Cluster headache patients often suffer long delays in achieving a correct diagnosis and hence appropriate treatment for an agonising and debilitating condition. The perception of a typical cluster headache sufferer is one of a male, with bouts occurring in an episodic fashion. In recent years this has been challenged by data mainly from tertiary referral headache centres. I collected information on cluster headache patients attending a District General Hospital headache clinic over 10 years. 167 patients meeting International Headache Society criteria for cluster headache were identified, 127 episodic (94 male, 33 female), 30 chronic (23 men, 7 women), an additional 2 men transformed from chronic to episodic and 5 from episodic to chronic (3 unclassified). Overall sex ratio male:female 3.2. Mean age at onset 32 years for both men and women for episodic cluster headache, 36 years for men and 40 yearrs for women with chronic cluster headache.
This data concords with previous studies from tertiary centres to emphasise a narrowing of the gender difference in cluster headache patients and a trend towards an older age of onset for chronic headache sufferers, particularly women. A change in perception of the stereotypical patient may increase confidence in diagnosis and treatment.