cinchonismheadache

Cinchonism is a syndrome caused by exposure to quinine or related alkaloids, typically resulting from therapeutic use of quinine-containing medications or excessive intake of products such as tonic water. Headache is a common feature of cinchonism, and the condition can include a broader range of neurologic and sensory symptoms.

Causes and risk factors include ingestion or administration of quinine and quinidine, either at prescribed doses or in excess. Large amounts of tonic water or quinine-containing preparations can contribute. Risk factors that increase quinine levels or susceptibility include liver or kidney impairment, advanced age, dehydration, and interactions with other drugs that inhibit quinine metabolism (such as certain antibiotics and antifungals). Individual sensitivity also plays a role.

Clinical features commonly involve headache, tinnitus, and hearing loss or impairment, often accompanied by dizziness or vertigo. Visual disturbances, nausea, flushing, sweating, and tachycardia may occur. In more severe cases, confusion, delirium, seizures, or hypotension can develop.

Diagnosis relies on clinical history and examination, with attention to recent quinine exposure. There is no single specific test for cinchonism; serum quinine levels may be checked in some cases, but management is guided by symptoms and exposure. The condition is distinguished from other causes of headache by its temporal association with quinine-containing substances.

Treatment centers on stopping the offending agent and providing supportive care. Most cases improve as quinine is cleared from the body. Severe symptoms or instability require hospitalization and close monitoring. Prognosis is generally favorable with discontinuation and appropriate care. Prevention focuses on limiting quinine exposure and avoiding high-dose or unnecessary use of quinine-containing products.