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Lloyd K, Harrison S, Sallis HM, Davey Smith G, Munafò MR, Wootton RE. Exploring the Bidirectional Causal Pathways Between Smoking Behaviors and Headache: A Mendelian Randomization Study. Nicotine Tob Res 2024; 26:903-912. [PMID: 37702655 PMCID: PMC11190053 DOI: 10.1093/ntr/ntad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Although observational data suggest a relationship between headache and smoking, there remain questions about causality. Smoking may increase headache risk, individuals may smoke to alleviate headaches, or smoking and headache may share common risk factors. Mendelian randomization (MR) is a method that uses genetic variants as instruments for making causal inferences about an exposure and an outcome. AIMS AND METHODS First, we conducted logistic regression of observational data in UK Biobank assessing the association between smoking behaviors (smoking status, cigarettes per day amongst daily smokers, and lifetime smoking score) on the risk of self-reported headache (in the last month and for more than 3 months). Second, we used genetic instruments for smoking behaviors and headache (identified in independent genome-wide association studies [GWAS]) to perform bidirectional MR analysis. RESULTS Observationally, there is a weak association between smoking behavior and experiencing headache, with increased cigarettes per day associated with increased headache risk. In the MR analysis, genetic liability to smoking initiation and lifetime smoking increased odds of headache in the last month but not odds of headaches lasting more than 3 months. In the opposite direction, there was weak evidence for higher genetic liability to headaches decreasing the chance of quitting. CONCLUSIONS There was weak evidence for a partially bidirectional causal relationship between smoking behaviors and headache in the last month. Given this relationship is distinct from smoking heaviness, it suggests headache and smoking may share common risk factors such as personality traits. IMPLICATIONS Using MR, this study addresses the uncertainty regarding the observed relationship between headache and smoking. There was evidence for weak causal effects of smoking initiation and lifetime smoking (but not smoking heaviness) on likelihood of experiencing headache in the last month, but not over a prolonged period of more than 3 months. Those with higher genetic liability to headaches were also less likely to successfully stop smoking. This partially bidirectional causal relationship distinct from smoking heaviness suggests that observed associations are unlikely due to biological effects of tobacco smoke exposure and may be explained by shared personality traits.
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Affiliation(s)
- Katherine Lloyd
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean Harrison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Hannah M Sallis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
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Kim SA, Choi SY, Youn MS, Pozo-Rosich P, Lee MJ. Epidemiology, burden and clinical spectrum of cluster headache: a global update. Cephalalgia 2023; 43:3331024231201577. [PMID: 37728577 DOI: 10.1177/03331024231201577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND This narrative review aims to broaden our understanding of the epidemiology, burden and clinical spectrum of cluster headache based on updated findings with a global perspective. METHODS We conducted a literature search on the following topics: (a) epidemiology; (b) burden: quality of life, disability, economic burden, job-related burden and suicidality; and (c) clinical spectrum: male predominance and its changes, age, pre-cluster and pre-attack symptoms, aura, post-drome, attack characteristics (location, severity, duration and associated symptoms), bout characteristics (attack frequency, bout duration and bout frequency), circadian and seasonal rhythmicity and disease course. RESULTS New large-scale population-based reports have suggested a lower prevalence than previous estimations. The impact of cluster headache creates a significant burden in terms of the quality of life, disability, economic and job-related burdens and suicidality. Several studies have reported decreasing male-to-female ratios and a wide age range at disease onset. The non-headache phases of cluster headache, including pre-cluster, pre-attack and postictal symptoms, have recently been revisited. The latest data regarding attack characteristics, bout characteristics, and circadian and seasonal rhythmicity from different countries have shown variability among bouts, attacks, individuals and ethnicities. Studies on the disease course of cluster headache have shown typical characteristics of attacks or bouts that decrease with time. CONCLUSIONS Cluster headache may be more than a "trigeminal autonomic headache" because it involves complex central nervous system phenomena. The spectrum of attacks and bouts is wider than previously recognised. Cluster headache is a dynamic disorder that evolves or regresses over time.
