ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2025
The profile of refractory chronic cluster headache.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cluster headache diagnostic delay and its predictors: a systematic review with a meta-analysis.The journal of headache and pain · 2025Pooled it
- The Prevalence and Incidence of Cluster Headache: A Norwegian Population-Based Time-Trend Study.Neurology · 2026Article
- Predictors of Response to Occipital Nerve Stimulation in Patients with Refractory Chronic Cluster Headache: Protocol for a Prospective Observational Study.Brain sciences · 2026Article
- Extremely low dose norepinephrine in treatment of refractory chronic cluster headache: two case reports and literature review.Frontiers in neuroscience · 2026Article
- Hallmarks of primary headache: part 3 - cluster headache.The journal of headache and pain · 2025Review
- Evaluating Repetitive Transcranial Magnetic Stimulation for Refractory Chronic Cluster Headache Prevention: Insights from a Randomized Crossover Pilot Trial.Brain sciences · 2025Article
- Unraveling the relationship between inflammation and cluster headache.Frontiers in neurology · 2025Review
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15 authors.
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Abstract
introductionChronic cluster headache (CCH) is a relatively rare primary headache disorder whose management is often challenging. The prevalence of refractory CCH (rCCH) is unknown. Our aim is to describe the frequency of rCCH within a population of CCH, define the clinical profile of the refractory patients and the treatments they underwent.
methodsWe conducted a cross-sectional study through a review of the medical records of CCH patients in six hospitals in Madrid, Spain. Data on epidemiological, clinical presentation, treatment and disease activity at the moment were collected. The European Headache Federation diagnostic criteria were used for rCCH definition. High disease activity was defined as having at least 3 severe attacks per week that impact quality of life despite treatment. Non-rCCH and rCCH groups were compared.
results88 CCH patients were analyzed, 68.2% (60/88) met rCCH criteria at some point in their evolution. A longer diagnostic delay (4.6 ± 7.1 vs. 3.2 ± 3.7 years, p = 0.017) was observed in rCCH. All rCCH patients tried therapies without established evidence from randomized clinical trials. OnabotulinumtoxinA and galcanezumab were initiated in 77.3% (68/88) and 5.7% (5/88), but discontinued in 52.9% (36/68) and 60.0% (3/5), respectively. Occipital nerve stimulation (ONS) was implanted in 29.6% (26/88), with 50.0% (13/26) still active. Other treatment options are described and discussed. Despite treatment, 60.2% (53/88) still have high disease activity.
conclusionCCH is a disorder with poor prognosis, meeting refractoriness criteria in more than half. OnabotulinumtoxinA and ONS could be the effective in refractory patients.
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