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How different are cluster headaches in women? Image credit: Ana Luz Crespi/Stocksy.
  • Cluster headaches affect more men than women. However, the gap in diagnosis is narrowing.
  • It is a severely painful condition that can prove debilitating to people affected.
  • Researchers have been aware of the differences between the sexes in the symptoms and triggers for the condition.
  • A recent study of a Swedish cohort has quantified some of these differences.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Cluster headaches affect about one in 1,000 people and typically, the condition impacts more men than women. The pain associated with this condition is so severe that it can be seriously limiting and disabling.

A recent study has shown that while the majority of people with the condition are male, females are more likely to have a more severe form of the condition.

The results published in Neurology, show that not only are females more likely to have a chronic form of the condition, but they are more likely to have certain symptoms than males and have different triggers.

Dr. Andrea Carmine Belin, a neuroscientist at Karolinska Institutet in Stockholm, Sweden led the study and told Medical News Today in an interview:

“[Patients] come to a neurologist with all the symptoms of cluster headache, but still, the neurologist says, oh, no, you can’t [have them] if you’re a woman. And that’s sort of why we did this study, because we know there are women with cluster [headaches].”

While the study did not ask females who had cluster headaches if they had previously been diagnosed with migraine, it was possible that underdiagnosis of females with cluster headaches happens, she said, as they might be wrongly diagnosed with migraine instead.

To look at the sex differences in the way cluster headaches present, researchers looked for individuals with cluster headaches from medical records requested from hospitals and neurology departments for the period 2014–2020.

They identified a total of 874 study participants of whom 66% were male and 34% were female.

Participants received a questionnaire containing questions about background personal and medical information, symptoms experienced, including pain intensity and lifestyle.

The analysis of the responses to questionnaires showed that while most people with cluster headaches were male, just 9% of them had the chronic rather than episodic version of the condition, compared to 18% of females with cluster headaches.

Symptoms were also different. Females reported longer periods of pain from headaches, an increased prevalence of eyelid drooping, restlessness, and a link between the timing of headaches to a certain time of day.

Twice as many females (15%) had a family history of cluster headaches, confirming previous findings, as males (7%). “One hypothesis is that women tend to know more about their family history,” explained Dr. Carmine Belin.

Triggers also differed, as alcohol was more likely to be a trigger for cluster headaches in males than females — 54% versus 48% — whereas lack of sleep was more likely to be a trigger for females than males: 31% versus 20%.

The possibility that males and females have different presentations of cluster headaches has been investigated since 2007, said Dr. Parisa Gazerani from Aalborg Universitat, Copenhagen, Denmark, who was not involved in the study.

“As far as I am aware, historically, more than 40 years ago, cluster headache was described as [a] male-dominant primary headache,” she told MNT in an email. “However, over [the] years this clinical manifestation showed changes in the ratio between the genders with a change towards lower men: women ratio.”

“The reason is not clear but has been proposed to be related to hormones, lifestyle, and an increase in awareness of women about this headache,” added Dr. Gazerani.

The authors of the study suggest that understanding the differences in the way in which the disease presents in men and women could influence treatment options.

Dr. Gazerani said insight into these differences could help to elucidate the mechanism behind the disease and help doctors to know how to treat the disorder better.

Dr. Carmine Belin said the team had a number of plans for further research to clarify what could be behind these results. For example, while she thought the effect observed would be seen globally, the current results were for a cohort from Sweden, so they could not be extrapolated.

Seeing if the results could be reproduced in different regions was a potential further step for research.

“When it comes to treatment, both in migraine and cluster headaches, it’s only like 75% [of people] that respond well to this treatment and why is that? And this is different between men and women,” said Dr. Carmine Belin.

“We’re very interested in the genetics, so we also want to explore the genetic link to the response to [treatment] better or worse, and if it’s different between men and women, of course,” she told us.