Cluster headache presents differently in never-smokers, survey finds

 

Los Angeles – Cluster headache, a severe, one-sided headache that occurs in cyclical patterns or clusters, is highly associated with smoking, but when it presents in people without any lifetime tobacco exposure, there are key differences – possibly due to a different underlying pathology.

At the American Academy of Neurology annual meeting, Todd D. Rozen, MD, of the Mayo Clinic in Jacksonville, Fla., presented a new analysis from the United States Cluster Headache Survey, an online survey of 1,134 patients with cluster headache, of whom only 12% reported neither personal tobacco use nor a parent who smoked. Dr. Rozen is a coauthor on the original survey, which collected data for a two-month period in late 2008, and has published several analyses using the survey’s data (Headache. 2012 Jan;52[1]:99-113).

Eraxion/Thinkstock

The latest analysis “is the first study that looks at the true non-tobacco exposed versus tobacco-exposed cluster headache populations, and they’re different,” he said in an interview. People with cluster headaches who never smoked, and who did not grow up in a smoking household, tend to develop cluster headache at a younger age, have a more episodic pattern of disease and are less likely to present with agitation and suicidal ideation compared with those who smoke, smoked, or had a parent who smoked, Dr. Rozen found.

Patients not exposed to tobacco developed cluster headache at a younger age than exposed subjects, with a significantly higher percentage reporting onset in their 20s and 30s, while tobacco-exposed people were more likely to see onset at aged 40 years or older.

And there were other important differences. The tobacco-naïve were more likely to have a family history of migraine (65% vs. 50%, P equal to .002). They were significantly more likely to have headache cycles that varied throughout the year rather than being concentrated during specific months or seasons (52% vs. 40%, P equal to .02), which is a hallmark of cluster headache.

Tobacco-exposed patients were more likely to transition from episodic to chronic cluster headaches (23% vs. 14%, P equal to .02) and to have cycles lasting 7 weeks or more (54% vs. 35%, P equal to .0003) compared with those who were tobacco-naïve. They also reported significantly more frequent attacks per day, and were more likely to develop cluster headache during the night (12 pm to 6 am).

“With cluster headache, the majority of patients smoke, and started smoking before they ever developed cluster headache,” Dr. Rozen said. Among the tobacco-exposed patients in the survey, 85% had what he described as a “double hit” – a parent who smoked and a personal history of smoking. “And that may be what’s necessary to develop cluster headache of this classic type,” he said.

 

Dr. Rozen said he suspects that tobacco-exposed people with cluster headache may have abnormal hypothalamic entrainment related to injury from toxins, though the exact mechanisms are unknown.

“So in times of hypothalamic stress – whether clock change or solstice, the hypothalamus has to work more, it doesn’t work correctly, and headache develops,” he said, noting the highly cyclical nature of the classic cluster phenotype.

As to what causes cluster headache in the non-exposed, Dr. Rozen said it’s possible that genetic factors may be more relevant – a possibility underscored by the higher rate of familial migraine reported among the tobacco-naïve in the cohort.

Dr. Rozen reported no financial conflicts of interest related to his findings.

SOURCE: Rozen TD, et al. AAN2018, P3 122.

 

Los Angeles – Cluster headache, a severe, one-sided headache that occurs in cyclical patterns or clusters, is highly associated with smoking, but when it presents in people without any lifetime tobacco exposure, there are key differences – possibly due to a different underlying pathology.

At the American Academy of Neurology annual meeting, Todd D. Rozen, MD, of the Mayo Clinic in Jacksonville, Fla., presented a new analysis from the United States Cluster Headache Survey, an online survey of 1,134 patients with cluster headache, of whom only 12% reported neither personal tobacco use nor a parent who smoked. Dr. Rozen is a coauthor on the original survey, which collected data for a two-month period in late 2008, and has published several analyses using the survey’s data (Headache. 2012 Jan;52[1]:99-113).

Eraxion/Thinkstock

The latest analysis “is the first study that looks at the true non-tobacco exposed versus tobacco-exposed cluster headache populations, and they’re different,” he said in an interview. People with cluster headaches who never smoked, and who did not grow up in a smoking household, tend to develop cluster headache at a younger age, have a more episodic pattern of disease and are less likely to present with agitation and suicidal ideation compared with those who smoke, smoked, or had a parent who smoked, Dr. Rozen found.

Patients not exposed to tobacco developed cluster headache at a younger age than exposed subjects, with a significantly higher percentage reporting onset in their 20s and 30s, while tobacco-exposed people were more likely to see onset at aged 40 years or older.

And there were other important differences. The tobacco-naïve were more likely to have a family history of migraine (65% vs. 50%, P equal to .002). They were significantly more likely to have headache cycles that varied throughout the year rather than being concentrated during specific months or seasons (52% vs. 40%, P equal to .02), which is a hallmark of cluster headache.

Tobacco-exposed patients were more likely to transition from episodic to chronic cluster headaches (23% vs. 14%, P equal to .02) and to have cycles lasting 7 weeks or more (54% vs. 35%, P equal to .0003) compared with those who were tobacco-naïve. They also reported significantly more frequent attacks per day, and were more likely to develop cluster headache during the night (12 pm to 6 am).

“With cluster headache, the majority of patients smoke, and started smoking before they ever developed cluster headache,” Dr. Rozen said. Among the tobacco-exposed patients in the survey, 85% had what he described as a “double hit” – a parent who smoked and a personal history of smoking. “And that may be what’s necessary to develop cluster headache of this classic type,” he said.

 

Dr. Rozen said he suspects that tobacco-exposed people with cluster headache may have abnormal hypothalamic entrainment related to injury from toxins, though the exact mechanisms are unknown.

“So in times of hypothalamic stress – whether clock change or solstice, the hypothalamus has to work more, it doesn’t work correctly, and headache develops,” he said, noting the highly cyclical nature of the classic cluster phenotype.

As to what causes cluster headache in the non-exposed, Dr. Rozen said it’s possible that genetic factors may be more relevant – a possibility underscored by the higher rate of familial migraine reported among the tobacco-naïve in the cohort.

Dr. Rozen reported no financial conflicts of interest related to his findings.

SOURCE: Rozen TD, et al. AAN2018, P3 122.

 

Los Angeles – Cluster headache, a severe, one-sided headache that occurs in cyclical patterns or clusters, is highly associated with smoking, but when it presents in people without any lifetime tobacco exposure, there are key differences – possibly due to a different underlying pathology.

At the American Academy of Neurology annual meeting, Todd D. Rozen, MD, of the Mayo Clinic in Jacksonville, Fla., presented a new analysis from the United States Cluster Headache Survey, an online survey of 1,134 patients with cluster headache, of whom only 12% reported neither personal tobacco use nor a parent who smoked. Dr. Rozen is a coauthor on the original survey, which collected data for a two-month period in late 2008, and has published several analyses using the survey’s data (Headache. 2012 Jan;52[1]:99-113).

Eraxion/Thinkstock

The latest analysis “is the first study that looks at the true non-tobacco exposed versus tobacco-exposed cluster headache populations, and they’re different,” he said in an interview. People with cluster headaches who never smoked, and who did not grow up in a smoking household, tend to develop cluster headache at a younger age, have a more episodic pattern of disease and are less likely to present with agitation and suicidal ideation compared with those who smoke, smoked, or had a parent who smoked, Dr. Rozen found.

Patients not exposed to tobacco developed cluster headache at a younger age than exposed subjects, with a significantly higher percentage reporting onset in their 20s and 30s, while tobacco-exposed people were more likely to see onset at aged 40 years or older.

And there were other important differences. The tobacco-naïve were more likely to have a family history of migraine (65% vs. 50%, P equal to .002). They were significantly more likely to have headache cycles that varied throughout the year rather than being concentrated during specific months or seasons (52% vs. 40%, P equal to .02), which is a hallmark of cluster headache.

Tobacco-exposed patients were more likely to transition from episodic to chronic cluster headaches (23% vs. 14%, P equal to .02) and to have cycles lasting 7 weeks or more (54% vs. 35%, P equal to .0003) compared with those who were tobacco-naïve. They also reported significantly more frequent attacks per day, and were more likely to develop cluster headache during the night (12 pm to 6 am).

“With cluster headache, the majority of patients smoke, and started smoking before they ever developed cluster headache,” Dr. Rozen said. Among the tobacco-exposed patients in the survey, 85% had what he described as a “double hit” – a parent who smoked and a personal history of smoking. “And that may be what’s necessary to develop cluster headache of this classic type,” he said.

 

Dr. Rozen said he suspects that tobacco-exposed people with cluster headache may have abnormal hypothalamic entrainment related to injury from toxins, though the exact mechanisms are unknown.

“So in times of hypothalamic stress – whether clock change or solstice, the hypothalamus has to work more, it doesn’t work correctly, and headache develops,” he said, noting the highly cyclical nature of the classic cluster phenotype.

As to what causes cluster headache in the non-exposed, Dr. Rozen said it’s possible that genetic factors may be more relevant – a possibility underscored by the higher rate of familial migraine reported among the tobacco-naïve in the cohort.

Dr. Rozen reported no financial conflicts of interest related to his findings.

SOURCE: Rozen TD, et al. AAN2018, P3 122.