Pre-cluster symptoms in a Taiwanese cohort of cluster headache: symptom profiles and clinical predictions.

IF 7.3 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Headache and Pain Pub Date : 2024-10-08 DOI:10.1186/s10194-024-01862-8

Jr-Wei Wu, Shu-Ting Chen, Yen-Feng Wang, Shih-Pin Chen, Shin-Yi Tseng, Yih-Shiuan Kuo, Wei-Ta Chen, Chia-Chun Chiang, Shuu-Jiun Wang

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: PCSs were very common in CH and could be used to predict upcoming bouts. Different symptom categories of PCSs may have different clinical implications.

查看原文本刊更多论文

台湾群集性头痛患者的群集前症状：症状特征和临床预测。

背景：丛集前症状（PCSs）是丛集性头痛发作前的症状，可能对丛集性头痛（CH）的治疗有影响。本研究调查了集束前症状的发生率、其在预测即将到来的发作中的作用以及与疗效的关联：我们前瞻性地收集了 CH 患者的数据。方法：我们对 CH 患者进行了前瞻性数据收集，每位患者都接受了结构化访谈，并在 CH 发作期间完成了问卷调查。在子研究 1 中，我们横截面地分析了即将爆发的患病率、症状学和可预测性。我们共调查了 34 种 PCS，分为 7 个类别，包括头颈部疼痛、头颅自主神经症状、烦躁不安、疲劳或情绪变化、睡眠改变、体质症状和全身疼痛。在子研究 2 中，我们根据患者的头痛日记，记录了在开始使用维拉帕米的同时进行为期 14 天的过渡治疗后，CH 的每周发作频率。对维拉帕米有反应者的定义是，在开始使用维拉帕米 4 周后，CH 的每周发作频率比基线降低至少 50%：共有 168 名心脏病患者（女性/男性：39/129）完成了研究。在子研究 1 中，我们发现有 149 人（88.7%）经历过 PCS，中位数为发作前 24 小时（IQR 18 至 72 小时）。多达 57.7% 的 PCS 患者表示，他们可以预测即将到来的阵痛。在七类 PCS 中，头颈部疼痛最为常见（81.0%），并且与较高的即将发生的阵痛可预测性相关（几率比 [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 PCS 与维拉帕米的反应相关：睡眠改变（OR = 2.5 [95% CI = 1.3-4.8]，P = 0.004）和≥1 种颅内自主神经症状（OR = 2.7 [95% CI = 1.4-5.1]，P = 0.003）：PCS在CH中非常常见，可用于预测即将到来的发作。不同类别的 PCS 可能具有不同的临床意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Headache and Pain 医学-临床神经学

CiteScore

11.80

自引率

13.50%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data. With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.