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  • Updated 03.02.2021
  • Released 01.21.1994
  • Expires For CME 03.02.2024

Headache associated with illicit drug use



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 may 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 (ICHD-3), published in January 2018. Two papers reported the high frequency of illicit drug use in patients with cluster headache and discussed the possible mechanism for this association.

Key points

• Illicit drugs, including cocaine, methamphetamine cannabis, and opioids, can induce headache. However, acute withdrawal of opioids can also induce headache.

• The diagnostic criteria of headache induced by illicit drugs are provided in the third edition of The International Headache Classification (ICHD-3), which was published in January 2018.

• 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.

• Compared with the normal population, patients with cluster headache were likely to use illicit drugs.

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 (30; 20; 39). 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 (05; 04).

The third edition of the International Classification of the Headache Disorders (ICHD-3) defines 4 headache syndromes related to illicit drug use; they include cocaine-induced headache, cannabis-induced headache, opioid-overuse headache, and opioid-withdrawal headache (26).

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