Aura in Cluster Headache: A Cross-Sectional Study

Ilse F. de Coo, MD; Leopoldine A. Wilbrink, MD; Gaby D. Ie, MD; Joost Haan, MD, PhD; Michel D. Ferrari, MD, PhD


Headache. 2018;58(8):1203-1210. 

In This Article

Material and Methods

Study Setting and Participants Selection. —This explorative cross-sectional study was conducted as part of the ongoing, nation wide, Leiden University Cluster Headache neuroanalysis program (LUCA).[10] There have been earlier reports based on the LUCA program including the results of studies on allodynia.[11–14] In one smaller study, the results of an interview by phone regarding aura symptoms were reported (in Dutch).[13] Although the results did not differ substantially with this study, the 2 studies cannot be compared completely as the previous study was smaller and did not use this aura questionnaire.

The LUCA website is heavily promoted throughout the Netherlands through professional contacts and various local lay and medical media to attract as many potential participants as possible. In addition, participants attending the LUMC and other headache clinics are invited as well to participate in the LUCA study.

For the LUCA study, persons of 18 years or older who are living in the Netherlands and who believe they have cluster headache, either confirmed or not by a physician, were invited to fill in a validated, web-based, screening questionnaire for cluster headache. The questionnaire is based on the ICHD-II criteria[15] and has a diagnostic specificity of 0.89 for cluster headache.[10] More details about the validation of this screening methods can be found in the report of Wilbrink et al.[10] In the Netherlands, the Dutch General Practitioners Guidelines recommend referral to a neurologist when one is suspecting cluster headache, for diagnosis and start of cluster headache treatment.[16] Therefore virtually all participants received a diagnosis by a neurologist. All people who screened positive received a second, more extensive web-based questionnaire, which is based on the ICHD-II. As known, all participants fulfilling the ICHD-II criteria fulfill also to the ICHD-III beta version for cluster headache.[1,11]

For this aura study, subjects diagnosed with cluster headache as described above received an email asking them to fill in an additional validated questionnaire about aura symptoms, which was previously found to have a positive predictive value of 88% and a negative predictive value of 70%.[17] The questionnaire contains questions regarding the presence, duration and clinical characteristics of visual, sensory, aphasic, and dysarthric aura symptoms preceding or during cluster headache attacks. In addition, it contains questions about (comorbid) migraine. Those who did not respond to the initial email were reminded twice per email and when still not responding, they were contacted 2 more times (once by regular mail and finally once by telephone). All participants who screened positive for aura like symptoms were contacted by telephone for confirmation of the ICHD-III criteria for typical aura with headache for their cluster headache attacks, which took about 30 minutes per participant. In addition, they were asked about having migraine (with or without aura) according to the ICHD-III criteria.

Only participants who had filled in all items and were available for a telephone interview (when screened positive for aura like symptom) were included.

The study was approved by the local medical ethical committee of Leiden University Medical Centre and all participants provided written informed consent.

Statistics.—No power analysis was performed for this cross-sectional study. Comparisons between attack characteristics was made using a Mann Whitney test for ordinal data, a chi-square test for nominal data, and an independent T test for interval data (2-tailed). No adjustments were made for multiple comparisons. Analyses were performed using SPSS 20.0 (SPSS Inc., IBM, Armonk, NY, USA). Statistical significance was set at P < .05.