SIB# 439- The Intense Pain of Cluster Headaches
The Study: Cluster headache is one of the most intensely painful human conditions: Results from the International Cluster Headache Questionnaire
Overview: This paper is a cross sectional survey in which sufferers of cluster headaches were asked to rate their cluster headache pain on a 0-10 numerical scale. The study also looked at demographics, mood scores and patient response to treatment.
Key Points:
The study looked at a total of 1604 cluster headache respondents .
Interestingly, cluster headache was rated as significantly more painful (rating 9.7) than every other condition covered in the survey. The majority of respondents rated their cluster headache attack at maximal (10.0) pain.
Other items covered in the study are shown here along with their pain scale rating. included were: Labor pain (7.2), Pancreatitis (7.0), Nephrolithiasis (6.9)
Those subjects reporting maximal pain were significantly more likely to have also experience cranial autonomic features compared to respondents who rated their pain lower on the scale.
Other reported cranial symptoms included conjunctival injection or lacrimation (91%), eyelid edema (77%), forehead/facial sweating (60%), fullness in the ear (47%) and miosis/ptosis (85%).
Respondents with maximal pain also had other statistically significant more frequent attacks.
Pain intensity was not associated with restlessness, headache duration, age of onset, or chronicity.
Author’s Conclusions: “Cluster headache is an intensely painful disorder, even in the context of other disorders considered intensely painful. Maximal pain intensity is associated with more cranial autonomic features.”
Reviewer's Comments: Normally I avoid survey type papers because of the problems associated with getting accurate responses from subjects long after their experience with whatever symptom or illness is being surveyed. But this paper caught my attention for a couple of reasons. First, the fact that subjects rated their cluster headache pain as more severe than kidney stones, labor pains or pancreatitis all of which are extremely painful. I’ve never experienced a kidney stone (or labor pains for that matter), but I have had one bout of pancreatitis which ranks as my personal “10” and was about as much fun as I could stand. Second, I was not personally aware of the relationship between cluster headaches and the above mentioned cranial symptoms so I found it informative. The paper gave me a new level of empathy for just how badly the cluster headache patient may be suffering
Reviewer: Mark R. Payne DC
Reference: Mark J. Burish MD, PhD Stuart M. Pearson MA Robert E. Shapiro MD, PhD Wei Zhang PhD Larry I. Schor PhD Cluster headache is one of the most intensely painful human conditions: Results from the International Cluster Headache Questionnaire.- Headache Journal of Head and Face Pain. Dec. 2020
Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/33337540/
Link to Full Text: https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14021