Cluster Headache in Subjects With Substance Use Disorder: A Case Series and a Review of the Literature

Abstract

Objective To describe a case series of 7 patients presenting cluster headache (CH) criteria and a substance use disorder, reported to a French Addictovigilance center. Then, to assess clinical, pharmacological, and neurobiological linkages between substance use and CH onset. Background CH patients are presenting a higher prevalence of comorbidities, among which the use of psychoactive substances, licit or illicit, have been explored by a few authors. Recently, 3 cases of CH in patients seen in the hospital‐based addiction care center have been reported to the Toulouse addictovigilance center. Methods Other cases have been identified in the same tertiary hospital after a collaborative investigation done with the departments of neurology and psychiatry and included in the case series. A narrative review was performed to assess the potential of psychoactive substance consumption to induce or facilitate CH. Results From 2016 to 2018, 6 males and 1 female aged between 26 and 54 years old, presenting CH criteria and a substance use disorder, were included in our case series. Among substances used, there are: (1) daily use of tobacco and alcohol in 5/7 subjects; (2) daily or almost daily use of cocaine in 5/7 subjects; (3) regular use of cannabis before attacks beginning in 4/7 subjects; and (4) opioids, as a substitutive medication or abused, in 5/7 subjects. The intranasal route administration is reported by all the subjects and precedes the beginning of attacks for 5/7 subjects. Conclusions We have found a CH prevalence of 0.9% in our studied population, while it is estimated at 0.1% in the general population. The coexistence of cluster headache and addiction behaviors reflects possible common neurobiological pathways, which would include the hypothalamus. Research could be conducted on the potential of hypothalamic therapeutic targets.

Substance use related cluster headache: A case series

“…CH secondary to exposure to psychoactive substances like cocaine, cannabis, and opioids have been reported. 9 The exact mechanism by which these EOs cause CH is not known. CHs are known to occur after exposure to the scents of the plant Umbellularia californica, also called the "headache tree."…”

“…CH temporally related to exposure to EOs containing preparations are not reported. CH secondary to exposure to psychoactive substances like cocaine, cannabis, and opioids have been reported 9 …”

Cocaine-Induced Headache: A Review of Pathogenesis, Presentation, Diagnosis, and Management

“…Dissection of both extracranial carotid and vertebral arteries is not common as a result of cocaine use [10]. Few cases were reported having cluster headache criteria and substance use disorder, and cocaine was also one of those substances [13]. Luke Glancy et al reported a case of a 49-year-old man suffering from a gradually deteriorating headache a week after smoking crack.…”

Testing the Decision Support Tool for Responsible Pain Management for Headache and Facial Pain Diagnosis with Opioid-Risk-Stratified Treatment

“…Severe headaches, affecting 16% of the US population [ 6 ] and up to 70% of patients with COVID-19 [ 7 , 8 ], result in 4.3 million ambulatory-care visits yearly [ 6 ] and are the fifth most common reason for emergency department (ED) visits [ 9 ]. Opioids are currently used in over 50% of migraine visits in the ED [ 10 , 11 ]. ED patients receiving opioids have higher risk for recurrent opioid use 1 year later [ 12 – 15 ]; however, predicting opioid misuse is challenging.…”