New insights in post-traumatic headache with cluster headache phenotype: a cohort study

Objectives To define the characteristics of post-traumatic headache with cluster headache phenotype (PTH-CH) and to compare these characteristics with primary CH. Methods A retrospective study was conducted of patients seen between 2007 and 2017 in a headache centre and diagnosed with PTH-CH that developed within 7 days of head trauma. A control cohort included 553 patients with primary CH without any history of trauma who attended the headache clinic during the same period. Data including demographics, attack characteristics and response to treatments were recorded. Results Twenty-six patients with PTH-CH were identified. Multivariate analysis revealed significant associations between PTH-CH and family history of CH (OR 3.32, 95%CI 1.31 to 8.63), chronic form (OR 3.29, 95%CI 1.70 to 6.49), parietal (OR 14.82, 95%CI 6.32 to 37.39) or temporal (OR 2.04, 95%CI 1.10 to 3.84) location of pain, and presence of prominent cranial autonomic features during attacks (miosis OR 11.24, 95%CI 3.21 to 41.34; eyelid oedema OR 5.79, 95%CI 2.57 to 13.82; rhinorrhoea OR 2.65, 95%CI 1.26 to 5.86; facial sweating OR 2.53, 95%CI 1.33 to 4.93). Patients with PTH-CH were at a higher risk of being intractable to acute (OR 12.34, 95%CI 2.51 to 64.73) and preventive (OR 16.98, 95%CI 6.88 to 45.52) treatments and of suffering from associated chronic migraine (OR 10.35, 95%CI 3.96 to 28.82). Conclusion This largest series of PTH-CH defines it as a unique entity with specific evolutive profile. Patients with PTH-CH are more likely to suffer from the chronic variant, have marked autonomic features, be intractable to treatment and have associated chronic migraine compared with primary CH.