DOI: 10.1177/25158163261462937 ISSN: 2515-8163

Sex differences in cluster headache, treatment insights, and burden of disease in Türkiye: A multi-center cross-sectional study

Esme Ekizoğlu, Pınar Yalınay Dikmen, Mustafa Ertaş, Edis Hacılar, Elif Ilgaz Aydınlar, Elif Kocasoy Orhan, Ferda Selçuk, Aynur Özge, Ayşenur Şahin, Tuba Erdogan Soyukibar, Betül Baykan
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Aim

There is a growing recognition of the need for sex-specific approaches in primary headache disorders. Research on sex differences in cluster headache (CH) is quite limited, and examining this data across different populations is crucial for understanding genetic and sociocultural differences. We aimed to investigate sex differences in clinical features, acute treatment responses, and the burden of CH in Türkiye.

Methods

This multicenter cross-sectional study was conducted between January and June 2024 and involved patients with CH from tertiary healthcare centers, who met the International Classification of Headache Disorders (ICHD-3) criteria. Patients with cluster-like secondary headache conditions were not included. Sociodemographic data, clinical characteristics, acute treatment responses, and the burden of CH were assessed using a semi-structured questionnaire. Statistical comparisons were done between male and female patients.

Results

A total of 318 patients (244 males, 76.7%), with a mean age of 45.0 ± 10.9 years, were included. Previous misdiagnosis rates were significantly higher in females (71.6%) compared to males (50.8%) ( p  = 0.002). While the frequency and duration of cluster bouts were similar in both sexes, compared to males, females were more likely to experience headache attacks lasting longer than 2 h (44.3% vs. 60.8%; p  < 0.013) and more frequently experience agitation during the attacks (66% vs. 79.7%; p  = 0.025). The presence of autonomic symptoms also varied by sex; males reported higher rates of conjunctival injection (52.5% vs. 35.1%; p  = 0.009) and facial sweating (37.3% vs. 17.6%; p  = 0.002). Males showed a higher therapeutic benefit from subcutaneous sumatriptan (91.7% vs. 66.7%; p  = 0.002). Both sexes reported a negative impact of CH on daily life in the previous year, with a mean of 18.3 days in males and 22.5 days in females.

Conclusion

Several sex differences were observed in patients with CH: attack duration was longer, agitation during the attacks, and misdiagnosis were more frequent. On the other hand, autonomic features such as conjunctival injection and facial sweating tended to accompany CH attacks more often in males, who responded better to subcutaneous triptan than females. These findings highlight the necessity of investigating the underlying mechanisms of sex-specific differences in future research, as well as the careful consideration of these factors in diagnostic and treatment planning.

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