Substance use related cluster headache: A case series.

Area of Science:

• Neurology
• Toxicology

Background:

• Essential oils (EOs) with pro-convulsant properties are known to induce seizures and exacerbate migraines.
• Cluster headache (CH) is a debilitating neurological condition.
• The potential role of specific EOs in triggering CH has not been extensively studied.

Purpose of the Study:

• To report cases of cluster headache (CH) secondary to the use of toothpastes containing pro-convulsant essential oils (EOs).
• To investigate the relationship between specific EO-containing toothpastes and the onset or exacerbation of CH.
• To evaluate the efficacy of discontinuing EO-containing toothpastes in managing CH attacks.

Main Methods:

• Case series involving five patients diagnosed with CH from headache clinics in South India.
• Diagnosis of CH confirmed using the International Classification of Headache Disorders, 3rd edition criteria.
• Data collected included detailed patient history, clinical examination, and brain magnetic resonance imaging; descriptive statistics were employed.

Main Results:

• Five cases of EO-related CH (EORCH) were identified between February 2020 and August 2021.
• Patients used toothpastes containing various combinations of camphor, eucalyptus, sage, thujone, clove, and fennel EOs for extended periods.
• Complete resolution of CH attacks occurred within 5-10 days of discontinuing the EO-containing toothpastes, with one patient experiencing recurrence upon re-challenge.

Conclusions:

• Pro-convulsant EOs found in products like toothpastes may act as triggers for cluster headaches (CH).
• Physicians should consider assessing patient exposure to pro-convulsant EOs in cases of CH.
• Advising discontinuation of toothpastes containing these EOs may offer a potential therapeutic strategy for CH remission.