Headache associated with illicit drug use

Shuu-Jiun Wang MD (Dr. Wang of the National Yang-Ming University School of Medicine and the Neurological Institute, Taipei Veterans General Hospital received consulting fees from Eli Lilly.)
Originally released January 21, 1994; last updated April 12, 2016; expires April 12, 2019

This article includes discussion of headache associated with illicit drug use and drug-induced headache. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

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 article, the author 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.

Historical note and terminology

Although the use of opium and its derivatives dates back to the 3rd century BC, headache caused by illicit drugs appears to be a relatively recent phenomenon, with the earliest reports dating from the mid-1980s (Langemark and Olesen 1984; El-Mallakh 1987; Satel and Gawin 1989). El-Mallakh described the appearance of migraine headaches after the abrupt discontinuation of long-term marijuana use. Satel, Gawin, Lipton and colleagues have described migraine-like headaches as also being associated with cocaine use. Neurologic complications, including headache, are rarely reported in association with ecstasy (3,4-methylenedioxymethylamphetamine, MDMA) use (Balmelli et al 2001; Auer et al 2002).

The third edition (beta version) of the International Classification of the Headache Disorders (ICHD-3β) defines 4 headache syndromes related to illicit drug use; they include cocaine-induced headache, cannabis-induced headache, opioid-overuse headache, and opioid-withdrawal headache (Headache Classification Subcommittee of the International Headache Society 2013).

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