Sex Differences in Cluster Headache: Insights from the Chinese Cluster Headache Register Individual Study (CHRIS)

Abstract

<title>Abstract</title> <bold>Background</bold> Sex differences in the clinical characteristics of cluster headache (CH) remain controversial in both Eastern and Western studies, and such differences have not been thoroughly investigated among Chinese patients. <bold>Methods</bold> This large-scale, multicenter cohort study included 1,206 patients from 31 provinces across China diagnosed with CH between May 2021 and December 2024, and was conducted within the framework of the Chinese Cluster Headache Register Individual Study. Demographic and clinical data were systematically collected from each participant using an electronic structured questionnaire, and compared all variables between sexes. <bold>Results</bold> In total, 1,206 patients were enrolled, with a female-to-male ratio of 1:3.94. Demographic analysis showed that women had an earlier mean age of onset, higher educational attainment, and fewer unhealthy lifestyle factors compared with men. Women were also more likely to have comorbid migraine (28.28% vs. 15.90%, P &lt; 0.001) and psychological conditions such as anxiety and depression, and to use oral rizatriptan for acute treatment (27.78% vs. 15.80%, P &lt; 0.001). With respect to cranial autonomic symptoms (CASs), women experienced eyelid edema (18.85% vs. 12.47%, P = 0.010) and ptosis (56.97% vs. 49.90%, P = 0.048) more frequently, and reported migraine-associated symptoms more often. Conversely, men more commonly presented with conjunctival hyperemia (56.03% vs. 38.52%, P &lt; 0.001), rhinorrhea (47.92% vs. 38.93%, P = 0.012), and facial sweating (38.15% vs. 30.74%, P = 0.032). Women had significantly higher frequencies of attacks during the early morning hours (2:00–8:00), whereas men experienced significantly more attacks during midday (10:00–14:00) and evening (16:00–20:00). <bold>Conclusion</bold> This study provides the first comprehensive analysis of multidimensional sex differences in Chinese patients with CH, encompassing social characteristics, clinical phenotypes, psychological burden, and circadian attack distribution. These findings offer valuable evidence for developing precision medicine approaches and sex-specific clinical management strategies for CH.

Affiliated Institutions

• First People's Hospital of Yunnan Province CN
• Chongqing Medical University CN
• Affiliated Hospital of Qingdao University CN
• Xiangya Hospital Central South University CN
• Xingtai People's Hospital CN
• First Affiliated Hospital of Wenzhou Medical University CN
• Chinese PLA General Hospital CN
• Southern Medical University CN
• Chengde Medical University CN
• Tongji Hospital CN
• Sun Yat-sen University CN
• Second Affiliated Hospital of Zhejiang University CN
• The Affiliated Yongchuan Hospital of Chongqing Medical University CN
• First Hospital of Shanxi Medical University CN
• Shandong Provincial Hospital CN
• First Affiliated Hospital of Soochow University CN
• Guizhou Provincial People's Hospital CN
• Nanfang Hospital CN
• Renmin Hospital of Wuhan University CN
• Wuhan University CN
• Lishui Central Hospital CN
• The First Affiliated Hospital, Sun Yat-sen University CN
• Sanya Central Hospital CN
• University of Science and Technology of China CN
• Command Hospital IN
• Central South University CN
• Qilu Hospital of Shandong University CN
• Hebei Medical University CN
• First Affiliated Hospital of Xiamen University CN
• Sun Yat-sen Memorial Hospital CN
• Soochow University CN
• Shandong First Medical University CN
• First Affiliated Hospital of Kunming Medical University CN
• Hebei General Hospital CN
• Huazhong University of Science and Technology CN
• Dalian Municipal Central Hospital CN
• Wuhan City Chinese Medicine Hospital CN
• Kunming Medical University CN
• Qingdao University CN
• Wenzhou Medical University CN

Related Publications