Chronic cluster headache (CCH) may be more common and severe in women than men, according to a study of 874 people with cluster headaches between 17 and 83 years of age.

Of those with cluster headache, 34.2 per cent were women and 65.8 per cent were men with an average age of 50.5 years. Doctors diagnosed 18.4 per cent of women and 9.4 per cent of men with the condition’s chronic form. 

Attacks lasted longer in women: 8.0 per cent said that clusters lasted, on average, four to seven months, compared with 5.2 per cent of men. Only 26.0 and 29.8 per cent of women and men respectively said that clusters lasted, on average, less than one month. 

Women experienced ptosis (60.5 and 47.0 per cent respectively) and restlessness (53.9 and 45.6 per cent respectively) more often than men, were more likely to have a first- or second-degree family member with a history of cluster headache (15.4 and 7.1 per cent respectively) and use prophylactic treatment (60.2 and 47.7 per cent respectively). 

Lack of sleep triggered attacks more commonly in women than men (30.4 and 19.7 per cent respectively). Men reported that alcohol triggered headaches more often than women (54.4 and 47.5 per cent respectively). Fewer males than females self-reported migraine (12.5 and 29.4 per cent respectively) and tension-type headache (43.1 and 55.9 per cent respectively). 

“Cluster headache is still often misdiagnosed in women, perhaps because some aspects can be similar to migraine,” said study author Dr Andrea Belin of the Karolinska Institute, Stockholm. 

“While the ratio of men to women with cluster headache has been shifting over the years, it is still considered mainly a disorder of men, making it more difficult for women with milder symptoms to be diagnosed. It is possible this could contribute to the higher rate of chronic cluster headache in women.” (Neurology DOI: 10.1212/WNL.0000000000201688)