Cluster Headaches: a Plague among Men
The insidious condition called a cluster headache is
in reality a form of migraine headache with one very obvious difference;
cluster headaches occur primarily among young to middle-aged men, and
they occur in cycles that can last for weeks, rather than single-episode
migraines.
Medical science has no explanation for this, but research bears out its
truth. Since there are exceptions to every so-called rule, men do have
“normal” migraines such as women mostly have – if such pain can ever be
called normal- and some women have cluster migraines too. These are
simply manifestations of the over-all syndrome of the horrific pain of
the migraine headache.
Medical researchers soon found several notable differences in “regular”
migraines and cluster migraine headaches. Cluster headaches mostly occur
in men, their pain level is even more intense than that of a non-cluster
migraine, and cluster headaches don’t appear to respond as well to the
new triptan drugs like Imitrex, Maxalt and Relpax as non-cluster
migraines do.
Non-cluster migraine sufferers tend to scoff at the idea that clusters
are even more painful, knowing just how truly incapacitating a migraine
headache can be. But research also bears this to be true; it may be that
men don’t tolerate pain as well as women, or the cluster headache may
truly deserve its vicious reputation.
Migraine headaches of both types occur when a blood vessel in the brain
suddenly constricts and then engorges, causing intense, throbbing pain
usually behind or near an eye. They are typically relieved by the
triptan class of drugs that are vaso-constrictors; these drugs shrink
the engorged vessels, thus relieving pain.
Cluster migraine headaches result from a large group of engorged blood
vessels also in proximity to an eye, but they also can occur anywhere in
the head, unlike non-cluster headaches. Clusters tend to wax and wane;
just as the sufferer starts to feel less pain, the pain suddenly
increases to its previously intense level.
What Helps Cluster Headaches?
Many sufferers find relief with a combination of preventative medication
like Inderal, an anti-hypertensive drug, and use of a triptan medication
when a cluster headache does occur. Clusters, however, are capricious by
nature; is it truly gone, or will it be back in two hours?
Unfortunately, once a cluster headache cycle takes hold, it leaves its
calling card as if saying “…..I’ll be back!”
Unlike non-cluster migraines, these headaches occur in cycles; a man may
have a severe episode of cluster headaches that can last for weeks, on
and off. Of course, this is extremely physically handicapping because
the sufferer never knows when the next one will come; at work, at his
son’s ballgame or in the middle of the night? Being awakened by a
cluster migraine is a classic diagnostic feature; non-clusters don’t
spontaneously occur at night, and clusters do.
An additional danger with cluster headaches is the possibility that the
sufferer may be so incapacitated and demoralized by this unbearable
condition that he starts to think about suicide, and may actually have a
plan to take his own life to get away from his pain. For this reason, a
neurologist treating a man for cluster migraines will consult with a
psychiatrist regarding anti-depressant medication. This, combined with
supportive psychotherapy in pain management, helps decrease
significantly the danger of suicide.
If nothing seems able to break the cycle of cluster headaches,
neurologists have no choice but to administer to the patient a
“cocktail” of Thorazine (a sedating anti-psychotic), Valium (a
tranquilizer and muscle relaxer) and Phenobarbital (a sedative
barbiturate). This treatment must be carefully “concocted” and
monitored, usually by a day or two in the hospital since overdose of any
of these medications can be fatal. The neurologist may keep the sufferer
deeply asleep for up to three days. But it works; once the cluster
headache cycle is broken, the patient finds relief…until the next cycle.
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