Cocaine Should Never Be Used to Treat Headaches or PMS
No, cocaine is absolutely contraindicated for the treatment of headaches and premenstrual syndrome malaise—it causes headaches rather than curing them and poses severe cardiovascular and neurological risks.
Why Cocaine Causes Rather Than Treats Headaches
Cocaine is a potent vasoconstrictor that triggers headaches through multiple mechanisms:
- Cocaine blocks reuptake of norepinephrine, dopamine, and serotonin, causing excessive sympathetic stimulation and severe vasoconstriction of cerebral and coronary arteries 1
- Even small intranasal doses cause coronary artery vasoconstriction through α-adrenergic receptor stimulation 1
- Cocaine increases endothelin-1 (a powerful vasoconstrictor) while decreasing nitric oxide (a vasodilator), creating a perfect storm for vascular complications 1
- Headache is one of the most common symptoms appearing after cocaine use, occurring through dopaminergic and serotoninergic system impairment 2
- Cocaine-induced headaches can occur immediately after use, within 40-90 minutes of a binge, or even after prolonged abstinence 2
Severe Medical Complications of Cocaine Use
The cardiovascular and neurological toxicity makes cocaine dangerous even in small doses:
- Cocaine causes dose-dependent increases in heart rate, blood pressure, and myocardial oxygen demand while simultaneously reducing coronary blood flow through vasoconstriction 3, 1
- Neurological complications include reversible cerebral vasoconstriction syndrome (RCVS), aneurysm formation, ischemic stroke, hemorrhagic stroke, subdural and subarachnoid hemorrhage, and seizures 2
- Most deaths from cocaine intoxication are sudden and occur before medical intervention is possible 4
- Cocaine has high addiction potential—while one case report describes attempted self-medication of migraine with cocaine, the patient developed full-blown cocaine dependency disorder 5
Evidence-Based Treatments for Headaches
For migraine and tension-type headaches, proven effective treatments include:
- Amitriptyline 30-150 mg/day is the first-line preventive agent with consistent evidence for efficacy in chronic tension-type headache and migraine prevention 3, 6
- Propranolol 80-240 mg/day and timolol 20-30 mg/day have strong evidence for migraine prevention 3, 6
- NSAIDs (naproxen, ibuprofen) are first-line acute treatment for mild-to-moderate migraine 7
- Triptans are recommended for moderate-to-severe migraine attacks 7
Evidence-Based Treatments for PMS-Related Symptoms
For premenstrual syndrome with headache component:
- Migraine without aura is the most common headache type in PMS (60%), followed by tension-type headache (30%) 8
- NSAIDs have demonstrated effectiveness in menstrual migraine prophylaxis and can address both PMS symptoms and headache 9
- Magnesium, phytoestrogens, and combined oral contraceptives containing drospirenone taken continuously for 168 days show promise for PMS-related symptoms 9
- Short-term perimenstrual prophylaxis with NSAIDs or triptans can be used when symptomatic treatment is insufficient 9
Critical Clinical Pitfall
If a patient presents with cocaine-induced acute coronary syndrome and signs of acute intoxication (euphoria, tachycardia, hypertension), beta-blockers are contraindicated due to risk of unopposed alpha-adrenergic stimulation causing worsening coronary spasm 3. Instead, use benzodiazepines alone or combined with nitroglycerin 3.