Personality Traits in CH

[Craigo]

Greetings all,

It’s been a hot minute since I last thought about the intersection of personality profiles and CH but a recent literature dive brought it back into focus, unintentionally I might add. I don’t know if you’ve come across a tool called Harzing’s Publish or Perish, it makes searching the scientific literature super easy. Using it I stumbled upon a 2016 paper that struck a chord over the past couple days and I wanted to share it here.

I want to say before you read further there was an element of reading this study that was triggering / confronting so I just wanted to make that disclosure - this can be a challenging topic to navigate.

Personality traits in patients with cluster headache: a comparison with migraine patients

https://pmc.ncbi.nlm.nih.gov/articles/PMC4791411/

According to the Salamanca screening test, personality traits included in cluster A (odd or eccentric disorders) are more prevalent in CH patients than in a population of migraineurs. Larger studies are needed to determine whether certain personality traits are related to CH.

The study compared 80 CH sufferers (mostly male, average age 43) with 164 migraine patients (mostly female, average age 36). Using the Salamanca screening test, they found the most common traits in the CH group were:

Anancastic (52.5%)
Anxious (47.5%)
Histrionic (45%)
Schizoid (42.5%)
Impulsive (32.5%)
Paranoid (30%)

Compared to migraineurs, paranoid and schizoid traits were significantly more common in CH sufferers. According to this screening tool, Cluster A traits (odd or eccentric personalities) appear more common in CH patients than in migraine patients.

I was curious enough to simulate the Salamanca test using a language model and, no surprise, I scored highly on the same cluster: anancastic/OCPD, anxiety-related and schizoid traits. I did not score highly in the histrionic traits.

Here’s a brief overview of what the 2 of these personality patterns look like that were pertinent for me, starting with anancastic (also known as Obsessive-Compulsive Personality Disorder, which is distinct from OCD). Anancastic was a new term for me, I hadn't heard of it before:

Anancastic Traits (OCPD)

Preoccupied with rules, structure, and control
Perfectionism that interferes with task completion
Rigid thinking, especially around morality
Workaholic tendencies at the expense of relationships
Difficulty delegating due to high standards
Hoarding or excessive saving
Stubbornness and resistance to change

I score fairly solid on that one, lol. I look at the list and recognize a number of things that I consider work-on's in my life, balance between work and social relationships being one of them; real estate is not a great choice for that I must say. Definitely rigid in my thinking around morality, I wish I was an excessive saver(!!!) and I like tradition, I am not fond of change.

And then there’s schizoid which frankly the word has a certain connotation to it but putting that aside:

Schizoid Traits

Strong preference for solitude
Emotionally flat or detached
Disinterest in close relationships, including family
Limited enjoyment from most activities
Unmoved by praise or criticism
Few or no close friends or confidants

The last time I had really delved into the above traits was to explore one of the other topics of my podcast, fatherlessness - Freud wrote about some of these qualities in Mourning and Melancholia. I was surprised to see some of those traits appear in this study. I have often wondered what bearing early parental loss had in the context of my CH, again difficult to explore because the discussion is contextual, there's no hard and fast with such abstract subjects albeit I have little doubt that early life adversity played a part in my journey with CH.

Alas, if you’ve ever felt a bit “wired differently” or found it hard to relate to the social world most people seem to navigate with ease, this study suggests you may not be alone. It’s fascinating and maybe even a little validating to see how certain personality traits appear more frequently among cluster headache sufferers. It raises further discussion points. Are these traits a product of the pain, isolation and the unpredictability of CH? Or is there a deeper neurological or biological predisposition at play?

My wife also took the test and didn't score for these results. I could setup an anonymized poll via a Google sheet if there was interest - equally interested in your thoughts as always.

Craigo.

[Bejeeber]

Interesting indeed.

My, we're quite the lovely bunch, aren't we? 

The Google sheet sounds interesting, too, if it was quick and easy enough (what kind of personality trait does "wants things to be quick and easy" come under? 

[BoscoPiko]

Thanks for posting this @Craigo. Definitely something to chew on. I'm down for the Google Sheet poll. In all fairness though, I have to point out that these studies were conducted "after" the individuals were afflicted with either CH or migraine so I can't help but think that the trait outcomes being listed are skewed because who wouldn't be a bit paranoid, schizoid, depressed and anxious after dealing with a good ol fashioned brain arse kicking? I get that it would be hard to conduct the test prior (say on those with a higher likelihood of developing one or the other) but life changes after CH...    

[CHfather]

2 hours ago, BoscoPiko said:

have to point out that these studies were conducted "after" the individuals were afflicted with either CH or migraine so I can't help but think that the trait outcomes being listed are skewed because who wouldn't be a bit paranoid, schizoid, depressed and anxious after dealing with a good ol fashioned brain arse kicking?

