Cluster headache polygenetic risk and known functional variants of CYP3A4 are not associated with treatment response


BACKGROUND AND PURPOSE: The response to cluster headache treatments has a high interindividual variation. To date, treatment response has only been assessed by a candidate gene approach and no investigations into metabolic pathways have been performed. Our aim was to investigate the association between the polygenetic risk of cluster headache and treatment response to first-line cluster headache treatments as well as known functional variants of CYP3A4 and the response to verapamil. Further, it was aimed to replicate previous single nucleotide polymorphisms found to be associated with treatment response in cluster headache and/or migraine.

METHODS: In, 508 cluster headache patients diagnosed according to the International Classification of Headache Disorders were genotyped and participated in a semi-structured interview to evaluate treatment response. Polygenetic risk scores were calculated by the effect retrieved from a meta-analysis of the latest two genome-wide association studies on cluster headache.

RESULTS: Inferior treatment response to oxygen, triptans and verapamil is associated with chronicity of cluster headache were confirmed but no evidence was found that a response could be predicted by a high genetic risk of cluster headache. Likewise, verapamil response was not associated with functional variants of CYP3A4. No support of the genetic variants previously reported to be associated with treatment response to triptans or verapamil was found.

CONCLUSION: The clinically relevant variation in treatment response for cluster headache was not influenced by genetic factors in the present study.

Original languageEnglish
JournalEuropean Journal of Neurology
Issue number5
Pages (from-to)1425-1434
Number of pages10
Publication statusPublished - May 2023


  • Cluster Headache/drug therapy
  • Cytochrome P-450 CYP3A/genetics
  • Genome-Wide Association Study
  • Humans
  • Tryptamines
  • Verapamil/therapeutic use
  • polygenetic risk score
  • cytochrome P450 3A
  • cluster headache
  • verapamil
  • oxygen
  • sumatriptan


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