Emotional dynamics during glucocorticoid treatment in chronic cluster headache – Insights from dynamic time warp analysis

Structured Abstract Background Cluster headache can affect mental health due to the severe attacks, with high rates of depression and anxiety. When prophylactic treatment fails, high dose prednisone can be used as bridging therapy, but may cause neuropsychological side effects. This prospective, exploratory, observational pilot study, aimed to assess the temporal associations between emotions during glucocorticoid treatment in people with cluster headache. Methods During prednisone treatment (67 days), ten participants with chronic cluster headache completed daily questionnaires consisting of ecological momentary assessments regarding emotion, cluster headache bother and attack frequency. Undirected and directed dynamic time warp (DTW) analyses were used to examine the temporal relationship between symptoms at individual-level and group-level. Results The GAMM modelled levels of individual emotions showed a monotonic increase of negative emotions and decrease of positive emotions during follow-up. Individual-level DTW analyses showed high interindividual variability. Group-level DTW analyses found five symptom clusters with similar dynamics. Feelings of upset, hopelessness and low motivation showed the highest outstrength (temporal-lead) and tended to precede changes in other emotions. Cluster headache bother and attack frequency were not interconnected. Changes in attack frequency had temporal associations with subsequent emotional changes, whereas changes in cluster headache bother tended to be preceded by emotional changes, although both cluster headache items demonstrated a limited number of connections in the network plots. Conclusion At the end of glucocorticoid treatment, participants experienced less positive and more negative emotions. Temporal associations were mainly present between emotions. Cluster headache bother was associated with preceding adverse emotions rather than attack frequency, emphasizing the importance to include cluster headache bother when assessing the efficacy of prophylactic treatment. As our exploratory results showed temporal lead for feeling upset, low motivation and low hopefulness, tracking such symptoms may facilitate personally tailored interventions during a glucocorticoid treatment course.