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When patients complain of migraine-like headaches, add cocaine use to the differential diagnosis. This report describes three cases of new-onset headache syndromes in patients who had no family or personal history of migraine.
One case was a 27-year-old man who smoked crack and injected intravenous cocaine. He had recently accelerated his cocaine use, and during a binge he experienced the first of several throbbing headaches behind his right eye accompanied by photosensitivity. He injected more cocaine to get relief, but subsequently noticed that the headaches surged about 90 minutes after each injection. In another case, a 28-year-old woman noted right-sided headaches about 90 minutes after intranasal administration of cocaine. In the third…