Cluster headaches are possibly the worst pain humans can experience. Usually affecting one side, it feels like needles or red hot pokers being pushed into the head or the eye. It is usually associated with a tearing, red running eye, small pupil, sweating. They can occur in clusters, and in some people they occur regularly at the same time of the day or night. Possibly the daily biological rhythms may play some part, as changes to other time zones or daylight savings can start a series of clusters.
What your doctor can do
Drugs – there are a number of drugs which can be tried to prevent the attacks, including calcium channel blockers (verapamil – 240-360 mg/day), prednisone (30mg) or other steroids sometimes helps, and some anti epileptic drugs (Epelim and Tegretol).
- Intravenous magnesium can be used to treat an attack (click here), especially in those with low magnesium levels
- Sumitryptan (imigran) is very effective (pain-free in 20 minutes in 75% of people , best by subcutaneous injection. Some patients can administer these themselves. Nasally administered Zolmitriptan can also be used. However there is concern in people with heart disease where these drugs should be avoided, they can cause chest pain and should not be given more than every 12 hours.
- Lignocaine sprayed into the mouth or nose can sometimes help with an attacks
- Oxygen is the treatment of choice. Put on an oxygen mask and run it at as high a flow rate as possible (use rebreathing mask if possible) and it can stop an attack in seconds – it is like a miracle.
- For prevention, the calcium channel blocker Verapamil 240 – 320mg per day reduces attacks but some people need to go up to 960mg for maximal benefit. Steroid drugs may be helpful byt have long term side effects, and other drugs like methysergide and lithium are too poisonous to consider.
What you can do –
The change in time zones and belief that they start in the hypothalamus deep in the brain, suggests that regular time keeping and perhaps the use of melatonin may make some difference. Cigarette smoking is associated with these headaches, but stopping does not make them go away – it is best never to start.
Prevention
- Melatonin has been shown to help reduce cluster attacks, and if one is changing time zones, then taking melatonin at bedtime regularly may help.
- Magnesium given iv can help with an attack, so it seems logical to take magnesium regularly ( 500-800mg daily) as a preventative.
- Acupuncture helps some people
- Drinking plenty of water – some people find that drinking plenty of water (a glass every hour) at the times when clusters occur can make a difference.
For an acute attack
- Strong cups of coffee (or the drug cafergot) can sometimes help
- Focus on another part of the body – eg big toe may help
- Hard physical exercise sometimes helps.
- Oxygen is almost magic in its effect. If possible buy an oxygen cylinder and use it when an attack occurs (see above).
The Nutritional supplements I use and recommend to my patients
For my cluster headache patients I recommend – USANA – melatonin, Active Calcium plus, Proflavanol C –