe in women, and yet misdiagnosed.
Cluster Headaches in Women
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A new study published in Neurology (21 December) says that although cluster headache is seen as a men’s disorder, women get it more severely than men.  

The publication is the medical journal of the American Academy of Neurology. 

We found that the more severe form of cluster headache — chronic cluster headache — is more common among women than men,” Andrea C. Belin, the study’s principal investigator, tells Happiest Health.  

She adds that in chronic cluster headache, the person has less than three months of symptom-free periods per year. 

As the name indicates, cluster headache is an intense headache occurring in bouts or clusters. They last for periods of 15 minutes to three hours and occur up to eight times a day. These bouts can continue for weeks or months, followed by a headache-free period.  

The common symptoms of cluster headache — teary eyes, droopy eyelids and stuffy nose — overlap with sinus headaches and migraines and are often misdiagnosed.  

However, cluster headache requires different treatment approaches, so an accurate diagnosis is essential. For example, people with cluster headaches need oxygen therapy or painkiller injections to relieve the pain. 

“Cluster headache is still often misdiagnosed in women, perhaps because some aspects can be similar to migraine,” says Dr Belin in a statement. She adds that physicians need to be aware of how the headache shows up differently in men and women to ensure effective treatment is given as quickly as possible. 

With the help of a questionnaire, the researchers studied the symptoms, medications, headache triggers and lifestyle habits of 874 Swedish people (66 per cent men and 34 per cent women). From the reported information, they found that twice the number of women had chronic cluster headache than men.  

Suffering lasts for months  

The cluster headache cycles were also longer in women. Eight per cent of them had episodes that lasted for periods ranging from four to seven months, whereas five per cent of the men reported similar episodes. 

Also, the women had more family members with cluster headache than men. The study did not find age-related patterns for the onset of cluster headache between men and women. 

Night strikes and the sleep factor 

A unique feature of cluster headache is their periodicity: they occur mostly at night and recur at the same time every day during the cycle. Previous studies have shown that the hypothalamus region in the brain is activated during cluster headache attacks. The hypothalamus coordinates sleep cycles, hormone release and body temperature.  

Hence, “Lack of sleep is a trigger factor for cluster headaches, and it is more common among women, whereas in men, alcohol is a more common trigger,” says Dr Belin. Other triggers include stress.

While the ratio of men to women with cluster headache has been shifting over the years, it is still considered mainly a disorder of men, making it more difficult for women with milder symptoms to be diagnosed with cluster headache than men, says Dr Belin. “It is possible this could contribute to the higher rate of chronic cluster headache in women,” she says. 

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