Impact of continuing or quitting smoking on episodic cluster headache: a pilot survey

Abstract

BackgroundThe majority of patients suffering from cluster headache (CH) are smokers and it has been suggested that smoking may trigger the development of CH. The aim of this pilot survey was to describe: 1. the differences between current, former, and never smokers CH patients; 2. if smoking changed during an active cluster period; 3. if CH changed after quitting.MethodsAll outpatients with episodic CH according to the criteria of ICHD-II who were consecutively seen for the first time from October 2010 to April 2012 at a headache centre were interviewed by phone using a specifically prepared questionnaire. Statistical differences between continuous variables were analysed by the Student’s t-test or the one-way analysis of variance (ANOVA), followed by Newman-Keuls post-hoc testing. Comparisons between percentages were made using the Chi-square test or Fisher’s exact test. All data were expressed as the mean ± standard deviation (SD).ResultsAmong a total of 200 patients surveyed (172 males, 28 females; mean age ± SD: 48.41 ± 12 years) there were 60%, 21%, and 19% of current, former, and never smokers, respectively. Current smokers reported longer active periods (12.38 ± 10 weeks) and a higher maximum number of attacks per day (3.38 ± 1) compared to never smoker CH patients (5.68 ± 4 weeks, P <0.05 and 2.47 ± 1, P <0.05, respectively). During the active period most of the patients stated to decrease (45.7%) or not to change (45.7%) the number of cigarettes smoked. Among those who decreased smoking, most (83.8%) reported that they had less desire to smoke. After quitting, the majority of former smokers stated that their headache had not changed.ConclusionsPatients with episodic CH who are also smokers appear to have a more severe form of the disorder. However, it is unlikely that between CH and smoking there is a causal relationship, as CH patients rarely improve quitting smoking.

Tobacco, Nicotine, and Headache

“…In a study of possible predictive factors in the evolution of episodic to chronic CH, Torelli et al concluded cigarette‐smoking rates and causality still cannot be established with certainty . In a recent paper, Ferrari et al state it is unlikely that there is a causal relationship between CH and smoking, as CH patients rarely improve after quitting smoking . For further discussion of this topic, please reference an excellent recent review of CH and substance issues including tobacco …”

Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco‐Exposed: Results from the United States Cluster Headache Survey

“…Cluster headache (CH) is unique among all the primary headache syndromes based on its association with cigarette smoking/tobacco exposure . If a CH patient has no personal history of tobacco use, then there is typically a history of secondary cigarette smoke exposure as a child from the patient's parents .…”

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

“…Tobacco exposure is associated with a chronic state of CH . Some patients have smoked to manage pain attacks (eg, to distract from the pain) while others decreased their consumption to avoid exacerbation . In our case series, 5/7 patients reported daily use of tobacco (from 5 to 40 cigarettes a day), and cigarette consumption was identified as a trigger factor of CH by one of them.…”