An international multicenter study sheds light on the causes of cluster headache, an extremely disabling disease that mostly affects men and which, fortunately, is very rare (0.1%): there are eight regions of the genome associated with a greater risk of suffering from it that are activated especially by smoking. This would explain, in part, why 80% of those affected are smokers and the rest are people who were exposed to tobacco smoke by smoking parents as children.
The study, in which 16 headache research groups from 13 countries have collaborated and which has been published in the Annals of Neurology, is based on genetic data from 4,777 cluster headache patients and 31,575 healthy people from Europe and East Asia.. The episodes of pain can occur more than once a day for a period of time ranging from three weeks to three months and, in some cases, can become chronic.
Patricia Pozo-Rosich, section head of the Neurology Service and Headache Unit at the Vall d'Hebron University Hospital in Barcelona, head of the Headache and Neurological Pain group at the Vall d'Hebron Research Institute (VHIR) and director of the Migraine Adaptive Brain Center (Centre for Migraine and the Adaptive Brain) of Vall d'Hebron, has explained to this newspaper about the study, in which the VHIR Psychiatry, Mental Health and Addictions group has also collaborated, which has been possible because an international consortium on the genetics of migraine was created, from which another emerged (many of the researchers, including those from Vall d'Hebron, are part of both) focused on cluster headache, a disease that until now very little was known because of his scant research.
The expert recalls that, prior to this work, neuroimaging tests knew of the involvement of the posterior hypothalamus and a 2007 study in an animal model indicated that hypoxia (it can be caused by tobacco) acted on the hypothalamus, which is a central regulator biorhythms (when to release hormones).
Highlights of the new international study that associates the disease with several genes related to the brain and arteries, which reinforces the idea about the role that blood vessels play in the pathology. The smoking habit, for its part, is also related to the deterioration of the arteries. And it has been seen with this study that smoking increases the expression of the MERTK gene (also related to migraine) and decreases it in the CFTR gene, which are changes observed in patients with cluster headache.
Pozo-Rosich also underlines the importance of this new evidence for the prevention of the disease but also for the clinic, since in a patient with cluster headache who does not quit smoking it is very difficult to control the disease and, on the contrary, if kick the habit, it will get better.
He points out that the habitual consumption of tobacco in these patients would be explained by genetic factors shared with depression, defiant behaviour, attention deficit hyperactivity disorder (ADHD), musculoskeletal pain and a similar but not the same disease: migraine.. The work delves precisely into the relationship between cluster headache and migraine and concludes that the genetic basis differs greatly between them.
Pozo-Rosich believes that it is possible that there is another factor related to the disease, which, as mentioned above, is eminently masculine: testosterone. “Possibly there is more than one factor involved in the manifestation of the disease,” he concludes.