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Affiliation(s)
- Seung Ae Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - So Youn Choi
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Institute of Research, Departament Medicina, Universtitat Autonoma de Barcelona, Spain
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Seoul National University College of Medicine, Seoul, South Korea
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Theory of mind: a new perspective on cluster headache—a cross-sectional study. Neurol Sci 2022; 43:6047-6051. [DOI: 10.1007/s10072-022-06234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
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Crespi J, Gulati S, Salvesen Ø, Bratbak DF, Dodick DW, Matharu MS, Tronvik E. Epidemiology of diagnosed cluster headache in Norway. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221075569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Cluster headache (CH) is one of the most painful conditions in humans and there is limited epidemiological data on this debilitating condition. Objectives: To describe the epidemiology of CH in Norway Methods: We conducted a nationwide study to investigate the prevalence, incidence, and comorbidity of CH in Norway between January 1 2008 and December 31 2016. Treatment and outcome data from the Norwegian patient registry and the Norwegian prescription database were linked on an individual basis. Results: Among 3,892,260 individuals ≥18 years old of age, we identified a total of 1891 patients with CH. The prevalence of CH was 48.6 per 100,000, and the male-to-female ratio was 1.47. The estimated incidence of CH was 3.0 per 100,000/year. Among patients with CH, increased age and sex adjusted odds ratios ([OR], all with p-values <0.0001, were observed for medication-induced headache (OR 50.7, 95% CI 36.7–69.9), migraine (OR 25.2, 95% CI 22.5–28.3), chronic posttraumatic headache (OR 22.2, 95% CI 12.8–38.45), history of cranial trauma (OR 1.9, 95% CI 1.5–2.4), somatoform disorders (OR 4.2, 95% CI 3.0–5.8), suicide attempt (OR 3.9, 95% CI 2.6–5.8), personality disorder (OR 3.6, 95% CI 2.6–4.9), bipolar disorder (OR 3.6, 95% CI 2.8–4.8), peptic ulcer (OR 2.8, 95% CI 2.3–3.3), depression (OR 2.8, 95% CI 2.4–3.1), substance abuse (OR 2.6, 95% CI 2.0–3.3), and cerebrovascular disease (OR 2.4, 95% CI 1.8–3.1). Use of opioid analgesics during the study period was more common among patients with CH compared to others (81% vs. 22%, sex and age adjusted OR 23.4, 95% CI 20.8–26.2, p < 0.0001).
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Affiliation(s)
- Joan Crespi
- Department of Neurology, St. Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU (Norwegian University of Science and Technology), Trondheim, Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, NTNU (Norwegian University of Science and Technology), Trondheim, Norway
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, NTNU (Norwegian University of Science and Technology), Trondheim, Norway
| | - Daniel Fossum Bratbak
- Department of Neuromedicine and Movement Science, NTNU (Norwegian University of Science and Technology), Trondheim, Norway
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway
| | | | - Manjit Singh Matharu
- UCL Queen Square Institute of Neurology and The National Hospital of Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- Department of Neurology, St. Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU (Norwegian University of Science and Technology), Trondheim, Norway
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Gonzalez-Martinez A, Rodríguez Vázquez E, de la Red Gallego H, García-Azorín D, Gallego de La Sacristana M, Guerrero Peral ÁL, Gago-Veiga AB. Association Between Personality Traits and Onabotulinumtoxin A Response in Patients With Chronic Migraine. Headache 2019; 60:153-161. [PMID: 31691958 DOI: 10.1111/head.13693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the potential association between personality traits and onabotulinumtoxin A (onabotA) response in patients with chronic migraine (CM). BACKGROUND Previous studies from a categorial perspective show that patients with CM have anxious or obsessive personality according to the Salamanca screening test. However, the influence of personality traits in onabotA response in patients with CM has not yet been studied. We hypothesize that cluster C personality traits may be associated with non-response to onabotA. METHODS This case-control observational study includes patients with CM who received at least 2 treatment cycles of onabotA in 2 headache units between January and May 2018. onabotA response was defined as a reduction of at least 50% in the number of monthly migraine days. Personality traits were evaluated using the Salamanca questionnaire, a validated categorial inventory assessing 11 personality traits. RESULTS One hundred and twelve patients, 100/112 (89.6%) females, mean age (standard deviation): 43 (11) years, were recruited. 