Author Response: Clinical Characterization of Delayed Alcohol-Induced Headache: A Study of 1,108 Participants

We appreciate Dr. Goadsby’s comment on our article.1 As we used an online questionnaire, we were not able to catch the differentiation between regular stabs, which could be—as Dr. Goadsby pointed out—interpreted as throbbing. In our questionnaire, patients were allowed to describe more than 1 pain quality, and within the 219 (19.8%) participants who described stabbing headache, 58 (26.5%) of them described throbbing pain as well. The frequency of typical migraine symptoms was even higher than in the group of patients with stabbing pain when compared with those with throbbing pain: unilateral pain (24.4% vs 12.2%), photophobia (48.3% vs 37.7%), phonophobia (66.3% vs 59.4%), osmophobia (29.1% vs 25.9%), nausea (54.1% vs 51.9%), or vomiting (30.8% vs 31%). Therefore, future studies should clarify the cadence of the stabs. In addition, we calculated the percentage of patients with at least 1 migrainous symptom in the entire sample, including throbbing or stabbing pain, photophobia, phonophobia, osmophobia, vomiting, cranial autonomic symptoms, or aggravation with movement, and we found that it was 91%. Both findings suggest that migraine features are common in patients with delayed alcohol-induced headache despite just a proportion of them fulfilling International Classification of Headache Disorders phenotypic criteria.

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