Study Identifies Sex Differences and Attack Patterns in Cluster Headache Patients

In a cross-sectional study of 104 patients diagnosed with cluster headache at a specialized headache clinic in China, female patients exhibited significantly higher rates of depression, anxiety, and sleep disorders than male patients, along with distinct differences in attack laterality.

The investigation evaluated 135 patients with suspected cluster headache who first presented for headache attacks to the headache outpatient clinic at the Central Hospital of Dalian University of Technology, also designated Dalian Municipal Central Hospital, between January 2021 and March 2026. After excluding 31 patients who did not meet eligibility criteria due to secondary headache or incomplete clinical data, the research team analyzed the remaining 104 patients.

All 104 enrolled patients completed follow-up monitoring. The cohort demonstrated a male-to-female ratio of 4.2 to 1, comprising 84 men and 20 women. Regarding diagnostic classification, episodic cluster headache was established in 97.11 percent of the participants.

Psychological and sleep-related comorbidities differed significantly between sexes. Depression and anxiety were both significantly more prevalent among female patients than among male patients, with a p-value of 0.004 recorded for each condition. Sleep disorders also occurred at a significantly higher rate in women than in men, affecting 70.00 percent of female patients compared with 42.86 percent of male patients, with a p-value of 0.029.

The laterality of headache attacks revealed marked variation between male and female participants. Among male patients, right-sided attacks were the most common presentation, occurring in 64.29 percent of men, or 54 out of 84 individuals. Among female patients, left-sided attacks predominated, observed in 70 percent of women, or 14 out of 20 individuals. Alternating bilateral attacks were documented exclusively in four female patients, representing 20 percent of the women in the study.

A circadian pattern of attacks was identified in 82.69 percent of all patients, with the afternoon hours between 12:00 and 17:00 representing the predominant time of attack onset. A total of 7.69 percent of the cohort, or eight patients, experienced no autonomic symptoms during their attacks.

Among the eight patients who lacked autonomic symptoms, accompanying clinical features consisted of agitation with nausea, agitation with phonophobia or photophobia, or agitation presenting alone. The authors concluded that the analysis of clinical characteristics, comorbidity patterns, and attack features in the Dalian region provides insights to enhance physician awareness, reduce misdiagnosis, shorten time to diagnosis, and guide sex-specific clinical management strategies.

Subject of Research: Clinical characteristics and sex-specific patterns of cluster headache

Article Title: Clinical characteristics of 104 patients with cluster headache: a single-center cross-sectional study

Article References: Li, F., Pan, X., Sui, X., Tao, J., Liu, S., Zhang, Y., Dong, W., & Zhao, H. (2026). Clinical characteristics of 104 patients with cluster headache: a single-center cross-sectional study. Frontiers in Neurology, 17, Article 1993055. https://doi.org/10.3389/fneur.2026.1993055

Image Credits: AI Generated

DOI: 10.3389/fneur.2026.1993055

Keywords: cluster headache, neurology, headache disorders, sex differences, sleep disorders, psychiatric comorbidity, circadian rhythm, cross-sectional study, Clinical, characteristics, patients, cluster