The neuropsychology of cluster headache: cognition, mood, disability, and quality of life of patients with chronic and episodic cluster headache

Abstract

Background: Cluster headache (CH) is commonly regarded as one of the most disabling headache conditions, and referred to as one of the most painful conditions known to humankind. Although there has been some research indicating the severe impact of CH, there is little comprehensive evidence of its impact on quality of life, disability, mood, and cognitive function in both its episodic (ECH) and chronic (CCH) variants.

Methods: This cross-sectional study investigates various aspects of cognitive function including intelligence, executive function, and memory, and mood, disability, and quality of life in 22 patients with ECH and CCH compared with age-matched healthy controls.

Results: The results showed that intelligence and executive functions are intact in patients with CH, but that patients with CH perform significantly worse than healthy controls on tests of working memory and (all P < .05) report greater cognitive failures (P < .05). Around one third of both the ECH and CCH groups achieved "caseness" for depression, while self-reported anxiety was higher in those with CCH than the ECH patients, with 75% of the former compared with 38% of the latter groups achieving "caseness" on the measure of anxiety. Patients with CH reported high levels of disability, which was not significantly different between the 2 groups (P > .05). The patients with CH reported poor quality of life compared with healthy controls; however, this difference was not statistically significant.

Conclusion: Patients with CH show worse working memory, disturbance of mood, and poorer quality of life compared with healthy controls. The differences between patients with ECH and CCH, and the implications of these findings for the management of CH are discussed.

Keywords: chronic cluster headache; cognition; disability; episodic cluster headache; mood; quality of life.

Figure 1

Means and standard errors for patients with episodic and chronic cluster headache and healthy controls on 2 subtests of the Trail Making Test. HCs = healthy controls; ECH = episodic cluster headache; CCH = chronic cluster headache.

Figure 2

Mean and standard error for patients with episodic and chronic cluster headache and healthy controls on tests assessing memory. (a) WAIS-III Working Memory Index subtests; (b) Warrington Short Recognition Memory for Faces; (c) Cognitive Failures Questionnaire. HCs = healthy controls; ECH = episodic cluster headache; CCH = chronic cluster headache; WAIS-III = Wechsler Adult Intelligence Scale III; WMI = Working Memory Index.

Figure 3

Means and standard errors for (a) hopelessness (BHS), depression (BDI-II and HADS-D) and anxiety (HADS-A) and (b) quality of life for the patients with chronic or episodic cluster headache and healthy controls. BHS = Beck Hopelessness Scale; BDI-II = Beck Depression Inventory II; HADS-A = Hospital Anxiety and Depression Scale-Anxiety; HADS-D = Hospital Anxiety and Depression Scale-Depression; EQ5D = EuroQoL quality of life measure; ECH = episodic cluster headache; CCH = chronic cluster headache; CH = cluster headache; HCs = healthy controls.