According to a recent publication in the journal Neurology, data from a large analysis exploring gender differences in patients with a verified diagnosis of cluster headaches revealed that these types of headaches occur more frequently in men but were more likely to be more severe and debilitating in women.

The researchers from the Karolinska Institute in Stockholm, Sweden, indicated that studies on gender differences in cluster headaches have been conflicting and inconsistent.

The primary objective of this study was to characterize gender differences in patient demographics, clinical phenotype, chronobiology, triggers, treatment, and lifestyle in a Swedish cluster headache population.

Study participants were identified by screening medical records from 2014 to 2020, requested from hospitals and neurology clinics in Sweden for the International Classification of Diseases 10 code G44.0 for cluster headache. Each study participant completed a detailed questionnaire on clinical information about their symptoms, medications, headache triggers, and lifestyle habits.

The study included information from 874 study participants with a verified cluster headache diagnosis; 575 (66%) were male and 299 (34%) were female.

Chronic or severe cluster headaches were reported in 18% of female participants, compared with 9% of males. In addition, female participants reported lengthier attacks than male participants and utilized prophylactic treatment more often (60% vs. 48%).

The results indicated that 8% of females reported that headache attacks last an average of 4 to 7 months, compared with 5% of males, while 26% of females stated attacks on average lasted less than 1 month, compared with 30% of males.

Pertaining to associated symptoms, females experienced ptosis (61% vs. 47%,) and restlessness (54% vs. 46%) more often compared with males. A positive family history for cluster headache was reported among participants as 15% versus 7% for females and males, respectively.

In addition, females reported diurnal rhythmicity of their attacks more often than males (74% vs. 63%). Male participants also reported higher alcohol consumption than females and were more likely to report alcohol as a trigger for cluster headache, with 54% versus 48% in males and females, respectively. Lack of sleep triggering an attack was reported in 31% of female participants versus 20% of males.

A recall bias due to the use of self-reported data was noted as a limitation of the study.

The authors concluded that this was the largest study on gender differences in verified cluster headache patients to date, which may help to augment understanding of how cluster headaches manifest differently in males and females.

Lastly, the authors concluded that cluster headaches are still frequently misdiagnosed in women, perhaps because some aspects can be comparable to a migraine-like phenotype. Therefore, it is critical for prescribers to be cognizant of the gender differences when working in the clinic and meeting headache patients so the most effective treatment can be offered in a timely manner.

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