Editors' Note: Clinical Characterization of Delayed Alcohol-Induced Headache: A Study of 1,108 Participants

Abstract

In “Clinical Characterization of Delayed Alcohol-Induced Headache: A Study of 1,108 Participants,” Garcia-Azorin et al. reported that after surveying 1,108 university students who had headaches and consumed alcohol, they found that 95% of respondents met the criteria for delayed alcohol-induced headache (DAIH), which has features of both migraine and low-CSF-pressure headache. The latter headache phenotype was suggested because 66% of participants reported worsening headache in the upright or standing position. Gupta commented that the delay between consumption of alcohol and headache onset, which can also be seen with exposure to other headache triggers, may be related to the antinociceptive properties of vasopressin, serotonin, noradrenaline, and alcohol itself. Garcia-Azorin et al. responded that future studies on DAIH would benefit from serial measurement of blood and urine osmolarity, sodium, and copeptin, the precursor of plasma arginine vasopressin. Goadsby noted that although the results of this study are interesting, it is important to recognize that there are limitations to surveys and respondent perspectives on the definitions of key terms to describe their headaches may be inconsistent. Garcia-Azorin and Guerrero concurred that future studies should avoid variability in terminology by exploring the cadence of headache stabs, but reinforced the similarity between features of migraine and DAIH. Smith questioned the authors' conclusion about the frequency of low-CSF-pressure headaches among respondents given that they did not have documentation of CSF pressure or neuroimaging results. Garcia-Azorin and Guerrero agreed that this was an important point. They also noted that although research on the effects of alcohol is challenging, given that ethical considerations preclude forced intoxication, further creative approaches to research on DAIH are needed. In “Clinical Characterization of Delayed Alcohol-Induced Headache: A Study of 1,108 Participants,” Garcia-Azorin et al. reported that after surveying 1,108 university students who had headaches and consumed alcohol, they found that 95% of respondents met the criteria for delayed alcohol-induced headache (DAIH), which has features of both migraine and low-CSF-pressure headache. The latter headache phenotype was suggested because 66% of participants reported worsening headache in the upright or standing position. Gupta commented that the delay between consumption of alcohol and headache onset, which can also be seen with exposure to other headache triggers, may be related to the antinociceptive properties of vasopressin, serotonin, noradrenaline, and alcohol itself. Garcia-Azorin et al. responded that future studies on DAIH would benefit from serial measurement of blood and urine osmolarity, sodium, and copeptin, the precursor of plasma arginine vasopressin. Goadsby noted that although the results of this study are interesting, it is important to recognize that there are limitations to surveys and respondent perspectives on the definitions of key terms to describe their headaches may be inconsistent. Garcia-Azorin and Guerrero concurred that future studies should avoid variability in terminology by exploring the cadence of headache stabs, but reinforced the similarity between features of migraine and DAIH. Smith questioned the authors' conclusion about the frequency of low-CSF-pressure headaches among respondents given that they did not have documentation of CSF pressure or neuroimaging results. Garcia-Azorin and Guerrero agreed that this was an important point. They also noted that although research on the effects of alcohol is challenging, given that ethical considerations preclude forced intoxication, further creative approaches to research on DAIH are needed.