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 ParkChin Sang Chung, Soo Jin Cho

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish
Article number827734
JournalFrontiers in Neurology
StatePublished - 10 Feb 2022

Bibliographical note

Funding Information:
Conflict of Interest: SJC was involved as a site investigator of multicenter trial sponsored Otsuka Korea, Allergan, Ildong Pharmaceutical Co., Ltd., Novartis International AG, Eli Lilly and Company, Hyundaipharm. Co. Ltd., Biohaven Asia Pacific Ltd., H. Lundbeck A/S (Lundbeck), and Parexel Korea Co., Ltd., and received lecture honoraria from Allergan Korea, WhanIn Pharm Co., Ltd., Shinpoong Pharma. Co., Ltd., and SK chemicals in the past 24 months. MC was a site investigator for a multicenter trial sponsored by Otsuka Korea, Novartis International AG, and Eli Lilly and Company. He worked as an advisory member for Teva and has received lecture honoraria from Allergan Korea, Handok-Teva, and Yuyu Pharmaceutical Company in the past 24 months. He received grants from the Yonsei University College of Medicine and the National Research Foundation of Korea (2019R1F1A1053841).

Publisher Copyright:
Copyright © 2022 Kim, Chung, Kim, Lee, Chu, Ahn, Bae, Song, Sohn, Oh, Kim, Kim, Park, Chung, Moon, Cho, Seo, Kim, Choi, Park, Chung and Cho.


  • Korea
  • cluster headache
  • delayed diagnosis
  • headache
  • primary headache disorder


Dive into the research topics of 'Diagnostic Delay and Its Predictors in Cluster Headache'. Together they form a unique fingerprint.

Cite this