{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T13:24:04Z","timestamp":1762089844103,"version":"build-2065373602"},"reference-count":42,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:00:00Z","timestamp":1633564800000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with cluster headache (CH) are frequently burdened by misdiagnosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experience, we noticed a typical voice quality with low and croaking tone in patients with CH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>In this cross\u2010sectional study, we evaluated, by digital voice analysis, whether it is possible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After conducting digital recording of the voices from both patients with CH and HCs in a soundproof insulated cabin in the laboratory of the Audiology Department, a set of voice parameters was analyzed. We included the measures of fundamental frequency, calculations of jitter and shimmer, and noise\u2010to\u2010harmonics ratios as well as quantities related to the spectral tilt (i.e., H1\u2013H2, H1\u2013A1, H1\u2013A2, and H1\u2013A3) in 20 patients with CH and in 13 HCs. A videolaryngostroboscopy was performed in all subjects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with CH, explored during the cluster bout period, showed significantly lower second harmonic (H1\u2013H2) values compared with HCs (\u22126.9\u00a0\u00b1\u00a07.6 vs. 2.1\u00a0\u00b1\u00a06.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.002), usually characterizing the so\u2010called creaky voice. By using a laryngoscopy investigation, a significantly higher prevalence of mild to moderate vocal cord edema and laryngopharyngeal reflux signs were found in patients with CH (100% of patients with CH vs. 15% of HC,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Creaky phonation is a \u201cphysiological mode of laryngeal operation\u201d usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mechanisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in\u2010bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14222","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T14:48:58Z","timestamp":1633790938000},"page":"1452-1459","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis"],"prefix":"10.1111","volume":"61","author":[{"given":"Marcello","family":"Silvestro","sequence":"first","affiliation":[{"name":"Headache Center Department of Advanced Medical and Surgical Sciences University of Campania \u201cLuigi Vanvitelli\u201d Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca M.","family":"Dovetto","sequence":"additional","affiliation":[{"name":"Department of Humanistic Studies University of Naples Federico II Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Corvino","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasqualina","family":"Apisa","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Malesci","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Tessitore","sequence":"additional","affiliation":[{"name":"Headache Center Department of Advanced Medical and Surgical Sciences University of Campania \u201cLuigi Vanvitelli\u201d Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Milizia","sequence":"additional","affiliation":[{"name":"Department of Asia, Africa and the Mediterranean University of Naples l\u2019Orientale Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gioacchino","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Headache Center Department of Advanced Medical and Surgical Sciences University of Campania \u201cLuigi Vanvitelli\u201d Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elio","family":"Marciano","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0601-0475","authenticated-orcid":false,"given":"Antonio","family":"Russo","sequence":"additional","affiliation":[{"name":"Headache Center Department of Advanced Medical and Surgical Sciences University of Campania \u201cLuigi Vanvitelli\u201d Naples Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30405-2"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2018.6"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-018-3598-5"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102419863030"},{"key":"e_1_2_11_6_1","first-page":"38","volume-title":"Background to Migraine","author":"Graham JR","year":"1970"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.1972.hed1104175.x"},{"key":"e_1_2_11_8_1","first-page":"27","volume-title":"Migraine and Related Headaches","author":"Graham JR","year":"1975"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1121\/1.3514381"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000322059"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2012\/12-0148)"},{"key":"e_1_2_11_13_1","unstructured":"BoersmaP WeeninkD.Praat: doing phonetics by computer[Computer program]. 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