96/112 (85.7%) achieved response to onabotA. Dependent trait was significantly associated with non-response to onabotA (P = .008; OR: 0.223 [95%CI: 0.074 to 0.675]). Significant association with other personality traits or confounders was not found. CONCLUSIONS To the best of our knowledge, this is the first study showing personality traits may predict onabotA response in patients with CM. The presence of dependent personality trait in patients with CM is associated with non-response to onabotA.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Eva Rodríguez Vázquez
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Henar de la Red Gallego
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mercedes Gallego de La Sacristana
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
| | - Ángel Luis Guerrero Peral
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
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Santos-Lasaosa S, Bellosta-Diago E, López-Bravo A, Viloria-Alebesque A, Garrido-Fernández A, Pilar Navarro-Pérez M. Cognitive Performance in Episodic Cluster Headache. PAIN MEDICINE 2018; 20:1032-1037. [DOI: 10.1093/pm/pny238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sonia Santos-Lasaosa
- Neurology Department, University Clinical Hospital Lozano Blesa, Instituto Aragonés de Ciencias de la Salud, Grupo de Estudio de Trastornos del Movimiento y Cefaleas (GIIS070), Zaragoza, Spain
| | - Elena Bellosta-Diago
- Neurology Department, University Clinical Hospital Lozano Blesa, Instituto Aragonés de Ciencias de la Salud, Grupo de Estudio de Trastornos del Movimiento y Cefaleas (GIIS070), Zaragoza, Spain
| | - Alba López-Bravo
- Neurology Department, University Clinical Hospital Lozano Blesa, Zaragoza, Spain
| | - Alejandro Viloria-Alebesque
- Neurology Department, University Clinical Hospital Lozano Blesa, Instituto Aragonés de Ciencias de la Salud, Grupo de Estudio de Trastornos del Movimiento y Cefaleas (GIIS070), Zaragoza, Spain
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Piacentini SHMJ, Draghi L, Cecchini AP, Leone M. Personality disorders in cluster headache: a study using the Millon Clinical Multiaxial Inventory-III. Neurol Sci 2018; 38:181-184. [PMID: 28527059 DOI: 10.1007/s10072-017-2929-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A great deal of studies suggests that cluster headache (CH) patients are usually comorbid to anxiety-mood spectrum disorders and psychopathological symptoms; however, the personality profiles reported in the literature strictly depend on type of assessment used. Psychiatric comorbidities have been extensively studied in migraine and they are recognized to represent a major risk factor associated with poorer outcome, playing a role in the headache chronification process at once as cause and consequence of it. By contrast the incidence and role of psychopathological aspects in CH is still not clarified, insufficiently explored as the striking severity of such a physical pain apparently leaves no room to psychological explanations. The aim of the present study is to describe psychopathological aspects of CH patients by means of the Millon Clinical Multiaxial Inventory-III (MCMI-III), a psychological assessment tool compatible to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that correlates personality disorders (PDs) and clinical syndromes. We included all consecutive inward patients with CH between January 2014 and December 2016. Patients were evaluated using the MCMI-III a validated inventory assessing 14 PDs Scales (coordinate with DSM-IV Axis II disorders) and ten Clinical Syndrome Scales (coordinate with DSM-IV Axis I disorders). Twenty-six CH patients (24 chronic CH) were tested. Personality disorders were present in 92% of the patients. The most frequent PDs were: obsessive-compulsive (30.8%), histrionic (26.9%), narcissistic (11.5%), paranoid (11.5%) and avoidant (11.5%). According to the MCMI-III, patients with CH showed a high prevalence of personality disorders (Axis II-DSM-IV). PDs in CH patients can play an important role in determining CH course toward chronification. These preliminary results suggest that behavioral treatments can find room to support more conventional drug and neurostimulation therapies in these patients. In addition, the very high prevalence of PDs in our patients suggests that CH could in some cases be considered among the spectrum of somatoform and pain syndromes in patients with PDs.
