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Front. Neurol. | doi: 10.3389/fneur.2019.01220

Gender differences in the clinical presentation of Cluster Headache

 Marta Allena1*,  Grazia Sances1, Roberto De Icco1, 2,  Lara Ahmad1, 2, Alessia Putortì1, 2,  Rosaria Greco1, Ennio Pucci2 and  Cristina Tassorelli1, 2
  • 1Headache Science Centre, Neurological Institute Foundation Casimiro Mondino, Italy
  • 2Department of Nervous System and Behavioral Sciences, University of Pavia, Italy

Cluster Headache (CH) is a very well characterized primary headache disorder. CH mostly affects men but an increasing percentage of women also suffers from this disease. Available data on gender-related differences in CH are very scarce and partly discordant. The aim of this manuscript is the careful definition of clinical profile of CH between the sexes.
Material and methods
Retrospective analysis of a clinical database of CH patients diagnosed and followed at the Pavia Headache Center between September 2016 and December 2018.
We collected data from 250 CH patients, 163 males (mean age 41.46+10.37years) and 87 females (mean age 42.24+11.95 years). The mean age of CH onset was similar for both sexes but surprisingly the onset of disease often coincided with periods of abrupt fluctuations of sexual hormone levels (menarche, post-partum, menopause). Women had a longer mean attack duration (p=0.004) than men, without symptomatic treatment, and tended to have more attacks per day (p=0.053). Nausea and osmophobia were reported more frequently by women (p=0.048, p=0.037, respectively). Autonomic associated symptoms were almost equally prevalent in women and men, with the exception of ptosis (predominant in female) and enlarged temporal artery and nasal congestion (both more expressed in men). Concomitant thyroid diseases (23% vs 1.8%, p=0.001) and psychiatric disorders (17.2% vs 9.2%, p= 0.04) mostly occur in women than men. Snoring in sleep and smoking habit is more frequent in men: 53.4% vs 19.5% (p=0.00) and 67.5% vs 49.4% (p=0.005), respectively.
Despite an overall similar clinical presentation of cluster headache in both sexes, in women some features seem to overlap with migraine, as suggested by existing literature: the prevalence of “migrainous” associated symptoms during attacks, the more robust family history of migraine, the association of CH onset with hormonal changes, the longer duration of CH attacks and the more widespread distribution of pain.
These our findings may have a relevance in terms of a pathophysiological role of sexual hormones so far unexplored in CH. Further investigations along this line may lead to an improved global management of the disease, from the diagnosis to new gender-related therapeutic strategies.

Keywords: Cluster Headache, female, sex-differences, gender-related variables, Migraine

Received: 19 Jul 2019; Accepted: 01 Nov 2019.

Copyright: © 2019 Allena, Sances, De Icco, Ahmad, Putortì, Greco, Pucci and Tassorelli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Marta Allena, Headache Science Centre, Neurological Institute Foundation Casimiro Mondino, Pavia, Italy,