Citation

Choong CK, Ford JH, Nyhuis AW, Joshi SG, Robinson RL, Aurora SK, Martinez JM. Headache 2017; 57(9): 1359-1374.

Copyright

(Copyright © 2017, American Headache Society; American Association for the Study of Headache, Publisher John Wiley and Sons)

DOI

10.1111/head.13127

PMID

28581025

PMCID

PMC5655925

Abstract

OBJECTIVE: To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH).
BACKGROUND: CH is an uncommon trigeminal autonomic cephalalgia with limited evidence-based treatment options. Patients suffer from extremely painful unilateral headache attacks and autonomic symptoms with episodic and chronic cycles.
DESIGN/METHODS: This retrospective analysis used insurance claims from Truven Health Analytics MarketScan® research databases from 2009 to 2014. Two cohorts were compared: CH patients (with ≥2 CH claims) were propensity score matched with 4 non-headache controls, all with continuous enrollment for 12 months before and after the date of first CH claim or matched period among controls.
RESULTS: CH patients (N = 7589) were mainly male (57.4%) and 35-64 years old (73.2%), with significantly more claims for comorbid conditions vs controls (N = 30,341), including depressive disorders (19.8% vs 10.0%), sleep disturbances (19.7% vs 9.1%), anxiety disorders (19.2% vs 8.7%), and tobacco use disorders (12.8% vs 5.3%), with 2.5 times greater odds of suicidal ideation (all P < .0001). Odds of drug dependence were 3-fold greater among CH patients (OR = 2.8 [95% CI 2.3-3.4, P < .0001]). CH patients reported significantly greater use of prescription medications compared with controls; 25% of CH patients had >12 unique prescription drug claims. Most commonly prescribed drug classes for CH patients included: opiate agonists (41%), corticosteroids (34%), 5HT-1 agonists (32%), antidepressants (31%), NSAIDs (29%), anticonvulsants (28%), calcium antagonists (27%), and benzodiazepines (22%). Only 30.4% of CH patients received recognized CH treatments without opioids during the 12-month post-index period. These patients were less likely to visit emergency departments or need hospitalizations (26.8%) as compared to CH patients with no pharmacy claims for recognized CH treatments or opioids (33.6%; P < .0001).
CONCLUSIONS: The burden of CH is associated with significant co-morbidity, including substance use disorders and suicidal ideation, and treatment patterns indicating low use of recognized CH treatments.

Language: en

Keywords

Humans; United States; Adult; Aged; Female; Male; Middle Aged; Adolescent; Retrospective Studies; Young Adult; Substance-Related Disorders; Comorbidity; Cohort Studies; Treatment Outcome; Suicidal Ideation; Databases, Factual; Analgesics, Opioid; cluster headache; clinical characteristics; Cluster Headache; Insurance Claim Review; Tryptamines; Administrative Claims, Healthcare; claims database; matched case-control study; treatment patterns