George wrote on May 2nd, 2010 at 4:57pm:I realize that personal experience in particular is not really relevant to statistical phenomena in general, but it does tend to cause me to look at the occasional finger-pointing at tobacco use and/or alcohol use as a precipitating factor of CH by the medical profession with a somewhat jaundiced eye.
The question I always want to ask is...okay...HOW does it bring on CH?
That's a good question - and I don't think anyone has a definite answer ... our biochemistry is too complex. But here are some good possibilities.
Nicotine strongly interacts with serotonin-2 receptors - the same receptors that psilocybin and other clusterbusters work on. But while clusterbusters seem to push a 'reset button' for that receptor system, nicotine is more like 'jamming the ON button' ... nicotine stimulates the serotonin-2 receptors in a way that is opposite to kudzu. Chronic nicotine use also turns down the genes for producing serotonin transporter proteins. Long term use of nicotine also increases the activity of calcium channels (an effect that is just the opposite of verapamil) and disturbs TRP ions channels (which also seem to be involved in CH). All in all, there are lots of indications that nicotine and some key parts of the serotonin system don't get along very well, and that we may be the ones to suffer as a result.
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All of these disturbances can happen even if a person has never used nicotine in their life. But tobacco seems to guarantee these disturbances. It does seem to increase the odds of cluster pain, although it alone is not enough and requires other malfunctions in the body.
As far as the idea that previous heavy drinking might increase the odds of developing clusters ... maybe, but not much information to support that idea. At this point, not much that can be done about it anyway, so it is not a useful theory. There is no evidence that moderate alcohol consumption out of cycle increases the risk of clusters, although chronic heavy caffeine use could definitely be a factor for some people IMO.