De Novo Chronic Cluster Headache Following Occupational Inhalational Exposure to Nitric Acid and Nitrogen Oxides: A Case Report
Abstract
Background/Objectives: Nitric oxide (NO) donors reliably provoke cluster headache attacks in susceptible individuals, supporting an important role of NO signalling in cluster headache pathophysiology. Headache following accidental nitric acid inhalation has previously been reported; however, de novo chronic cluster headache following inhalational exposure to nitric acid and nitrogen oxides has not been described. We report a case in which the close temporal relationship and clinical circumstances raise the possibility of secondary headache attribution according to the principles of the International Classification of Headache Disorders, 3rd edition (ICHD-3). Methods: We describe the clinical course of a 54-year-old man without a previous history of cluster headache or comparable recurrent headache attacks who developed a novel headache immediately following occupational inhalational exposure involving nitric acid and nitrogen oxides. Clinical characteristics, temporal evolution, diagnostic findings and treatment response were evaluated according to ICHD-3 criteria and interpreted in the context of published evidence concerning nitric acid-induced headache and NO-provoked cluster headache. Results: Following the inhalational event in September 2024, a novel headache occurred immediately and subsequently evolved into a characteristic trigeminal autonomic cephalalgia. From December 2024 onward, the patient experienced 5-8 daily attacks of severe to very severe, strictly…
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