SYNOPSIS The relationship between the major system of histocompatibility antigens and cluster headache has already been studied by our group, and decreased frequency of HLA‐B14 antigen shown in cluster headache patients in comparison to a control population. The therapy of cluster headache with lithium salts is already widely acclaimed; nevertheless there are patients who derive no benefit or must suspend treatment due to side‐effects. Thus we wanted to study the relationship between genetic markers of patients with the illness and the therapeutic efficacy of lithium salts. 35 episodic cluster headaches have been studied; they had been already typed for the HLA antigens. The patients were treated with lithium carbonate for a period of 3 months. As parameters for evaluation of the efficacy of treatment, the headache index ratio, the wake‐sleep rhythm and the pupil diameter measurement were studied. Statistical evaluation was made and it was possible to separate two subgroups of patients: “responders” and “non responders” to lithium therapy. The phenotypical frequencies in the two subgroups was analyzed using the X2 test. A higher frequency of HLA‐B18 antigen (23.8% vs 0%; p< 0.0005; pc<0.06) and of HLA‐A9 antigen (42.9% vs 14.3%) showed in the “responders” group. In the “non responders” group was found a higher frequency in HLA‐A1 antigen (35.7% vs 14.3%).
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