It's a fascinating topic, but I am also strongly with you on this, Bosco'.  I guess people would have to think about whether they have always had the identified traits.

(Once after 18 months of severe back pain, my GP sent me to a pain management guy, who was also a psychiatrist. He administered a personality test (Minnesota Multiphasic) that among other things asked about pain frequency, intensity, and expectation of relief.  The doc solemnly told me that I seemed to have a predisposition for hypochondria.  I am a calm and polite person, but I lost it at that.)

[Alx]

I also read sometime that we(ch-heads) have a leathery skin and lion manes.

i thought that was very funny and it fits like a glove. Just like the above personality traits.  I am diagnosed on the autism spectrum  the OCPD is just like a description of autistic behavior.   And the schizoid thing is just the consequence of having a cluster.    And I also have a monobrow. And everyone knows what that means

[Craigo]

Here guys - take the Salamanca test - after taking the poll via a Google form you can see the google sheet. Its anonymous. Enter your email only if you want to receive a summary of your scores. If it looks interesting enough I might share it on FB to get some decent numbers. Give me some feedback before I do.

https://forms.gle/3THW4dYdRLShLgJi8

The questions are pretty out there in this test, bearing in mind its translated from I think Spanish. "I am more in touch with the paranormal than most people" an example of a question I am unsure as to how may be influenced by having CH. Given I grew up watching Mulder and Scully afterschool on rerun I scored pretty high on that one.

@CHfather @BoscoPiko @Bejeeber You know there is an obvious trend on the CB forum where members enlist a feline as their profile picture. Maybe I missed the memo. I have never been a cat guy - I lost my 15yr old black and white border collie Ollie a few months back and the very next day after his passing, a little black and white girl started hanging at the back door. It looked dishevelled. Had a broken tail. It was hungry. We didn't know the hard and fast rule so yes, we fed it. Yes, it stayed. Yes, every night I think I can hear my neighbours kid wailing themselves to sleep but there you go, I'm also now a cat guy so maybe I snap a quick pic and get rid of my profile mugshot.

@Alx Believe it was the late John R Graham that came up with the rugged face and skin of the CH sufferer in the 1970s. Those papers were pretty wild, - a different time - from his 1974 article CH, "Male patients are frequently brought to the physician by the wife, who also takes the prescriptions and makes the telephone calls and appointments for her husky suffering mate, leading to the terminology "the leonine mouse syndrome." Episodes of hysterical behavior, amnesia, fugues, transvestism, overt homosexuality, and psychotic breaks have occurred in some patients." 

[Alx]

And further back it was probably the witch trials.  
My greatgrandmother died in an asylum nobody knows why or what. But I think I got an idea why it happened .

I am so glad I was born in 1974. Today we got O2 and bustingagents.  
 

[BoscoPiko]

10 hours ago, Craigo said:

You know there is an obvious trend on the CB forum where members enlist a feline as their profile picture. Maybe I missed the memo.

I don't think it was ever meant to be a trend... Jeeb has had that profile pic since I joined the CB site and CHF changed his a while back (not sure why but assume it was in an attempt to look more cute) My profile image for social media stuff has always been of Bosco my late Abyssinian cat (coolest cat in the world)! Sorry to hear about the loss of your pup that's always hard. I lost my Abby Doo (lab mix) and Bosco (Abby cat) not to long ago and still have a rough time with it. Any animal profiles (except reptiles) are welcome in my book:) Thanks for the link. I'll give it a go and see just how bonkers I really am

[CHfather]

2 hours ago, BoscoPiko said:

CHF changed his a while back (not sure why but assume it was in an attempt to look more cute)

Indeed. I only put up my cat avatar because there was some joking I wasn't getting enough likes, and cats were a theme among the more-highly-liked posters. Never had a cat; never wanted one.

But then again, it's very relevant here to note that I don't have CH (my daughter does).  So you might want to take my scores (responder #3) off the spreadsheet.

In 1969, a fellow wrote about CH patients' "leonine" appearance," and in 1974, the great Dr. Kudrow "confirmed" that observation. PHYSICAL AND PERSONALITY CHARACTERISTICS IN CLUSTER HEADACHE, Headache: The Journal of Head and Face Pain | 10.1111/j.1526-4610.1974.hed1304197.x | DeepDyve  Kudrow also said there that his male CH patients were on average almost six feet tall, which was about three inches taller than the average American male.

