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What predicts evolution from episodic to chronic cluster headache?

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Curr Pain Headache. Rep 2002 Feb;6(1):65-70 Over the last few years, attention has increasingly been focused on the evolution of cluster headache over time. Predictive factors have been identified that are correlated with an increased risk of unfavorable evolution from the episodic form to the chronic form of cluster headache. Late onset, the presence of sporadic attacks, a high frequency of cluster periods, and short-lived duration of remission periods when the headache is still in its episodic form all correlate with a possible worsening of the clinical picture over time. The reasons for evolution of episodic cluster headache to chronic are still unknown, but some factors, such as head trauma and other lifestyle factors—eg, cigarette smoking and alcohol intake—have been suggested as having a negative influence on the course of cluster headache over time. Comment: Further longitudinal epidemiological research is needed to assess the impact of smoking cessation in these patients and to confirm or refute the hypotheses suggested in this paper. DSM Lee Kudrow documented that smoking, like nitroglycerin, lowers oxygen tension, which in turn can precipitate cluster attacks. Another possibility is that smoking and nitroglycerine are nitric oxide (NO) delivery systems and that the NO both precipitates attacks and worsens long-term cluster prognosis. SJT

Document Type: Research Article


Publication date: March 1, 2003


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