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Abstract

Objective:

As cluster headache (CH) is often referred to as “suicide headache,” we wanted to assess the prevalence of depression in CH patients, and to investigate determinants of depression such as sleep disturbances.

Methods:

In a cross-sectional, web-based, validated questionnaire study among 462 well-defined CH patients and 177 controls, we diagnosed CH according to the ICHD-III. We assessed depression using the Hospital Anxiety and Depression Scale (HADS-D) and the Center for Epidemiologic Studies Depression scale (CES-D) with supplementary questions to assess lifetime depression. Data were analyzed with logistic and linear regression models.

Results:

Lifetime depression showed almost 3 times higher odds in CH patients (n = 462) than controls (n = 177) (odds ratio 2.77; 95% confidence interval 1.70–4.51). Chronic (n = 67) vs episodic (n = 394) patients had a higher prevalence of lifetime depression and more sleeping problems. Current depression was associated with having active attacks (last attack <1 month) (adjusted p = 0.02), but no effect remained after correction for sleep disturbances.

Conclusions:

CH is associated with an almost 3 times increased odds of lifetime depression. Current depression is highly prevalent in patients with active disease, in part related to sleep disturbances due to current nocturnal attacks.

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Supplementary Material

File (supplementary_tables_and_figures.pdf)

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Letters to the Editor
14 November 2016
Depression risk in patients with cluster headache
Karel Kostev, Senior Manager Epidemiology Research

In the population-based cohort study by Louter et al., patients with cluster headache (CH) had odds three times higher for depression than controls. [1] Our longitudinal data (2005-2014) from a large database in Germany (IMS Disease Analyzer Germany) confirmed these results for German patients with CH. [2] Patients initially diagnosed with CH were identified; 3,103 patients were included and matched (1:1) to 3,103 controls without CH based on age, sex, and follow-up duration after the index date. During a mean follow-up of 4.8 years, 27.2% of patients with CH and 8.5% of controls were diagnosed with depression for the first time. The hazard ratio (Cox regression analysis) was 3.46 (95% CI 2.98-4.11; p<0.001) for CH. In line with other results, [1] our primary care data showed that patients with CH have three times higher risk for depression compared to patients without CH. We agree with Louter et al. that the detection of depression in patients with CH is very important, allowing antidepressant therapy to begin.

1. Louter MA, Wilbrink LA, Haan J, et al. Cluster headache and depression. Neurology 2016;87:1899-1906.

2. Becher H, Kostev K, Schroder-Bernhardi D. Validity and representativeness of the "Disease Analyzer" patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther 2009;47:617-626.

For disclosures, please contact the editorial office at [email protected].

Information & Authors

Information

Published In

Neurology®
Volume 87Number 18November 1, 2016
Pages: 1899-1906
PubMed: 27694264

Publication History

Received: March 4, 2016
Accepted: July 18, 2016
Published online: September 30, 2016
Published in print: November 1, 2016

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Disclosure

M. Louter, L. Wilbrink, J. Haan, E. van Zwet, W. van Oosterhout, and F. Zitman report no disclosures relevant to the manuscript. M. Ferrari reports grants and consultancy or industry support from Medtronic and independent support from the Netherlands Organisation for Scientific Research (NWO), NIH, European Community, and the Dutch Heart Foundation. G. Terwindt reports independent support from Netherlands Organisation for Scientific Research (NWO), European Community, the Dutch Heart Foundation, and the Dutch Brain Foundation. Go to Neurology.org for full disclosures.

Study Funding

This work was supported by grants of the Netherlands Organization for Scientific Research (NWO) (VIDI 91711319, G.M.T.) and the European Community (EC) (FP7-EUROHEADPAIN, no. 602633). They had no role in the design or conduct of the study.

Authors

Affiliations & Disclosures

Mark A. Louter, MD*
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
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1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Leopoldine A. Wilbrink, MD*
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
NONE
Legal Proceedings:
1.
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Joost Haan, MD, PhD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
J Head Pain
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
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1.
NONE
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1.
NONE
Legal Proceedings:
1.
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Erik W. van Zwet, PhD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Statistica Neerlandicaco-editor2015-present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
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1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Willebrordus P.J. van Oosterhout, MD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Frans G. Zitman, MD, PhD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Depression Research and Treatment, member editoriaal board, 2012 (?)-2014,
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Michel D. Ferrari, MD, PhD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Cephalalgia, associate editor
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) Medtronic
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Netherlands Organization for Scientific Research (NWO)(2) European Community(3) ZonMW
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Dutch Heart Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Gisela M. Terwindt, MD, PhD
From the Departments of Neurology (M.A.L., L.A.W., J.H., W.P.J.v.O., M.D.F., G.M.T.), Psychiatry (M.A.L., F.G.Z.), and Biostatistics (E.W.v.Z.), Leiden University Medical Centre; Department of Neurosurgery (L.A.W.), Maastricht University Medical Centre; and Department of Neurology (J.H.), Alrijne Hospital, Leiderdorp, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Supported by grants of the Netherlands Organisation for Scientific Research (NWO) (GMT Vidi 917-11-319), and FP7-EUROHEADPAIN-no.602633
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Terwindt: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
These authors contributed equally to this work as first authors.
These authors contributed equally to this work as last authors.

Author Contributions

M.A. Louter is principal investigator and contributed to design and conceptualization of the study, data collection, analysis and interpretation, as well as writing the first draft of the manuscript and revising. L.A. Wilbrink contributed to design and conceptualization of the study, data collection, analysis and interpretation, as well as writing the first draft of the manuscript together with M.A.L. and revising. J. Haan contributed to design and conceptualization of the study, as well as revising the first draft of the manuscript. E.W. van Zwet contributed to analysis and interpretation of the data. W.P.J. van Oosterhout contributed to data collection, as well as revising the manuscript for intellectual content. F.G. Zitman contributed to design and conceptualization of the study. M.D. Ferrari contributed to design and conceptualization of the study, interpretation of the data, as well as revising the manuscript for intellectual content. G.M. Terwindt contributed to design and conceptualization of the study, interpretation of the data, as well as revising the manuscript for intellectual content.

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