‘A cry in the dark’: a qualitative exploration of living with cluster headache

Context: Cluster headache is a rare primary headache disorder said to be one of the most painful conditions in existence. Limited evidence demonstrates cluster headache patients have difficulties securing a
diagnosis and poor access to services. There is a gap in research around psychosocial needs, meaning
there are no evidence-based guidelines to inform optimal management of this patient group in primary
care.
Objectives: The aim of this study is to explore the perspectives of cluster headache patients in the United
Kingdom in order to suggest ways their care can be improved.
Methods: It is an in-depth qualitative study involving telephone interviews with 15 participants with either
chronic or episodic cluster headache. Semi-structured interviews (43–58minutes) were conducted,
recorded and transcribed verbatim. Two researchers conducted thematic analysis to identify themes.
Results: Participants described the impact cluster headache has on their quality of life. They also felt the
legitimacy of their disorder was questioned. This situation was often exacerbated by a reported lack of
awareness among General Practitioners (GPs), which negatively impacted their care in terms of diagnosis and access to treatments and specialists. They attempted to control the pain through treatments and
avoiding triggers, often with detrimental consequences for their social contact and mental health.
Conclusion: Findings indicate the need to improve the lived experience of cluster headache patients in
two key areas: (1) raising awareness of the disorder and its impact among GPs, and (2) extending care
beyond clinical treatment provision, supporting patients in self-management and addressing its psychosocial impact, with implications for the management of this group in primary care.