Headache associated with illicit drug use

Shuu-Jiun Wang MD (

Dr. Wang of the Brain Research Center, National Yang-Ming University, and the Neurological Institute, Taipei Veterans General Hospital, received consulting fees from Eli Lilly, Daichi-Sankyo, and Novartis for advisory board membership and honorariums from Bayer as a moderator.

Originally released January 21, 1994; last updated April 13, 2020; expires April 13, 2023

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.


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, 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 (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 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 (Headache Classification Subcommittee of the International Headache Society 2018).

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.

Find out how you can join MedLink Neurology