START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE


Quote:

People with cluster headache who have never been exposed to tobacco may have a different type of headache syndrome than those with cluster headache who have been exposed to tobacco, either through a personal history of smoking or through secondhand smoke.1A recent study found that those exposed to tobacco smoke may have a worse headache syndrome, and more headache-related disability than those who were never exposed to tobacco. “The nonexposed subtype appears 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 subform,” wrote Todd Rozen, MD, FAAN, of Mayo Clinic Florida, Jacksonville, Florida. The study is first to systematically evaluate cluster headache in individuals never exposed to tobacco smoke. Past studies have focused on individuals exposed to tobacco and found a very strong link between smoking and increased risk for cluster headache. However, the cause has yet to be established. Some nonsmokers also develop cluster headache, further complicating the issue. To provide more evidence, researchers used data from the US Cluster Headache Survey, the largest survey completed to date about cluster headache in the US.2 The study took place from October through December 2008 and consisted of a web-based questionnaire with 187 multiple choice questions. Only patients with neurologist-diagnosed cluster headache were eligible to complete the survey. The analysis included responses from 1134 individuals. Twelve percent of respondents had no personal history of smoking or exposure to second-hand smoke in their childhood home (never-exposed group). Eighty-eight percent had either a personal history of smoking or had been exposed to smoke in their childhood home (exposed group). Results suggested that a significantly higher percentage of the never exposed group was diagnosed at a younger age, had a stronger family history of migraine, and had more variable headache cycles than the exposed group In contrast, a significantly higher percentage of the exposed group had a history of head trauma, experienced worsening of their headaches from episodic to chronic, had more frequent attacks, and had more severe symptoms, such as runny nose, agitation and suicidal ideation. The exposed group also had a significantly higher percentage of heavy coffee drinkers and headaches triggered by alcohol. Additionally, they had more work disability and lost days from work than the never exposed group, but these results were not significant. Both exposed and nonexposed groups had poor overall response to preventive and abortive medication, except for inhaled oxygen and injectable sumatriptan (see Table). The authors mentioned that the younger age of onset and stronger family history of migraine in the never exposed group could suggest a genetic contribution to this type of cluster headache. The later age of onset in the exposed group could result from the toxicity of cigarette smoke. Many individuals in this group continued smoking after their diagnosis of cluster headache, and continued smoking could be a risk factor for worsening of cluster headache from an episodic to a chronic condition. However, further study is needed to confirm the results and evaluate underlying mechanisms. The study did not confirm cluster headache diagnosis. Some participants may have instead suffered from migraine, which could have biased results. Also, the study could not evaluate other types of secondhand smoke exposure beyond what occurred in the childhood home. Take home points • First study to systematically evaluate cluster headache in individuals never exposed to tobacco suggests two subtypes for cluster headaches: tobacco-exposed and tobacco never-exposed • Tobacco never-exposed had earlier age of onset and stronger family history of migraine, suggesting a genetic contribution • Tobacco-exposed had later age of onset, more severe symptoms and more disability, suggesting toxic effects of cigarette smoke • Further research is needed to confirm results and evaluate underlying mechanisms

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGESTART PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

A very interesting article and it backs up what I've suspected for years in that there are multiple different causes of CH symptoms which are all classed as CH. This would explain so much about how different preventives work for different people, etc.

Mike,

A very interesting study. The results tie in with my personal experience, having grown up in a house full of smokers and being an ex-smoker myself.

It might also go some way to explaining why no two Cluster Heads experience exactly the same range of symptoms, severities, patterns or, as you say, respond to preventatives in the same way.

Thanks for drawing our attention to it.

Peter.

I worked with Dr. Rozen on this survey and developed most of the questions regarding oxygen therapy.  I also did some of the initial analysis of the survey results.

Dr. Rozen may have a new angle on the difference in CH pathogenesis between CHers who smoke and those that do not smoke.  This will be hard to prove for many reasons, but it does give headache researchers another avenue to explore.

I do think a point needs to be made regarding the table entry for suicide.  Yes many of us have entertained the thought of suicide at one point of another.  What caused these thoughts is the area of interest.  There's been a lot of research on the side effects of psychotropic pharmaceuticals too many of which are prescribed for CH.  In my case, I had just come off depakote and was a week into Neurontin (gabapentin).

Nearly all of these drugs fall into the following classes (types) of psychotropic medications:

    Stimulants
    Antidepressants
    Antipsychotics
    Mood stabilizers
    Antianxiety agents

Nearly all of them have side effects that include
  social withdrawal
  anxiety
  depression
  psychotic or manic symptoms

Suicide has been directly attributed to a few of them.

Or perhaps it could simply be that some people find it too difficult to face the prospect of a life ahead with endless and intolerable pain.  For all the tremendous good you do Batch, it might be worth considering laying aside your obvious bias against the pharmaceutical industry and stick to helping people without the implied attacks on medicines that have helped millions of people.

Tobacco use is a political animal, specially in NZ, and as such any information pertaining should be treated with utmost caution. It is the old story of not letting the facts get in the way of a good story. Now booze is another story!

Traveller wrote on Aug 6^th, 2018 at 10:36am:

Or perhaps it could simply be that some people find it too difficult to face the prospect of a life ahead with endless and intolerable pain.  For all the tremendous good you do Batch, it might be worth considering laying aside your obvious bias against the pharmaceutical industry and stick to helping people without the implied attacks on medicines that have helped millions of people.

As someone who has had CHs since 1985 and has been suicidal, I couldn't agree more.

An interesting read. Thanks Mike.

I spent 30 years as a smoker,  a ClusterHead and a pacer.  On quitting the cigarettes 10 years ago I remained a ClusterHead but immediately became a rocker and groaner instead.

No.  I have no idea, either.

AussieBrian wrote on Nov 8^th, 2018 at 11:33pm:

I spent 30 years as a smoker,  a ClusterHead and a pacer.  On quitting the cigarettes 10 years ago I remained a ClusterHead but immediately became a rocker and groaner instead. No.  I have no idea, either.

I'm a smoker...menthol...i chain smoke during hits as much as i can. i also suck on halls menthol cough drops on the same hit side. it helps me to try to remain calm during hits. My spot is in the garage sitting on a folding chair in the dark. it keeps me focused on willing the pain away...lol. if i don't chain smoke or have the halls at the same time, i can't sit still, pace, slap head, moan groan, and breath deep and fast. my experience is anything sensory doesn't impact the headache intensity at all, but does agitate my overall state....making the hit last longer. the only environmental trigger i have is perfume/cologne....guaranteed  KP10. interestingly as well, i don't really drink, but when i do its bourbon, and i have never had a hit during drink though the next morning hang-over. only tested that about 4 times over the last 3 years though. really i felt better hung over than i usually do....go figure.