Cluster headaches are more often misdiagnosed in women

Cluster headaches are much less common than migraines (less than a million vs 36 million sufferers), but are arguably the most painful type of headaches a man can experience. And it is usually a man because cluster headaches are thought to be 3-5 times more common in men. However, a study just published in Neurology suggests that the ratio of men to women is closer to 2:1.

This study by Danish researchers also established that women suffering from cluster headaches are more often misdiagnosed than men – 61% vs 46%. Consequently, it takes a year longer for a woman to be diagnosed than for a man – 6.5 years vs 5.5 years. But considering how devastating these headaches can be, these numbers are terrible for both sexes.

Cluster headaches get their name from the fact that they occur in clusters – daily or more frequent attacks lasting one to three hours for a period of a month or two, each year and often at the same time of year. One surprising finding of the study is that women are more likely to have chronic cluster headaches (no break from attacks for more than a month) – 44% vs 32%.

The reason for such high rates of misdiagnosis and long delays in diagnosing cluster headaches is that it is a relatively rare type of headaches and that it is easy to mistake cluster for a migraine or a sinus headache. Cluster headache is always one-sided and centers in the eye, which is common with migraines. It is usually accompanied by a runny nose (and tearing with redness of the eye) as occurs with a sinus headache.

But cluster headaches also have very distinctive features that should make the diagnosis easy, if only doctors asked a few questions. I’ve had a fair number of patients who diagnosed themselves after being misdiagnosed by doctors. During a cluster attack patients tend to be restless, pacing around, hitting their fist or even their head against walls, and sometimes screaming from pain, while migraine sufferers tend to stay very quiet since every movement, sound, and light worsen the pain. The fact that these occur every night for an hour or two and then resolve on their own is also a telltale sign. Migraine pain lasts for at least 4 hours and often for a couple of days without a break. Sinus headaches do not come and go and are easy to rule out by a CAT scan, a standard equipment in every emergency room and cluster sufferers do often end up in an ER.

Fortunately, once the correct diagnosis is made, cluster headaches can be treated very effectively in most patients. Some of the treatments overlap with migraines, such as sumatriptan injections, magnesium infusions, occipital nerve blocks, and Botox injections, but other help only cluster headaches. These include a 10-day high-dose course of steroids, oxygen inhalation, high-dose verapamil, lithium, and other.