Women are more affected by chronic cluster headache than previously thought, according to new research from Karolinska Institutet.
Chronic cluster headache, also known as ‘suicide headache’, has previously been described as a predominantly male disease. The new research shows that women are in fact, more affected by chronic cluster headaches than men.
Women have longer periods of pain, a higher frequency of related symptoms, use more prophylactic medicine and take more sick leave as a result of the condition.
The results have been in the journals Neurology, and the American Academy of Neurology.
Men are more likely to be diagnosed
“Cluster headache is still often initially misdiagnosed in women, perhaps because some aspects can be similar to migraine. It is important for physicians to be aware of how the disorder manifests differently in men and women so the most effective treatment can be given as fast as possible,” said study author Andrea Carmine Belin, associate professor at the Department of Neuroscience, Karolinska Institutet.
Men are around three to five times more likely to be diagnosed with chronic cluster headache than women. Because of this, the condition has largely been considered a male-dominated disease.
The condition affects one in a thousand people and is characterised by extremely painful bouts of headache that typically last between 15 minutes and three hours and can occur up to eight times a day. The cause of the condition is unknown, but some researchers believe it may be linked to the body’s internal biological clock as the bouts tend to follow circadian and annual rhythms, peaking at night and in the autumn and spring.
Research shows that women frequently tend to suffer from more severe variants of the disease, meaning that they have fewer than three symptom-free months per year.
Chronic cluster headache last longer in women
“Men and women report the same level of pain, but since the women’s periods of pain tend to last longer, their daily lives are also more impacted,” said Andrea Carmine Belin.
The researchers found twice as many of the women had a chronic variant of the disease as the men in their study of 874 participants. Each participant had been diagnosed with cluster headache by neurologists at clinics in Sweden between 2014 and 2020. Participants were asked to complete a questionnaire on their lifestyle, symptoms and treatment prior to the study.
More women used prophylactic drugs than men and they reported a higher frequency of associated symptoms such as drooping eyelids, and restlessness. Women tended to suffer slightly more from nightly attacks and sleep deficiencies. Women were also twice as likely to have a relative who suffered form cluster headaches.
“It’s hard to say what’s at the root of these differences, but what we see is that women who are diagnosed with cluster headache tend to present a more severe variant of the disease and that it’s time to stop thinking of cluster headache as a predominantly male disease,” said Caroline Ran, research specialist at the Department of Neuroscience, Karolinska Institutet.
The study also shows that patients with cluster headache often have other diagnoses in which women are over-represented. A total of 96% of female cluster headache patients residing in Sweden in 2010, had at least one other diagnosis.
“What’s striking is that almost every woman with cluster headache presents a comorbidity, which reinforces the view that these women suffer severely,” says Christina Sjöstrand, adjunct senior lecturer at the Department of Clinical Neuroscience, Karolinska Institutet.
“It’s reasonable to assume that it affects their ability to work and it’s important for the sake of the individual and society that they get help in the form of acute and prophylactic treatment and of follow-up and support,” she concluded.