Characteristics of pre-cluster symptoms in cluster headache: A cross-sectional multicentre study

Soohyun Cho, Soo Jin Cho, Mi Ji Lee, Jeong Wook Park, Min Kyung Chu, Heui Soo Moon, Pil Wook Chung, Jong Hee Sohn, Byung Su Kim, Daeyoung Kim, Jae Moon Kim, Jae Myun Chung, Kyungmi Oh, Jin Young Ahn, Young Eun Gil, Chin Sang Chung, Byung Kun Kim

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Contrary to pre-attack symptoms before an individual cluster headache attack, little is known about the pre-cluster symptoms before the onset of cluster bouts. We previously described pre-attack symptoms before cluster headache attacks. The aim of this study was to investigate characteristics of pre-cluster symptoms in patients with episodic cluster headache. Methods: In this multicentre study, 184 patients with episodic cluster headache were recruited between October 2018 and December 2020. They were interviewed by investigators and completed a structured questionnaire. To investigate pre-cluster and pre-attack symptoms, we assessed 20 symptoms and signs using the questionnaire. Results: The upcoming cluster bout was predictable in 35.3% (n = 65/184) of the patients. When present, pre-cluster symptoms occurred at a median duration of 7 days (interquartile range, 2.3–14 days) before the onset of the cluster bout. Patients with pre-cluster symptoms showed a higher proportion of women, prevalence of pre-attack symptoms and seasonal rhythmicity, frequency of cluster headache attacks per day, and total number of cluster bouts compared to patients without pre-cluster symptoms. In univariable and multivariable logistic regression analyses, female sex was associated with the predictability of pre-cluster symptoms (odds ratio = 2.297, p = 0.016). Conclusions: The upcoming cluster bout was predicted in approximately 35% of patients with episodic cluster headache, which may allow for an earlier preventive treatment and help understand the pathophysiology.

Original languageEnglish
Pages (from-to)570-578
Number of pages9
Issue number7
StatePublished - Jun 2022
Externally publishedYes


  • Trigeminal autonomic cephalalgia
  • cluster headache
  • pre-cluster symptoms


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