Cluster headaches, sleep disturbance, and depression

According to large epidemiological studies, migraine sufferers are 2-3 times more likely to develop depression, anxiety and other psychiatric disorders than those without migraines. And it is a bidirectional relationship, meaning that those with depression are 2-3 times more likely to develop migraines than those without depression. Cluster headaches, which have at times been referred to as “suicide headaches,” have been suspected to be also associated with depression. Until now, no similar large studies have been conducted in patients with cluster headaches in part because cluster headaches are much less common than migraines.

In a study just published in the journal Neurology, a group of Dutch physicians studied 462 patients with cluster headaches and compared them to 177 control subjects. They evaluated these patients for history of depression during their lifetime, current depression in the midst of a cluster period, and because many cluster attacks occur in sleep, they also looked for sleep disturbances. The results showed that depression was 3 times more likely to occur patients with cluster headaches than in healthy controls. Those with chronic cluster headaches had a higher risk of depression and sleep problems than patients with episodic cluster headaches. Current depression was associated with having active attacks within the preceding month, but this association was only present if the patient also had a sleep disturbance.

The authors concluded that cluster headache patients are three times more likely to develop depression in their life time. However, current depression was in part related to sleep disturbances due to ongoing nocturnal cluster attacks.