Restlessness in cluster headache: unveiling the role of its key associations and clinical implications from a cohort study.
5 affiliations
- 1Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
- 2Department of Neurology, Acibadem University School of Medicine, Istanbul, Türkiye.
- 3Department of Neurology, Burhan Nalbantoğlu State Hospital, Nicosia, Cyprus.
- 4NOROM Neuroscience and Excellence Center, Ankara, Türkiye.
- 5Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, Türkiye.
Abstract
Background
ICHD-3 recognizes restlessness/agitation as an accompanying feature of cluster headache (CH). However, its phenotypic significance within CH remains uncertain. We compared patients with CH with (CHwR) and without restlessness (CHwoR) to characterize the clinical features and symptom burden associated with restlessness.Methods
We conducted a cross-sectional cohort study of Turkish patients with CH (n = 318) across tertiary neurology clinics, using a standardized clinician-administered questionnaire. We compared patients with CHwR versus CHwoR across clinical domains, applied multivariable logistic regression to identify independent correlates, and used Partitioning Around Medoids clustering (six pre-specified variables) to explore data-driven profiles.Results
There were no patients diagnosed with restlessness alone, without any autonomic symptoms. Restlessness co-occurred with cranial autonomic symptoms-particularly eyelid ptosis and sweating-and also with photophobia, nausea and vomiting. Independent correlates were photophobia (OR 2.91; 95% CI 1.65-5.14), sweating (1.96; 1.04-3.71), and eyelid ptosis (1.75, 1.01-3.03). Workplace burden tended to be greater in CHwR (work-day loss median 10 vs. 5 days; work-life impact 84.1% vs. 73.4%), with higher work-life impact and a borderline difference in work-day loss. Exploratory clustering showed a graded pattern of restlessness, highest in the earlier-onset/high-burden profile.Conclusion
In this tertiary-care cohort, restlessness was associated with a broader, symptom-rich CH phenotype characterized by both cranial autonomic and migrainous features and greater clinical burden. As no migraine comparison group was included, its diagnostic discriminatory value cannot be directly assessed. These findings suggest that restlessness may be better interpreted in the context of the overall CH phenotype rather than as an isolated diagnostic feature.
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BibTeX
@article{hacılar2026restlessness,
title = {{Restlessness in cluster headache: unveiling the role of its key associations and clinical implications from a cohort study.}},
author = {Edis Hacılar and Pınar Yalınay Dikmen and Esme Ekizoğlu and Elif Ilgaz Aydınlar and Elif Kocasoy Orhan and Ferda Selçuk and Aynur Özge and Ayşenur Şahin and Tuba Erdogan Soyukibar and Bahar Taşdelen and Mustafa Ertaş and Betül Baykan},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1946721},
url = {https://europepmc.org/article/MED/42898184},
note = {CC BY},
}
RIS
TY - JOUR
TI - Restlessness in cluster headache: unveiling the role of its key associations and clinical implications from a cohort study.
AU - Edis Hacılar
AU - Pınar Yalınay Dikmen
AU - Esme Ekizoğlu
AU - Elif Ilgaz Aydınlar
AU - Elif Kocasoy Orhan
AU - Ferda Selçuk
AU - Aynur Özge
AU - Ayşenur Şahin
AU - Tuba Erdogan Soyukibar
AU - Bahar Taşdelen
AU - Mustafa Ertaş
AU - Betül Baykan
PY - 2026
DA - 2026/10/05
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1946721
UR - https://europepmc.org/article/MED/42898184
AB - Background ICHD-3 recognizes restlessness/agitation as an accompanying feature of cluster headache (CH). However, its phenotypic significance within CH remains uncertain. We compared patients with CH with (CHwR) and without restlessness (CHwoR) to characterize the clinical features and symptom burden associated with restlessness.Methods We conducted a cross-sectional cohort study of Turkish patients with CH (n = 318) across tertiary neurology clinics, using a standardized clinician-administered questionnaire. We compared patients with CHwR versus CHwoR across clinical domains, applied multivariable logistic regression to identify independent correlates, and used Partitioning Around Medoids clustering (six pre-specified variables) to explore data-driven profiles.Results There were no patients diagnosed with restlessness alone, without any autonomic symptoms. Restlessness co-occurred with cranial autonomic symptoms-particularly eyelid ptosis and sweating-and also with photophobia, nausea and vomiting. Independent correlates were photophobia (OR 2.91; 95% CI 1.65-5.14), sweating (1.96; 1.04-3.71), and eyelid ptosis (1.75, 1.01-3.03). Workplace burden tended to be greater in CHwR (work-day loss median 10 vs. 5 days; work-life impact 84.1% vs. 73.4%), with higher work-life impact and a borderline difference in work-day loss. Exploratory clustering showed a graded pattern of restlessness, highest in the earlier-onset/high-burden profile.Conclusion In this tertiary-care cohort, restlessness was associated with a broader, symptom-rich CH phenotype characterized by both cranial autonomic and migrainous features and greater clinical burden. As no migraine comparison group was included, its diagnostic discriminatory value cannot be directly assessed. These findings suggest that restlessness may be better interpreted in the context of the overall CH phenotype rather than as an isolated diagnostic feature.
SN - 1664-2295
ER -