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Affiliation(s)
| | - Lara Draghi
- Clinical Neuropsychological Service, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria, 11, 20133, Milan, Italy
| | - Alberto Proietti Cecchini
- Headache and Neuroalgology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Massimo Leone
- Headache and Neuroalgology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
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Abstract
Cluster headache is an excruciating, strictly one-sided pain syndrome with attacks that last between 15 minutes and 180 minutes and that are accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection. The pain is so severe that female patients describe each attack as worse than childbirth. The past decade has seen remarkable progress in the understanding of the pathophysiological background of cluster headache and has implicated the brain, particularly the hypothalamus, as the generator of both the pain and the autonomic symptoms. Anatomical connections between the hypothalamus and the trigeminovascular system, as well as the parasympathetic nervous system, have also been implicated in cluster headache pathophysiology. The diagnosis of cluster headache involves excluding other primary headaches and secondary headaches and is based primarily on the patient's symptoms. Remarkable progress has been achieved in developing effective treatment options for single cluster attacks and in developing preventive measures, which include pharmacological therapies and neuromodulation.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
| | | | - Delphine Magis
- University Department of Neurology CHR, CHU de Liege, Belgium
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, VHIR, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Shuu-Jiun Wang
- Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Poletti B, Carelli L, Lafronza A, Solca F, Faini A, Ciammola A, Grobberio M, Raimondi V, Pezzati R, Ardito RB, Silani V. Cognitive-constructivist Approach in Medical Settings: The Use of Personal Meaning Questionnaire for Neurological Patients' Personality Investigation. Front Psychol 2017; 8:582. [PMID: 28443057 PMCID: PMC5387101 DOI: 10.3389/fpsyg.2017.00582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/29/2017] [Indexed: 01/04/2023] Open
Abstract
Objective: The cognitive-constructivist psychotherapy approach considers the self as a continuous regulation process between present and past experience, in which attributions of meaning is characterized by the use of internal rules. In this conception, everyone would be driven by a specific inner coherence called Personal Meaning Organization (PMO). Such approach has never been applied to neurological patients by means of ad hoc developed tools. We performed an explorative study aimed to characterize personality styles in different neurological conditions within the theoretical framework of cognitive-constructivist model. Materials and Methods: Three groups of neurological patients (Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Primary Headache) and a sample of healthy participants, each composed by 15 participants, for a total of 60 participants, were recruited. The Personal Meaning Questionnaire (PMQ), an Italian questionnaire assessing PMOs construct, and other clinical tools for psychological and quality of life assessment were administered to all subjects. Results: The main finding concerned the detection, across all clinical conditions, of a higher prevalence of phobic personality style, with Amyotrophic Lateral Sclerosis showing a relevant prevalence of such PMO with respect to all other neurological conditions and controls. However, with respect to controls, in all clinical conditions, PMQ highlighted a tendency, even if not statistically significant, to codify experience by means of specific cognitive and emotional patterns. Conclusion: Our findings represent the first contribution towards understanding the personality profiles of patients affected by neurological conditions according to cognitive-constructivist theory.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy
| | - Monica Grobberio
- Laboratory of Clinical Neuropsychology, Department of Neurology - ASST LarianaComo, Italy
| | - Vanessa Raimondi
- Department of Neurology and Clinical Psychology Services, ASST CremaCrema, Italy
| | - Rita Pezzati
- University of Applied Sciences and Arts of Southern SwitzerlandManno, Switzerland.,Centro Terapia CognitivaComo, Italy
| | - Rita B Ardito
- Center for Cognitive Science, Department of Psychology, University of TurinTurin, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico ItalianoMilan, Italy.,Department of Pathophysiology and Transplantation and "Dino Ferrari" Center, University of Milan Medical SchoolMilan, Italy
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Chronic Cluster Headache with an Atypical Presentation and Treatment Response. Case Rep Neurol Med 2016; 2016:5230127. [PMID: 28127484 PMCID: PMC5227136 DOI: 10.1155/2016/5230127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 01/03/2023] Open
Abstract
The management of cluster headache (CH) may be challenging. We report a 50-year-old male with recurrent attacks of dull and severe unilateral periorbital pain, lasting 30–45 minutes, twice a day, exclusively during sleep, and accompanied by ipsilateral rhinorrhea and lacrimation. The pain switched sides within every attack. CH treatment was initiated but the patient maintained recurrence rates compatible with chronic CH, even after increasing verapamil to 460 mg/day. Afterwards we decided to add lithium (800 mg/day). With this treatment the severity and recurrence of CH substantially decreased, despite the patient's autonomous decision to take lithium only during the acute phase of the cluster. The exclusively alternating location and the excellent response to short cycles of lithium represent two unique features of CH.
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