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 or exposure of a substance. The clinical manifestations of substance-induced headache are variable. In this clinical summary, Dr. Chen of the National Yang-Ming University School of Medicine and Neurological Institute at Taipei Veterans General Hospital in Taipei, Taiwan, updates the current evidence regarding the clinical manifestations and pathophysiology of headache associated with the acute use or exposure of certain substances, with specific focus on nitric oxide donor and carbon monoxide, 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, 3rd edition (beta version) (2013).
  • 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.

In This Article

Historical note and nomenclature
Clinical manifestations
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited