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

I read the article by García-Azorín1 with interest. The clinical phenotyping of alcohol-induced headache is an interesting data set addressing a relatively common phenomenon not well studied. The extent to which low CSF pressure is responsible for the clinical features is complex. There are subtle linguistic aspects that are constrained by questionnaires. As an example, when a respondent uses the term stabbing, are they saying a sharp pain with irregular or regular cadence? The latter could be considered throbbing because throbbing is about cadence, not quality. The extent of overlap between the box ticked for sitting or standing as a manifestation of activity, rather than posture, can sometimes require very careful dissection of the history and may lead here to misattribution of the symptom. Looking at table 4, if one takes any migrainous symptom, 91% of patients classified as “orthostatic headache” had at least one. As with any good research, this is a great start to get a much better handle on the biological basis of alcohol-induced headache.

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