Tobacco Exposure Influences Cluster Headache Presentation

A man with a cluster headache
A man with a cluster headache
The United States Cluster Headache Survey assessed tobacco exposure in individuals with cluster headaches.

The United States Cluster Headache Survey revealed differences in presentation between cluster headache sufferers exposed to tobacco and those not exposed, according to research published in Headache.

This study found that respondents who were exposed to tobacco presented more severely in terms of headache frequency, disability due to headaches, and cycle frequency.

They also reported the development of cluster headaches at age 40 and older, were more likely to have experienced head trauma than nonexposed subjects (19% vs 10%, P =.02), and had a higher likelihood of transitioning to chronic cluster headaches from episodic ones (23% vs 14%, P =.02).

Those exposed to tobacco experienced more cranial autonomic symptoms and agitation, as well as increased thoughts of suicide (57% vs 43%, P =.02).

The respondents who were not exposed were more likely to experience cluster headaches prior to age 40; this group also demonstrated a higher incidence of family history of migraines. It was less common for those not exposed to present with specific headache triggers, and their headache cycles varied more over time than with the exposed phenotype (52% vs 40%, P =.02).

While both clinical phenotypes experienced disabling pain, the subjects who were not exposed had less disability at work and fewer sick days.

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The United States Cluster Headache Survey studied 1134 subjects via an online multiple-choice questionnaire. Of all subjects, 12% had never smoked or been exposed to secondhand smoke as a young child, while 88% had been exposed to tobacco. Of the latter group, 83% had smoked tobacco, 17% had only been exposed to it through by parental smoking, and 85% met both specifications.

This study found that individuals with cluster headaches who were not exposed to tobacco appeared to “have an earlier age of onset, higher rate of familial migraine, and less circadian periodicity and daytime entrainment, suggesting a possible different underlying pathology than in the tobacco exposed sub-form.”

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Rozen TD. 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[published online March 14, 2018]. Headache. doi: 10.1111/head.13295