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Background <p>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.</p> Methods <p>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.</p> Results <p>In total, 1,206 patients were enrolled, with a female-to-male ratio of 1:3.94. Demographic analysis revealed that female patients had an earlier mean age of onset, higher educational attainment, and fewer unhealthy lifestyle factors compared to male patients. Female patients were also more likely to have comorbidities such as migraine (28.28% vs. 15.90%, <i>P</i> &lt; 0.001) and psychological conditions, including anxiety and depression, and to use oral rizatriptan for acute treatment (27.78% vs. 15.80%, <i>P</i> &lt; 0.001). With respect to cranial autonomic symptoms (CASs), female patients experienced eyelid edema (18.85% vs. 12.47%, <i>P</i> = 0.010) and ptosis (56.97% vs. 49.90%, <i>P</i> = 0.048) more frequently, and reported migraine-associated symptoms more often. Conversely, male patients more commonly presented with conjunctival hyperemia (56.03% vs. 38.52%, <i>P</i> &lt; 0.001), rhinorrhea (47.92% vs. 38.93%, <i>P</i> = 0.012), and facial sweating (38.15% vs. 30.74%, <i>P</i> = 0.032). Female patients had significantly higher frequencies of attacks during the early morning hours (2:00–8:00), whereas male patients experienced significantly more attacks during midday (10:00–14:00) and evening (16:00–20:00).</p> Conclusion <p>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.</p>

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Sex differences in cluster headache: insights from the Chinese Cluster Headache Register Individual Study (CHRIS)

  • 期刊论文

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  • 发表日期：

    2026年1月31日

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  • Yuhan Wu,
  • Chunfu Chen,
  • Suiyi Xu,
  • Hongru Zhao,
  • Xingkai An,
  • Kaiming Liu,
  • Wensheng Qu,
  • Hongling Zhao,
  • Ran Zhang,
  • Dan Wang,
  • Zhiliang Fan,
  • Yuanrong Yao,
  • Zhibin Zhou,
  • Huifang Xu,
  • Wei Gui,
  • Yabin Ji,
  • Ling Chen,
  • Jianjun Chen,
  • Bing Wen,
  • Zheman Xiao,
  • Hebo Wang,
  • Liang Zhang,
  • Qiuling Tong,
  • Xiaosu Yang,
  • Zhonglin Liu,
  • Songjie Liao,
  • Ziru Li,
  • Kunlin Zhang,
  • Longteng Ma,
  • Shuhua Zhang,
  • Shengyuan Yu,
  • Mingjie Zhang,
  • Zhao Dong,
  • Lin Li,
  • Xiaobin Zhai,
  • Zhanyou Xue,
  • Dongmei Hu,
  • Kaiming Liu,
  • Jianjun Chen,
  • Sufen Chen,
  • Xiaoyu Gao,
  • Zhiliang Fan,
  • Dongjun Wan,
  • Xueqian Yuan,
  • Ming Dong,
  • Chunyang Ju,
  • Huifang Xu,
  • Yanhong Wang,
  • Zhe Wang,
  • Li Mei,
  • Peng Xu,
  • Haiyan Yu,
  • Yang Liu,
  • Min Chen,
  • Rui Liu,
  • Weiliang He,
  • Jiajun Yang,
  • Ge Tan,
  • Jiasi Li,
  • Dan Zhang,
  • Xianliang Li,
  • Yuhong Man,
  • Li Li,
  • Yusheng He,
  • Zhanxiu Ren,
  • Xiaojuan Wang,
  • Jie Zhang,
  • Zhongling Zhang,
  • Jing Zhang,
  • Yonghui Liu,
  • Yi Zhang,
  • Qun Gu,
  • Lijuan Wang,
  • Shi Qiu,
  • Haiyan Cai,
  • Lanyun Yan,
  • Nana Hu,
  • Chun Huang,
  • Mei Yin,
  • Ran Zhang,
  • Juan Yi,
  • Fang Chen,
  • Qiaolin Gao,
  • Yi Wang,
  • Zengqiang Zhang,
  • Yunqing Qin,
  • Yu Hao,
  • Qi Zhang,
  • Yongbin Song,
  • Hui Xue,
  • Peng Feng,
  • Mingxin Li,
  • Chenmin Huang,
  • Weian Chen,
  • Shengshu Wang,
  • Yingyuan Liu,
  • Yin Sun,
  • Siyuan Xie,
  • Deqi Zhai,
  • Ruobing Wang,
  • Linfeng liu,
  • kang Jin,
  • Mingyi Yang,
  • Xiu Liu,
  • Jiaqi Liu,
  • Ruozhuo Liu,
  • Xun Han,
  • Ye Ran,
  • Hui Su

摘要

Background

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.

Methods

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.

Results

In total, 1,206 patients were enrolled, with a female-to-male ratio of 1:3.94. Demographic analysis revealed that female patients had an earlier mean age of onset, higher educational attainment, and fewer unhealthy lifestyle factors compared to male patients. Female patients were also more likely to have comorbidities such as migraine (28.28% vs. 15.90%, P < 0.001) and psychological conditions, including anxiety and depression, and to use oral rizatriptan for acute treatment (27.78% vs. 15.80%, P < 0.001). With respect to cranial autonomic symptoms (CASs), female patients 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, male patients more commonly presented with conjunctival hyperemia (56.03% vs. 38.52%, P < 0.001), rhinorrhea (47.92% vs. 38.93%, P = 0.012), and facial sweating (38.15% vs. 30.74%, P = 0.032). Female patients had significantly higher frequencies of attacks during the early morning hours (2:00–8:00), whereas male patients experienced significantly more attacks during midday (10:00–14:00) and evening (16:00–20:00).

Conclusion

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.