Headache associated with acute substance use

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By Shih-Pin Chen MD

This clinical article includes discussion of headaches associated with alcohol, MSG (monosodium glutamate), nitrates.  Substance-use headaches may also be known by such terms as Hot dog headache and Chinese restaurant headache.

Substance headache is a headache that develops de novo with the use of or exposure to a substance. The clinical manifestations of substance-induced headache are variable. In this clinical article, Dr. Shih-Pin Chen of the National Yang-Ming University School of Medicine and Neurological Institute at Taipei Veterans General Hospital in Taipei, Taiwan reviews the current evidence regarding the clinical manifestations and pathophysiology of headache associated with acute use of or exposure to certain substances, including nitric oxide, monosodium glutamate, and alcohol, which provides a better understanding of headache biology.

Key points

  • The clinical manifestations of headache associated with the use or exposure of substances are variable.
  • Headache attributed to substances is currently placed under Section 8 of the International Classification of Headache Disorders, 2nd edition (2004).
  • Nitric oxide is a crucial component in the pathophysiology of primary headache disorders.
  • Headache attributed to monosodium glutamate might be associated with its dose-dependent neuronal toxicity.
  • Subjects vulnerable to alcohol-induced migraine or cluster headache could have a genetic predisposition.