Diagnostic Delay and Its Predictors in Cluster Headache

Byung-Su Kim; Pil-Wook Chung; Byung-Kun Kim; Mi Ji Lee; Min Kyung Chu; Jin-Young Ahn; Dae Woong Bae; Tae-Jin Song; Jong-Hee Sohn; Kyungmi Oh; Daeyoung Kim; Jae-Moon Kim; Jeong Wook Park; Jae Myun Chung; Heui-Soo Moon; Soohyun Cho; Jong-Geun Seo; Soo-Kyoung Kim; Yun-Ju Choi; Kwang-Yeol Park; Chin-Sang Chung; Soo-Jin Cho

doi:10.3389/fneur.2022.827734

Diagnostic Delay and Its Predictors in Cluster Headache

Front Neurol. 2022 Feb 10:13:827734. doi: 10.3389/fneur.2022.827734. eCollection 2022.

Authors

Byung-Su Kim¹, Pil-Wook Chung², Byung-Kun Kim³, Mi Ji Lee⁴, Min Kyung Chu⁵, Jin-Young Ahn⁶, Dae Woong Bae⁷, Tae-Jin Song⁸, Jong-Hee Sohn⁹, Kyungmi Oh¹⁰, Daeyoung Kim¹¹, Jae-Moon Kim¹¹, Jeong Wook Park¹², Jae Myun Chung¹³, Heui-Soo Moon², Soohyun Cho¹⁴, Jong-Geun Seo¹⁵, Soo-Kyoung Kim¹⁶, Yun-Ju Choi¹⁷, Kwang-Yeol Park¹⁸, Chin-Sang Chung⁴, Soo-Jin Cho¹⁹

Affiliations

¹ Department of Neurology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, South Korea.
² Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
³ Department of Neurology, Eulji Hospital, Eulji University, Seoul, South Korea.
⁴ Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁵ Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁶ Department of Neurology, Seoul Medical Center, Seoul, South Korea.
⁷ Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
⁸ Department of Neurology, Seoul Hospital, Ewha Womans University, College of Medicine, Seoul, South Korea.
⁹ Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea.
¹⁰ Department of Neurology, Korea University College of Medicine, Seoul, South Korea.
¹¹ Department of Neurology, Chungnam National University College of Medicine, Daejeon, South Korea.
¹² Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, South Korea.
¹³ Department of Neurology, Inje University College of Medicine, Seoul, South Korea.
¹⁴ Department of Neurology, Eulji University, Uijeongbu, South Korea.
¹⁵ Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea.
¹⁶ Department of Neurology, Gyeongsang National University College of Medicine and Gyeonsang National University Hospital, Jinju, South Korea.
¹⁷ Dr. Choi's Neurology Clinic, Jeonju, South Korea.
¹⁸ Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea.
¹⁹ Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.

Abstract

Objective: Cluster headache (CH) is a rare, primary headache disorder, characterized of excruciating, strictly one-sided pain attacks and ipsilateral cranial autonomic symptoms. Given the debilitating nature of CH, delayed diagnosis can increase the disease burden. Thus, we aimed to investigate the diagnostic delay, its predictors, and clinical influence among patients with CH.

Methods: Data from a prospective multicenter CH registry over a 4-year period were analyzed. CH was diagnosed according to the International Classification of Headache Disorders (ICHD)-3 criteria, and diagnostic delay of CH was assessed as the time interval between the year of the first onset and the year of CH diagnosis. Patients were classified into three groups according to the tertiles of diagnostic delay (1st tertile, <1 year; 2nd tertile, 1-6 years; and 3rd tertile, ≥7 years).

Results: Overall, 445 patients were evaluated. The mean duration of diagnosis delay was 5.7 ± 6.7 years, (range, 0-36 years). Regarding the age of onset, majority of young patients (age <20 years) belonged to the third tertile (60%), whereas minority of old patients (>40 years) belonged to the third tertile (9.0%). For year of onset, the proportion of patients in the 3rd tertile was the highest for the groups before the publication year of the ICHD-2 (74.7%) and the lowest for the groups after the publication year of the ICHD-3 beta version (0.5%). Compared with the first CH, episodic CH [multivariable-adjusted odds ratio (aOR) = 5.91, 95% CI = 2.42-14.48], chronic CH (aOR = 8.87, 95% CI = 2.66-29.51), and probable CH (aOR = 4.12, 95% CI = 1.48-11.43) were associated with the tertiles of diagnostic delay. Age of onset (aOR = 0.97, 95% CI = 0.95-0.99) and PHQ-9 score (aOR = 0.96, 95% CI = 0.93-0.99) were inversely associated with the tertile of diagnostic delay. The prevalence of suicidal ideation was highest in the patients of the third tertile. The mean HIT-6 score increased significantly with the diagnostic delay (p = 0.041).

Conclusions: Patients with a younger onset of CH have a higher risk of diagnostic delay. Nevertheless, the rate of delayed diagnosis gradually improved over time and with the publication of the ICHD criteria, supporting the clinical significance of diagnostic clinical criteria and headache education to reduce the disease burden of CH.

Keywords: Korea; cluster headache; delayed diagnosis; headache; primary headache disorder.