Questionable as all that might be, there is this spooky-seeming thing from 2021: "Frontal Bone Height and Facial Width were able to discriminate, one independently from the other, CH patients from Healthy Controls with an overall accuracy of 77.00%."  (PDF) Can Craniometry Play a Role in Cluster Headache Diagnosis? A Pilot Exploratory TC-3D Based Study 

Well, I took the Salamanca test.  As you say, it seems to leave a lot to be desired. For one thing, the questions/items on the survey do not seem to be well correlated with the actual traits they are supposed to be measuring. I'm guessing that there are two questions per category (there are 11 categories), and you get one point for "sometimes," two for "frequently," and three for "always." (The actual line between "sometimes" and "frequently" seems much blurrier to me than the line between "frequently" and "always.") My top three traits were schizoid, anancastic, and paranoid, all of which are in the CH top six. I also got the same score for "anxious" (also in their CH top six) as I did for anancastic, but somehow they decided that anancastic was in my top three but anxious wasn't.  I have to say that by the "normal" definitions of these terms, I am not an anxious or paranoid person. 

So my four top answers were all in the six most common ones for people who actually have CH.  No idea what that might mean about the validity of the findings/instrument.

  

Edited Saturday at 05:52 PM by CHfather

[BoscoPiko]

1 hour ago, CHfather said:

(The actual line between "sometimes" and "frequently" seems much blurrier to me than the line between "frequently" and "always.")

Agreed. The "Sometimes" was a bit frustrating because you are forced to go with that selection even if your response would have been "Never".. That aside, my top three were anancastic, anxious and dependant. The dependant one was a bit funny to me because my husband swears all the time "you have your mind made up and there's no talking sense to you"!!

 

[Craigo]

3 hours ago, CHfather said:

But then again, it's very relevant here to note that I don't have CH (my daughter does).  So you might want to take my scores (responder #3) off the spreadsheet.

 

Thanks CHfather, I have updated the poll to ask the question and record if the person is a sufferer or not and if so, what form. I take it you added your email and received the analysis run through the prompt - it's just sending your results via an automation to a model with a prompt to analyse them - the prompt deals with a tie in scores based on prioritizing CH traits and if a tie stills exists, rank in alphabetical order - I have made that now clear in the email summary.

3 hours ago, CHfather said:

Questionable as all that might be, there is this spooky-seeming thing from 2021: "Frontal Bone Height and Facial Width were able to discriminate, one independently from the other, CH patients from Healthy Controls with an overall accuracy of 77.00%."  (PDF) Can Craniometry Play a Role in Cluster Headache Diagnosis? A Pilot Exploratory TC-3D Based Study 

 

Thanks for sharing these studies! Raises more questions than answers. Significant that the observed craniometric abnormalities were independent of smoke and alcohol intake which contrasts previous hypotheses that lifestyle factors might explain facial features like the "leonine face" that Graham and Kudrow wrote about.

We also have a new paper published a few days back - Smoking in primary headaches – a systematic review and meta-analysis looking at smoking in primary headaches and found a weighted-pooled prevalence of smoking in CH patients of 65% being the highest prevalence among primary headache types evaluated, compared to 20% for migraine and 19% for TTH. Despite this they concluded that current smoking was not associated with CH diagnosis when compared to controls and suggest this lack of association might be due to the limited number of studies included for CH in their meta-analysis but also state that while smoking is commonly associated with CH, it may result from other as yet unidentified factors which aligns with the 2021 craniometry study's finding that the observed bone abnormalities are independent of smoking and alcohol consumption.

6 hours ago, BoscoPiko said:

I don't think it was ever meant to be a trend... Jeeb has had that profile pic since I joined the CB site and CHF changed his a while back (not sure why but assume it was in an attempt to look more cute) My profile image for social media stuff has always been of Bosco my late Abyssinian cat (coolest cat in the world)! Sorry to hear about the loss of your pup that's always hard. I lost my Abby Doo (lab mix) and Bosco (Abby cat) not to long ago and still have a rough time with it. Any animal profiles (except reptiles) are welcome in my book:) Thanks for the link. I'll give it a go and see just how bonkers I really am

On the losing beloved family pets, oh man it's tough. I'm sorry. We lost Harper our female border collie at 9 maybe 2 years back, Ollie held tough, my loyal mate, for another couple of years and he enjoyed great health over his 15 years with me. The sharpness of the pain has subsided but boy do I miss him, I find myself telling "Gurl" that Ollie would have adored her, he got so excited around cats. Cats are so different, try and approach them they run away, ignore them and they come to you.

Alas its my Sunday and I have one very important task to do today, and that is book flights to Dallas for September. We are very excited but trying to figure out how much time to spend exploring Dallas and maybe Austin before going upto Seattle. It's a long old flight to not make the most of it - 24 hours, ungh.

