Cluster Headache: Worse in Female Patients

In the current issue of Neurology®, Fourier et al.1 published one of the most comprehensive studies of sex differences in cluster headache; they confirmed previous epidemiologic suspicions, provided new insights, and raised important questions into sex hormones and the influence of genetic factors. The authors surveyed 874 participants who were diagnosed with cluster headache by neurologists using the criteria of the International Classification of Headache Disorders (ICHD)-3.2 Approximately half were personally assessed by study authors, while the other half were identified through International Classification of Diseases 10 (ICD10) codes and had their charts reviewed by a study neurologist applying ICHD-3 criteria. Participants then completed a questionnaire that included demographics, headache features, and treatments. This questionnaire provided information on prevalence (higher in male participants), incidence (peaks between 20- and 29-year-olds), family aggregation (more common in female participants), and burden of disease (worse in female participants).