title: Impact of continuing or quitting smoking on episodic cluster headache: a pilot survey.
abstract: BACKGROUND
  The majority of patients suffering from cluster headache (CH) are smokers and it has been suggested that smoking may trigger the development of CH. The aim of this pilot survey was to describe: 1. the differences between current, former, and never smokers CH patients; 2. if smoking changed during an active cluster period; 3. if CH changed after quitting.
  
  
  METHODS
  All outpatients with episodic CH according to the criteria of ICHD-II who were consecutively seen for the first time from October 2010 to April 2012 at a headache centre were interviewed by phone using a specifically prepared questionnaire. Statistical differences between continuous variables were analysed by the Student's t-test or the one-way analysis of variance (ANOVA), followed by Newman-Keuls post-hoc testing. Comparisons between percentages were made using the Chi-square test or Fisher's exact test. All data were expressed as the mean ± standard deviation (SD).
  
  
  RESULTS
  Among a total of 200 patients surveyed (172 males, 28 females; mean age ± SD: 48.41 ± 12 years) there were 60%, 21%, and 19% of current, former, and never smokers, respectively. Current smokers reported longer active periods (12.38 ± 10 weeks) and a higher maximum number of attacks per day (3.38 ± 1) compared to never smoker CH patients (5.68 ± 4 weeks, P <0.05 and 2.47 ± 1, P <0.05, respectively). During the active period most of the patients stated to decrease (45.7%) or not to change (45.7%) the number of cigarettes smoked. Among those who decreased smoking, most (83.8%) reported that they had less desire to smoke. After quitting, the majority of former smokers stated that their headache had not changed.
  
  
  CONCLUSIONS
  Patients with episodic CH who are also smokers appear to have a more severe form of the disorder. However, it is unlikely that between CH and smoking there is a causal relationship, as CH patients rarely improve quitting smoking.
authors.affiliation: Headache and Drug Abuse Inter-Department Research Centre, Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia- Policlinico, Largo del Pozzo, 71-41100 Modena, Italy. anna.ferrari@unimore.it
authors.forename: Anna
authors.initials: A
authors.lastname: Ferrari
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zappaterra
authors.forename: Federica
authors.initials: F
authors.lastname: Righi
authors.forename: Michela
authors.initials: M
authors.lastname: Ciccarese
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tiraferri
authors.forename: Luigi Alberto
authors.initials: LA
authors.lastname: Pini
authors.forename: Simona
authors.initials: S
authors.lastname: Guerzoni
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Cainazzo
mesh_terms: D003027:Cluster Headache / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D011795:Surveys and Questionnaires