[CHfather]

3 hours ago, Craigo said:

while smoking is commonly associated with CH, it may result from other as yet unidentified factors

Well, sticking with the Salamanca traits, I suppose one might imagine that you would see more smoking in a group of people who are more anxious, impulsive, paranoid, and OCDish than others  (For example, "Those with higher obsessive compulsive symptoms report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons." Obsessive-Compulsive Symptoms and Cigarette Smoking: An Initial Cross-Sectional Test of Mechanisms of Co-Occurrence - PMC)  

[Alx]

14 hours ago, CHfather said:

In 1969, a fellow wrote about CH patients' "leonine" appearance," and in 1974, the great Dr. Kudrow "confirmed" that observation. PHYSICAL AND PERSONALITY CHARACTERISTICS IN CLUSTER HEADACHE, Headache: The Journal of Head and Face Pain | 10.1111/j.1526-4610.1974.hed1304197.x | DeepDyve  Kudrow also said there that his male CH patients were on average almost six feet tall, which was about three inches taller than the average American male.

Questionable as all that might be, there is this spooky-seeming thing from 2021: "Frontal Bone Height and Facial Width were able to discriminate, one independently from the other, CH patients from Healthy Controls with an overall accuracy of 77.00%."  (PDF) Can Craniometry Play a Role in Cluster Headache Diagnosis? A Pilot Exploratory TC-3D Based Study 

  

At the time I was reading about this I looked like my avatar picture. So it was like “whaaaaat?”      And my zodiac sign is lion.  And I am 1.86cm in height. That is probably 6feet in American?     

[CHfather]

  This could be the photo in the dictionary next to "leonine"!!

[CHfather]

A small (I hope) hijacking.  I've been reading more about Dr. Graham, who first provided the "leonine" characterization.  Just thought these quotes about women were worth mentioning. 

"It's a man's disease," says Dr. Graham, and women who are afflicted with cluster headache tend to "act mannishly."  What's new on heads and their aches? (This article recounts a couple of 1977 talks about CH at a conference. On one hand, they're pretty cringeworthy, and on the other they at least show some folks trying to figure out what to do about CH. (CH was considered just a subdivision of migraine until the 1960s -- which, depending on your age, might seem like a long time ago or pretty recent.) (In 1960, 5% of medical students were women.))

This is from 2006.  I think it still took a long time after that to really acknowledge that many women have CH (and many doctors still don't seem to know that), but she (the author) was trying, at least. "Cluster headache is a notoriously painful and dramatic disorder. Unlike other pain disorders, which tend to affect women, cluster headache is thought to predominantly affect men. Drawing on ethnography, interviews with headache researchers, and an analysis of the medical literature, this article describes how this epidemiological “fact”—which recent research suggests may be overstated—has become the central clue used by researchers who study cluster headache, fundamentally shaping how they identify and talk about the disorder. Cluster headache presents an extreme case of medicalized masculinity, magnifying the processes of gendering and bringing into relief features of the world whose routine operation we might otherwise overlook."  Uncovering the Man in Medicine - Joanna Kempner, 2006

[Bejeeber]

8 hours ago, CHfather said:

This could be the photo in the dictionary next to "leonine"!!

Plus you have the (Moog??!!) modular synth action going on in the background, which....OK....may have nothing to do with CH, but is cool as hell. 

[Bejeeber]

7 hours ago, CHfather said:

"It's a man's disease," says Dr. Graham

Dr. Graham's Credibility takes the biggest of hits right there. 

[Bejeeber]

First, thank you @Craigo for the poll, and second, I do have to agree with @BoscoPiko on this one:

On 6/7/2025 at 2:58 PM, BoscoPiko said:

The "Sometimes" was a bit frustrating because you are forced to go with that selection even if your response would have been "Never"

 

[Alx]

11 hours ago, Bejeeber said:

Plus you have the (Moog??!!) modular synth action going on in the background, which....OK....may have nothing to do with CH, but is cool as hell. 

It is ROLAND SYSTEM 500  and at the time a Moog voyager oldschool plus vx and cp breakoutboxes  

 It can make sounds that scare beasts away but not ‘“the beast”

[Bejeeber]

15 hours ago, Alx said:

It is ROLAND SYSTEM 500  and at the time a Moog voyager oldschool plus vx and cp breakoutboxes

[jon019]

...cool beans Craigo!

...as CHfathers's citation(s) demonstrates,  don't be leery of older studies(not that i doubt you!). i distinctly recall discussions and papers demonstrating higher incidence among clusterheads of OCD, smoking, alcohol abuse, and mental health issues, etc...and i'm talking 20+ yrs ago.

..will certainly take this test but just by subhead alone, i know i'll score off the board

[jon019]

14 hours ago, jon019 said:

higher incidence among clusterheads of OCD, smoking, alcohol abuse, and mental health issues, etc..

...i waver between thinking these are caused by CH vs being part of the whole package of a "wonky hypothalamus"....

[Racer1_NC]

I still think we are more prone to hedonistic behavior than average as a way to balance pain we experience with pleasure. 

No....I'm not admitting to a damn thing..... It's merely a theory. 

Edited Tuesday at 09:33 PM by Racer1_NC

[devonrex]

Certainly all lines up exactly with having chronic clusters, my results simple describe how I am living with them and the results are also 99% caused by them