Cluster headache with Brugada electrocardiogram pattern: a case report

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Brugada electrocardiogram (ECG) pattern and Brugada syndrome are associated with cardiac risks, leading to restrictions on certain medications.
• Cluster headache (CH) is a debilitating neurological condition often treated with agents that block sodium channels.

Observation:

• A 40-year-old male patient with CH presented with a Brugada ECG pattern.
• Standard CH therapies lacking sodium channel blocking effects were ineffective for this patient.
• The patient experienced severe unilateral orbital pain characteristic of cluster headaches.

Findings:

• Exceptional treatments for cluster headache, clonazepam and codeine phosphate, were administered.
• Both clonazepam and codeine phosphate demonstrated effectiveness in alleviating the patient's severe unilateral orbital pain.
• This suggests a potential therapeutic role for these agents in specific CH cases with Brugada ECG patterns.

Implications:

• The findings suggest that certain sodium channel blocking agents, typically contraindicated in Brugada patterns, may be safely and effectively used for cluster headache management in select patients.
• This case highlights the need for individualized treatment strategies in patients with co-existing neurological and cardiac conditions.
• Further research is warranted to explore the safety and efficacy of clonazepam and codeine phosphate in a broader population of cluster headache patients with Brugada ECG patterns.