The Good Health Magazine
After migraine, the most common type of severe headache is the cluster headache, which comes in two forms--episodic and chronic. In the episodic form, the headaches come in clusters of one to three a day for about two months. The patient then may go for a year or longer without headaches until the next cluster occurs.
In the chronic form, the patient gets one to 10 headaches every day for the rest of his life.
In cluster headaches, the pain generally is more severe than in migraines. The most common description is that it is like having a red-hot poker slowly pushed through one of your eyeballs.
In addition to the pain, tears pour from one eye and the nose runs. The affected eye turns red, the pupil gets smaller, and the lid droops. Throughout all of this, the opposite eye “is clear as a bell,” says Gary Diamond of Van Nuys, a 34-year-old pawnbroker who had his first cluster headache when he was 17. “Nobody can mistake it when it is happening.”
Regarding gender, cluster headaches are the opposite of migraines: Men are six times more likely to have cluster headaches than women. But as is the case with migraines, physicians don’t really know what causes them.
Dr. Lee Kudrow of the California Medical Clinic for Headache in Encino has his suspicions. Tests on himself and others show that cluster victims have unusually low concentrations of oxygen in their blood during the cluster periods. Those concentrations are controlled by the hypothalamus, that portion of the brain that controls circadian rhythms--the 24-hour cycles that regulate body temperature, hormone levels, and a host of other functions.
In an unexpected finding reported this summer, Kudrow found that cluster headaches occur with the highest frequency in January and July, about 7 to 10 days after the longest and shortest days of the year. The second most common times are 7 to 10 days after daylight savings time begins and ends. The results suggest that the changes in the length of the day alter circadian rhythms in the hypothalamus and thereby somehow affect oxygen concentrations in the blood.
Cluster headaches can be aborted in many people with ergotamine and similar drugs that constrict blood vessels. But by far the best therapy is breathing pure oxygen for at least 15 minutes. Oxygen will cure the headaches during that period in at least 90% of patients, Kudrow says.
Diamond had his first cluster headache when he was on a camping trip. “I thought something had bored into my head,” he says. They became so frequent and severe that he dropped out of school in the 11th grade. “I lived at home, I couldn’t work.”
Seven years ago, he first visited Kudrow after another neurologist told him that “you’ll just have to learn how to live with them.” Says Diamond, “(Kudrow) was the first break I ever had for clusters.”
Kudrow started him on two drugs, ergotamine and verapamil, a member of a family of drugs called calcium-channel blockers. “That was the point where my headaches started to go away,” Diamond says.
He also keeps tanks of oxygen at home and at his work, although he rarely has to use them. “My last real headaches were more than a year ago. They were very mild, but you could tell they were clusters. There was a two-year gap before that . . . I am very grateful.”
