Cluster Headache Ranked More Painful Than Childbirth
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Patients with cluster headache face a double whammy: Physicians too often fail to recognize it, and their condition is among the most severe and debilitating among headache types. In fact, a new survey of patients with cluster headache shows that they rank the pain as worse than most other painful experiences in life, including childbirth, passing of kidney stones, and pancreatitis, among others.

The study compares cluster headaches to other painful experiences to help non-sufferers relate to the experience. "Headache is a terrible word. [A cluster headache] doesn't ache. It's a piercing intensity like you just can't believe," the coauthor says. Ranking cluster headaches as worse than experiences helps to describe the experience in terms that more people can relate to.

A researcher called for physicians to consider cluster headache an emergency, because of the severity of pain and also the potential for suicidality. Treatments remain comparatively sparse, but high-flow oxygen can help some patients, and intranasal or intravenous triptans can treat acute pain. In 2018, the Food and Drug Administration approved galcanezumab (Eli Lilly) for the prevention of episodic cluster headaches.

Cluster headaches are often misdiagnosed. Women may be particularly vulnerable to misdiagnosis because migraines are more common in women. Neurologists are taught that cluster headache is primarily a male disease. She noted that patients with side-locked headache should be evaluated for cluster headache, and asked how long the pain lasts in the absence of medication.

For the survey, the researchers asked 1,604 patients with cluster headache patients to rate pain on a scale of 1 to 10. Cluster headache ranked highest at 9.7, then labor pain (7.2), pancreatitis (7.0), and nephrolithiasis (6.9). Cluster headache pain was ranked at 10.0 by 72.1% of respondents.

Those reporting maximal pain or were more likely to have cranial autonomic features in comparison with patients who reported less pain, including conjunctival injection or lacrimation, eyelid edema, forehead/facial sweating, fullness in the ear, and miosis or ptosis. They had more frequent attacks, higher Hopelessness Depression Symptom Questionnaire scores, and reduced effectiveness of calcium channel blockers. They were more often female.

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