Clinical characteristics and treatment patterns of patients with episodic cluster headache: results from the United States, United Kingdom and Germany

To describe clinical characteristics and regional treatment patterns of episodic cluster headache (CH). A point-in-time survey of physicians and their patients with CH was conducted in the United States, United Kingdom and Germany in 2017. Overall, 1012 patients with episodic CH were analyzed. Demographic and clinical findings were generally consistent across regions. Most patients were men (66.6%) and the mean age was 40.9 years. The greatest proportion of patients (38.3%) had ≤1 attack per day. The mean number of attacks per day (APD) was 2.4 and mean number of cluster periods per year was 2.6; the mean cluster period duration was 30.8 days. Most patients (69.3%) did not report a specific or predicable time when cluster periods occurred. Acute treatment was prescribed for 47.6% of patients, 10.3% of patients received preventive treatment, and 37.9% of patients received combined acute and preventive treatment; 4.2% of patients were not receiving treatment. Frequently prescribed acute treatments were sumatriptan, oxygen, and zolmitriptan; oxygen use varied considerably across countries and was prescribed least often in the United States. Frequently prescribed preventive treatments were verapamil, topiramate, and lithium. Lack of efficacy and tolerability were the most common reasons for discontinuing preventive treatment. We observed high use of acute treatments, but only half of patients used preventive treatments despite experiencing several cluster periods per year with multiple cluster APD. Further studies about the need for and benefits of preventive treatment for episodic CH are warranted. People with cluster headache (CH) experience headache attacks of excruciating stabbing pain, usually on one side of the head around the eye. These headache attacks typically last between 15 min and 3 h, and come in clusters (or bouts) occurring up to several times a day for a few weeks or months at a time. This greatly impacts a patient’s quality of life. We surveyed doctors and their patients across the United States, the United Kingdom and Germany, looking at symptoms that occurred during CH attacks, how long the headache attacks lasted, how often the patient had them, and what medicines were being given. Our results showed that patients with CH suffered from clusters (bouts) of headache attacks several times a year. Nearly, a third of patients had a wrong diagnosis before being diagnosed with CH. Patients experienced stress, agitation, restlessness, difficulty relaxing and depression during a headache attack, especially those who had more CH attacks each day. Although many patients were taking medication, only half of patients were prescribed medicines to prevent their headache attack from starting. Side effects and the medicines not working were the most common reasons patients stopped taking medicine to prevent their headache attacks. The differences seen in medicines prescribed between countries suggest differences in guidance, or in doctors’ awareness of current medication guidelines. Further studies about the need for and benefits of medicines to prevent CH attacks are needed.

本研究旨在描述发作性丛集性头痛（episodic cluster headache, CH）的临床特征与区域治疗模式。2017年，研究团队在美国、英国及德国开展了针对医师及其CH患者的时点调查。最终共纳入1012例发作性CH患者进行分析。各区域的人口统计学与临床特征总体一致。多数患者为男性（66.6%），平均年龄为40.9岁。最大比例的患者（38.3%）每日发作次数≤1次。平均每日发作次数（attacks per day，缩写为APD）为2.4次，平均每年发作丛集期次数为2.6次；平均丛集期持续时长为30.8天。69.3%的患者未报告丛集期发作存在明确或可预测的时间点。
47.6%的患者接受了急性治疗，10.3%的患者接受了预防性治疗，37.9%的患者接受了急性联合预防性治疗；另有4.2%的患者未接受任何治疗。临床中常用的急性治疗药物包括舒马曲坦（sumatriptan）、吸氧治疗及佐米曲普坦（zolmitriptan）；吸氧治疗在各国间差异显著，美国的处方率最低。常用的预防性治疗药物包括维拉帕米（verapamil）、托吡酯（topiramate）及锂剂。患者停用预防性治疗的最常见原因为疗效不足与耐受性不佳。
本研究观察到急性治疗使用率较高，但尽管患者每年多次出现丛集期且每日多次发作，仅半数患者使用了预防性治疗。未来有必要开展进一步研究，评估发作性CH预防性治疗的必要性与获益。
丛集性头痛（cluster headache, CH）患者会出现剧烈刺痛样头痛发作，通常位于单侧眼眶周围。此类头痛发作通常持续15分钟至3小时，呈成簇（或发作期）出现，每日可达数次，单次发作期可持续数周至数月，严重影响患者的生活质量。
本研究对美国、英国、德国的医师及其患者开展调查，内容涵盖CH发作时的症状、头痛发作持续时长、发作频率及所使用的治疗药物。
研究结果显示，CH患者每年会多次出现头痛发作成簇的情况。近三分之一的患者在确诊CH前曾被误诊。
患者在头痛发作期间会出现焦虑、烦躁、躁动、难以放松及抑郁症状，尤其是每日发作次数较多的患者。
尽管多数患者接受了药物治疗，但仅半数患者被处方了用于预防头痛发作的药物。
不良反应与药物疗效不佳是患者停用预防性治疗药物最常见的原因。
各国间处方药物的差异提示，临床指南或医师对当前药物指南的认知存在差异。
未来仍需开展更多研究，明确预防性治疗CH发作的必要性与获益。