Headache associated with illicit drug use

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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, 2nd edition (ICHD-2), 2004. This updated summary includes a recent report on emergency department patients who took energy drinks. Headache was one of their adverse events, and of note, some patients reported purposely ingesting energy drinks with illicit drugs.

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 second edition of The International Headache Classification (ICHD-2), published in 2004.
  • 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.