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Cocaine Use Linked to the Development and Worsening of Headache

As many as 21 million people across the world use cocaine, and headache ranks near the top of the list of health ailments that result from its use.

To better understand cocaine-induced headache, researchers at the IRCCS San Raffaele Pisana in Rome, Italy, studied 80 patients at a drug treatment facility. Ninety percent reported current headache — a higher percentage than previous research has indicated.

Of the 72 patients with headache, 40.3 percent reported a prior headache history, and almost 60 percent reported the development of headache after using cocaine initially. The most common types of headache reported were migraine without aura and probable migraine without aura. The majority of patients reported that cocaine intake made their headaches worse, although a minority reported that acute cocaine use eased their headache pain.

An unexpected finding, the authors said, is that cocaine-induced headache, as classified by the ICHD-II criteria, occurred in just 2.2 percent of the participants. Cocaine-induced headaches are defined as those that develop within an hour after cocaine use and last up to 72 hours, with at least one of the following symptoms: bilaterality, frontotemporal location, pulsating quality, and worsening with physical activity. In more than 87 percent of the study patients, headache developed 2 or more hours after cocaine use, and almost one-third of patients reported pain outside of the frontotemporal area.

Also significant, the authors said, is that the majority of patients reported taking analgesics without medical advice to control their migraine-related pain.

“This interesting finding underlines the concern that self-medication without consulting a physician could increase the risks related to drug interactions and medication overuse,” they wrote.

It is not clear how cocaine contributes to headache, but the authors say they believe it likely creates an imbalance in the dopamine and serotonin systems, although cocaine also affects the cardiovascular system, and those effects could contribute as well.

Arthur Elkind, MD, the National Headache Foundation President, noted that cocaine and subsequent persistent headaches could be a manifestation of a serious cerebrovascular condition or other central nervous system consequences of the drug’s use.

The authors of the study, which appeared recently in Cephalalgia, recommend that health care professionals should inquire about cocaine use, especially among their migraine patients.

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