@article{ref1,
title="Pain and behaviour in cluster headache. A prospective study and review of the literature",
journal="Functional neurology",
year="2003",
author="Torelli, Paola and Manzoni, Gian Camillo",
volume="18",
number="4",
pages="205-210",
abstract="Cluster headache (CH) has also been called &quot;suicide headache&quot; on account of the extremely severe pain that characterizes its attacks. It is indeed well known that CH sufferers exhibit peculiar behaviours during attacks. The purposes of our study were: i) to investigate prospectively prodromes and clinical pain features and behaviour of patients during typical, spontaneous attacks of CH defined according to the International Headache Society classification criteria; and ii) to investigate retrospectively the premonitory signs and symptoms preceding onset of the cluster period. Forty-two episodic CH patients consecutively referred to the University of Parma Headache Centre were asked to fill in a questionnaire soon after a &quot;typical&quot; CH attack. In the questionnaires, the patients were requested: a) to describe in their own words the type of pain experienced during the attack; b) to rate peak pain intensity on a visual analogue scale (VAS); c) to indicate the time elapsing between headache onset and peak pain intensity; d) to report the signs and symptoms preceding the attack (prodromes), choosing them from a 65-item list; and, e) to describe in their own words their behaviour during the attack. Each patient was also requested to report any signs and/or symptoms preceding onset of the cluster period (premonitory symptoms). Data analysis showed that the clinical features of pain were very complex and varied widely among patients. In 85.7% of cases, patients rated their peak pain intensity (reached on average within 8.9 minutes of attack onset) at between 8 and 10 on the VAS. Most (88.1%) exhibited typical signs of pyschomotor agitation (restlessness) during the attack. Prodromes were reported by almost all the patients in our sample (97.6%), and premonitory symptoms by only 40.5%. The results of our study suggest: i) that the pain in CH cannot be described either as vascular- or as neuralgic-type; ii) that a traditional three-item scale (mild, moderate, severe) does not allow adequate categorization of pain intensity, and should be replaced by the VAS in order to reflect a broader spectrum of pain intensity; iii) that restlessness during attacks is so frequent that it should become a CH diagnostic criterion; and, iv) that prompt and accurate reporting of prodromes and/or premonitory symptoms could be helpful in establishing early treatment.<p /><p>Language: en</p>",
language="en",
issn="0393-5264",
doi="",
url="http://dx.doi.org/"
}