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CH - tobacco exposure link to impact (Read 1679 times)
Mike NZ
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CH - tobacco exposure link to impact
Apr 8th, 2018 at 2:37am
 
Pretty much hot off the press, with the research published three weeks ago.

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The conclusion, by Todd Rozen, who is one of the world CH experts:

Quote:
Cluster headache sufferers who were never exposed to tobacco (personal or secondary as a child) appear to present uniquely compared to the tobacco exposed subgroup. The tobacco exposed clinical phenotype appears to have a more severe syndrome based on attack frequency, cycle duration, and headache related disability. Tobacco exposure is associated with cluster headache chronification. 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 sub‐form.


I'm not quite sure what the threshold for non-exposure was as the survey isn't published, so was just one minute spent in a room where someone smoked enough to count as being exposed? Or was it "regularly"? The devil can be in the detail.

Also it links head trauma to CH, with 19% of those doing the survey linking this to their CH if they were exposed as to 10% for unexposed. But that might just be linked to the population that smokes / is exposed to it being more likely to have head injuries as opposed to it being a CH specific link.

Those exposed are also more likely to have CHs overnight.

Similarly those exposed are more likely to have suicidal ideation (57%) compared to non-exposed (43%), although I'm amazed that both are that low.

Interesting reading.
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jon019
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Re: CH - tobacco exposure link to impact
Reply #1 - Apr 8th, 2018 at 3:21am
 
Mike....WHAT!!!!?

My Father smoked...I smoked for 30 years...this post is confusing..............what are you saying?
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Peter510
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Re: CH - tobacco exposure link to impact
Reply #2 - Apr 8th, 2018 at 6:19am
 
My Father smoked, my Mother smoked. I smoked (not for some years now). All my siblings (8) smoke (1 passed from Cancer).

I’m chronic, highly susceptible to Circaedian rhythms and get hit night and day.

Who knows what’s true?

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Mike NZ
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Re: CH - tobacco exposure link to impact
Reply #3 - Apr 8th, 2018 at 4:04pm
 
jon019 wrote on Apr 8th, 2018 at 3:21am:
Mike....WHAT!!!!?

My Father smoked...I smoked for 30 years...this post is confusing..............what are you saying?


If you had exposure to smoking (like you had in your example), you are more likely to:
  • Start CH after the age of 40
  • Less likely to have a family history of migraine
  • More likely to have had a head injury
  • More likely to go from episodic to chronic CH
  • More likely to be agitated during a CH
  • Less likely to have specific CH triggers
  • More likely to be triggered by alcohol
  • More likely to be a heavy user of caffeine
  • More likely to have CH cycles at specific times of the year
  • More likely to get CH 12am-6am
  • More likely to get more CHs per day
  • More likely to get suicidal ideation
  • More likely to have more work related disability and lost home-days due to CH
If you had not been exposed to smoking, you are more likely to:
  • Start CH before the age of 40
  • More likely to have a family history of migraine
  • Less likely to have had a head injury
  • Less likely to go from episodic to chronic CH
  • Less likely to be agitated during a CH
  • More likely to have specific CH triggers
  • Less likely to be triggered by alcohol
  • Less likely to be a heavy user of caffeine
  • Less likely to have CH cycles at specific times of the year
  • Less likely to get CH 12am-6am
  • Less likely to get more CHs per day
  • Less likely to get suicidal ideation
  • Less likely to have more work related disability and lost home-days due to CH
So in other words, if you get CH you have better outcomes if you hadn't had exposure to smoking either first or second hand.

But what it doesn't say is:
  • If you don't smoke / weren't exposed you won't get CH
  • If it makes a difference if you smoke / were exposed and you stop if you are likely to see an improvement.
It also only says more / less likely. For example if you had no exposure you can still have no migraine in the family, have had a head injury, go chronic, get agitated during a CH, not have specific CH triggers, be triggered by alcohol, be a coffee addict, get CH cycles at set times, get CHs overnight, get many CHs per day, have suicidal thoughts and be off work due to CH. All it means is less likely / more likely compared to the other group.
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« Last Edit: Apr 8th, 2018 at 4:09pm by Mike NZ »  
 
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Mike NZ
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Re: CH - tobacco exposure link to impact
Reply #4 - Apr 9th, 2018 at 12:53am
 
It is all down to statistics which can be pretty complex.

Imagine a simpler case where we want to take a coin and to see if it is totally fair with the same chance that it will come up heads as it is to come up tails.

If you toss it once, it will be one of heads / tails and a single test will tell you nothing really.

If you do it 100 times and it comes out as:
  • 50 heads 50 tails - it is probably fair
  • 51 heads, 49 tails - it is probably fair
  • 47 heads, 53 tails - it is probably fair but might be a bit biased towards tails
  • 20 heads, 80 tails - it is almost certainly biased towards tails
However the 47th (for example) toss of the coin in the last set could come up heads and in itself it would tell you nothing.

There are also some mathematical tests you can do based on factors including the number of outcomes and the number of tests to help show how likely the observed results are just down to chance which would probably be the case for the 51-49 outcome. Equally the 20-80 result is highly unlikely to be due to chance and is most likely due to a biased coin (or how the coin is tossed or bad recording of the data....).

What the CH statistical analysis does is to show how tobacco exposure with over 1000 data samples can show significant impacts on how people with / without exposure experience CH. It can not predict for any one person what their outcome will be, but what is more / less likely as a group with the predictions getting more accurate the larger the effect and the larger the data set.

What it does suggest is that the CH related outcomes are slightly better where someone has no tobacco exposure, but since CH can emerge decades after tobacco exposure this isn't going to be too useful unless you did something like totally ban tobacco and never mind the arguments around if this should be done from personal liberty viewpoint, the difference in impact is most likely small when compared to the total population (given that CH is relatively rare).

What would be very useful is if the data included any questions around people who were smokers / had ongoing exposure and they stopped, did it make any difference to their CH. If it did, this could potentially help them improve their CH "experience". It wouldn't guarantee an improvement but it could make it more likely which is better than nothing.

This type of data analysis is very important in medical trials, so if a sample size of 10 patients were used to "prove" something then there is a significant potential for it to be due to chance, but if the sample size was 10,000 people then it is much less likely to be due to chance.

I hope this helps to explain the research paper results.
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« Last Edit: Apr 9th, 2018 at 12:54am by Mike NZ »  
 
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