ArticleThe journal of headache and pain2024
Pre-cluster symptoms in a Taiwanese cohort of cluster headache: symptom profiles and clinical predictions.
Article in The journal of headache and pain, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Premonitory phase in primary headaches: shared and divergent mechanisms in migraine and cluster headache, the Junior Editorial Board Members' vision.The journal of headache and pain · 2026Review
- Sex differences in cluster headache: insights from the Chinese Cluster Headache Register Individual Study (CHRIS).The journal of headache and pain · 2026Observational
- Hallmarks of primary headache: part 3 - cluster headache.The journal of headache and pain · 2025Review
- Reviewing the complex relationship between circadian rhythms and cluster headache.Cephalalgia : an international journal of headache · 2025Review
- Unraveling the relationship between inflammation and cluster headache.Frontiers in neurology · 2025Review
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Authors and funding
9 authors.
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Abstract
backgroundPre-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.
methodsWe 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.
resultsA 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).
conclusionPCSs were very common in CH and could be used to predict upcoming bouts. Different symptom categories of PCSs may have different clinical implications.
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