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October 13, 2020; 95 (15) Article

Clinical characterization of delayed alcohol-induced headache

A study of 1,108 participants

David García-Azorín, Laura Aparicio-Cordero, Blanca Talavera, Andrew Johnson, Henrik Winther Schytz, View ORCID ProfileÁngel Luis Guerrero-Peral
First published September 1, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010607
David García-Azorín
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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Laura Aparicio-Cordero
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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Blanca Talavera
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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Andrew Johnson
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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Henrik Winther Schytz
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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Ángel Luis Guerrero-Peral
From the Headache Unit (D.G.-A., A.L.G.-P.), Neurology Department (B.T.), Hospital Clínico Universitario; Medicine Faculty (L.A.-C.), University of Valladolid, Spain; Pain Management Clinic (A.J.), RC Hospital and Clinics, Olivia, MN; Danish Headache Center (H.W.S.), Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; and Institute of Biomedical Research of Salamanca (A.L.G.-P.), Salamanca, Spain.
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  • ORCID record for Ángel Luis Guerrero-Peral
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Clinical characterization of delayed alcohol-induced headache
A study of 1,108 participants
David García-Azorín, Laura Aparicio-Cordero, Blanca Talavera, Andrew Johnson, Henrik Winther Schytz, Ángel Luis Guerrero-Peral
Neurology Oct 2020, 95 (15) e2161-e2169; DOI: 10.1212/WNL.0000000000010607

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Abstract

Objective To evaluate the International Classification of Headache Disorders (ICHD) criteria and to characterize the clinical phenotype of delayed alcohol-induced headache (DAIH).

Methods We conducted a cross-sectional study of university students who voluntarily consumed alcohol and experienced headache. Participants completed a survey that included demographic and clinical data. We analyzed the phenotype of the headache, validated ICHD phenotype criteria for DAIH, and analyzed whether participants fulfilled criteria for low-CSF-pressure headache or migraine.

Results A total of 1,108 participants were included (58% female, mean age 23 years, 41% with headache history). Mean alcohol intake was 158 g; spirits were consumed by 60% of the participants; beer was consumed by 41%; and wine was consumed by 18%. The ICHD criteria for DAIH were met in 95% of the participants. Headache duration (mean, 6.7 hours) correlated with total grams of alcohol consumed (r = 0.62, p = 0.03). Pain was bilateral in 85% of patients with predominantly frontal topography (43%). Pain quality was mainly pressing (60%) or pulsatile (39%) and was aggravated by physical activity in 83% of participants. ICHD low-CSF pressure-headache criteria were fulfilled in 58% of patients, and migraine criteria were fulfilled by 36%.

Conclusions DAIH is a moderate-intensity headache, is typically bilateral, and presents with frontal predominance and a pressing quality. The phenotype of DAIH combines features of both migraine and low-CSF-pressure headaches.

Glossary

ABV=
alcohol by volume;
CI=
confidence interval;
DAIH=
delayed alcohol-induced headache;
ICHD-3=
International Classification of Headache Disorders, 3rd edition;
MS-Q=
Migraine Screen Questionnaire;
VAS=
visual analog scale

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received January 4, 2020.
  • Accepted in final form May 8, 2020.
  • © 2020 American Academy of Neurology
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Letters: Rapid online correspondence

  • Author response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • David García-Azorín, Neurologist, Hospital Clínico Universitario de Valladolid
    • Ángel L. Guerrero, Neurologist, Hospital Clínico Universitario de Valladolid
    Submitted October 16, 2020
  • Reader response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • Jonathan H. Smith, MD, Associate Professor of Neurology, Mayo Clinic (Rochester, MN)
    Submitted October 15, 2020
  • Author response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • David García-Azorín, Neurologist, Hospital Clínico Universitario Valladolid, Valladolid, Spain
    • Ángel L. Guerrero, Neurologist, Hospital Clínico Universitario de Valladolid (Valladolid, Spain)
    Submitted October 07, 2020
  • Reader response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • Peter J. Goadsby, Neurologist, University of California, Los Angeles/King's College London
    Submitted October 03, 2020
  • Author response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • David García-Azorín, Neurologist, Hospital Clínico Universitario de Valladolid
    • Henrik W. Schytz, Neurologist, Danish Headache Center
    • Ángel L. Guerrero, Neurologist, Hospital Clínico Universitario de Valladolid
    Submitted September 10, 2020
  • Reader response: Clinical characterization of delayed alcohol-induced headache: A study of 1,108 participants
    • Vinod K. Gupta, Physician-Medical Director, Migraine-Headache Institution, Gupta Medical Centre (New Delhi, India)
    Submitted September 03, 2020
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