Misuse of cocaine in a patient with cluster headache: A clinico-biological case report

Cluster headache (CH) is a severe and disabling headache disorder generally considered as the greatest level of physical pain a person can experience. Despite the significant range of -therapeutic and pharmacological options available, the intense pain the patient endures is poorly controlled. In this way, drugs misuse and illicit substances use, notably amphetamines is widely reported in patient with cluster headache. We herein describe a case of addiction to cocaine and other drugs in a patient with cluster headache following intranasal treatment with Bonain anesthetic mixture, a compounded preparation including cocaine and still used in some european countries. Cocaine misuse was confirmed by the clinical observations and the use of toxicological screening using liquid chromatography on urines. This last one highlights the presence of cocaine and its metabolites (benzoylecgonine, anhydroecgonine, ecgonine, ecgonine methylester, norbenzoylecgonine) and some other drugs the patient used to misuse (cyamemazine, codeine). In blood, the concentrations of cocaine, benzoylecgonine and ecgonine methylester were 2.5 ng/mL, 149.3 ng/mL and 6.5 ng/mL respectively. These results are consistent with a misuse of cocaine due to the benzoylecgonine high concentration and the absence of phenol and menthol, the other compounds of the Bonain anesthesic mixture. This case highlights the importance of performing toxicological monitoring in CH patients, particularly among those who have an increased risk of addictological behavior.