Headache associated with illicit drug use

Introduction
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By Shuu-Jiun Wang MD

In general, most physicians are not familiar with headache syndromes induced by the use of illicit drugs such as cocaine, marijuana, and opioids. Some patients can develop thunderclap headache and reversible cerebral vasoconstriction syndrome. In this clinical summary, Shuu-Jiun Wang, Professor of Clinical Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, provides an update on the underlying pathophysiology and reviews the clinical aspects of headache syndromes induced by illicit drugs in light of the criteria presented in the International Classification of Headache Disorders, 3rd edition, beta version (ICHD-3β). A study reported that occurrence or worsening of migraine or migraine-like headache was as high as 90% in chronic cocaine users.

Key points

  • Illicit drugs, including cocaine, cannabis, and opioids, can induce headache. However, acute withdrawal of opioids can also induce headache.
  • The diagnostic criteria of headache induced by illicit drugs is provided in the third edition (beta version) of The International Headache Classification (ICHD-3β), which was published in 2013.
  • Reversible cerebral vasoconstriction syndrome manifesting as thunderclap headache was reported as a complication of the use of illicit drugs such as cocaine and cannabis.
  • Cocaine- and amphetamine-induced acute severe headache may be related to a sympathomimetic effect.
  • Headache is one of the symptoms in some Emergency Department patients who purposely ingest energy drinks and illicit drugs together.
  • A study reported that occurrence or worsening of migraine or migraine-like headache was as high as 90% in chronic cocaine users.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors