Patients with cluster headaches present differently depending on whether they have ever been exposed to tobacco, suggesting a possible difference in underlying pathology, according to results published in Headache.
Patients with cluster headaches who had been exposed to tobacco tended to have a more severe type of syndrome based on attack frequency, cycle duration, and headache-related disability. Patients with cluster headaches who had never been exposed to tobacco have an earlier age of onset, higher rate of familial migraine, and less circadian periodicity and daytime entrainment.
The results come from the US Cluster Headache Survey, which was completed by 1134 participants. The survey included 187 multiple choice questions related to cluster headache including patient demographics, clinical headache characteristics, family history, triggers, smoking history (personal and secondary), and headache-related disability.
Of the surveyed population, 12% (133) participants had never been exposed to tobacco either personally or via secondhand exposure as an infant or child. Episodic cluster headache occurred in 80% of the nonexposed group.
The rest of the population (88%, n=1001) had been exposed to tobacco. Of the exposed population, 83% had a personal smoking history and 17% had secondary exposure via parents who smoked.
Nonexposed participants were significantly more likely to develop cluster headache at age 40 years and younger compared with exposed participants, who often developed cluster headaches at age 40 years and older.
Exposed participants were significantly more likely to have a history of head trauma compared with nonexposed participants (19% vs 10%; P =.02).
Nonexposed participants were significantly more likely to cluster headache cycles that vary throughout the year compared with exposed participants (52% vs 40%; P =.02).
Exposed participants were more likely to experience cranial autonomic symptoms and agitation compared with nonexposed participants. Exposed participants were also significantly more likely to have suicidal ideation with their headaches compared with nonexposed participants (57% vs 43%; P =.003).
Rozen TD. Cluster headache clinical phenotypes: tobacco nonexposed (never smoker and no parental secondary smoke exposure as a child) versus tobacco-exposed: results from the United States Cluster Headache Survey [published online March 14, 2018]. Headache. doi:10.1111/head.13295