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April 20, 2020

Family History of Cluster Headache: A Systematic Review

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco, San Francisco
  • 2Houston Methodist Hospital, Houston, Texas
  • 3McGovern Medical School, Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston
JAMA Neurol. 2020;77(7):887-896. doi:10.1001/jamaneurol.2020.0682
Key Points

Question  What is the family history rate and inheritance pattern of cluster headache?

Findings  In a systematic review of articles published between 1985 and 2016, which included 22 large cohort studies, cluster headache has a family history rate of 0% to 22%, with a median of 8.2%. A total of 67 pedigrees were identified, and the inheritance pattern of cluster headache was consistent with an autosomal dominant pattern in 69% of participants and an autosomal recessive pattern in 28%.

Meaning  Per this systematic review, cluster headache is an inherited disorder in a subset of patients, and the pattern of inheritance could be the result of multiple susceptibility genes as well as environmental factors.


Importance  Genetic and environmental factors are thought to contribute to cluster headache, and cluster headache can affect multiple members of a family. A thorough understanding of its inheritance is critical to understanding the pathogenesis of this debilitating disease.

Objective  To systematically review family history rates and inheritance patterns of cluster headache.

Evidence Review  A systematic review was performed in PubMed, Embase, and Cochrane Library. Search criteria were created by a librarian. Articles published between 1985 and 2016, after the publication date of a large review in 1985, were analyzed independently by 2 neurologists to identify family history rates and pedigrees. Pedigrees were analyzed by a genetic counselor.

Findings  A total of 1995 studies were found (1988 through the search criteria and 7 through other means). Forty articles met inclusion criteria: 22 large cohort studies, 1 twin-based study, and 17 case reports or small case series. Across the 22 large cohort studies, the positive family history rate of cluster headache varied between 0% and 22%, with a median of 8.2%. The largest 5 studies, of 1134, 785, 693, 609, and 500 probands each, had a positive family history in 18.0% (numerator not provided), 5.1% (40 of 785 cases), 10.0% (numerator not provided), 2.0% (12 of 609 cases), and 11.2% (56 of 500 cases), respectively. No meta-analysis was performed, given differences in methodologies. Separately, 1 twin-based study examined 37 twin pairs and reported a concordance rate of 5.4% (2 pairs). Finally, 67 pedigrees were identified. Most pedigrees (46 of 67 [69%]) were consistent with an autosomal dominant pattern, but 19 of 67 (28%) were consistent with an autosomal recessive inheritance pattern; 10 pedigrees of probable or atypical cluster headache were identified, and all were consistent with an autosomal dominant inheritance pattern. The sex ratio for cluster headache in identified pedigrees was 1.39 (103:74) in affected men and boys compared with affected women and girls, which is lower than that of the general cluster headache population.

Conclusions and Relevance  Cluster headache is an inherited disorder in a subset of families and is associated with multiple hereditary patterns. There is an unexpectedly high preponderance of women and girls with familial cluster headache; genetic subanalyses limited to female participants are necessary to further explore this observation, because these data are otherwise masked by the higher numbers of male participants with cluster headache. Overall, this systematic review supports the notion that familial cluster headache is likely the result of multiple susceptibility genes as well as environmental factors.

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