The prevalence of cluster headache may be higher in individuals with a substance use disorder than in the general population, according to a case series published in Headache.

This case series included 7 patients (6 men and 1 woman; aged 26-54 years) who presented to a French Addictovigilance clinic with cluster headache and substance use disorder.

Patients were asked about their experience with several substances. Five of these patients reported daily use of tobacco and alcohol use, 5 patients reported using cocaine daily/almost daily, 5 patients were using/abusing opioid medications, 4 patients reported attacks preceded by cannabis use, and 3 participants reported lifetime or recent use of amphetamines or MDMA.

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All 7 participants reported intranasal administration of at least 1 of the above substances, and 5 reported that intranasal administration preceded attacks. The researchers reviewed the literature to examine possible associations between an intranasal route of administration of drugs and the development of cluster headache. Repeated intranasal use may be associated with cluster headaches because of damage associated with orofacial lesions, according to the case series authors.

“This work leads us to 2 nonexclusive hypotheses. First, substance use disorder comes about as the result of the intolerable pain of [cluster headache],” noted the researchers. “Second, substance use disorder in itself…or peripheral damages due to substance administration…cause impairments of the hypothalamus or its cortical connections.”


Ponté C, Giron A, et al. Cluster headache in subjects with substance use disorder: A case series and a review of the literature [published online April 7, 2019]. Headache. doi:10.1111/head.13516

This article originally appeared on Clinical Pain Advisor