DEAR DR. GOTT: My 43-year-old son has cluster headaches that began about five years ago. The first series was twice daily at about the same time each day. The bout lasted between six and eight weeks, and then stopped.
Two years later, they returned once daily. His doctor did an MRI that was normal and diagnosed him with cluster headaches. He was put on heavy doses of steroids that weren’t successful.
He recently began another series. They now occur once daily between 9 p.m. and 11:30 p.m. He went to a neurologist and tried several different medications that were unsuccessful. This time frame and duration fluctuates more, and he skipped two days twice. Pain medications don’t work.
My son has done a lot of research on the Internet. However, so far the legal recommended procedures do not work for him.
Isn’t there anything to relieve the terrible pain he endures, as well as the anxiety he experiences prior to their occurrence? The pain he describes is like he would imagine having an ice pick stuck in his head in the exact same location. He also says he cannot breathe out of his nose during an attack, and his eyes water so that he cannot see. Any help or advice would be sincerely appreciated.
DEAR READER: Your son’s presentation of cluster headaches is textbook. Events may last from weeks to months, followed by periods of remission, when they may stop completely. Remission can be for a month or for several years. The duration of a single attack may be several minutes or, unfortunately, several hours. Attacks commonly occur at the same time each day. Patterns vary from person to person. Unfortunately for your son, his events occur more frequently than the norm, which is one or two annual cluster periods.
Cluster headaches may occur without prior warning. Symptoms include a stuffy or runny nose, restlessness, redness and swelling around the eye on the affected side of the face, and excessive tearing. Most people with the diagnosis avoid lying down during an attack, because the position appears to exacerbate pain.
The cause of the cluster is unknown; however, it is believed tied to an abnormality of the hypothalamus, the portion of the brain that controls many bodily functions to include the nervous and endocrine systems. Chemicals that carry impulses to the brain are thought to be involved as well. Abnormal melatonin and cortisol levels are common during events.
Unfortunately, there is no cure for cluster headaches. Once diagnosed, long-term medication will likely be prescribed. This will likely be backed with short-term medication that may prevent an attack until the long-term drug kicks in. Treatment is directed toward decreasing pain, shortening the duration of events and prevention. Over-the-counter medications are ineffective. A physician, however, might prescribe sumatriptan, commonly used for migraines, zolmitriptan nasal spray, inhaled or IV dihydroergotamine, or oxygen inhaled through a mask. Surgery can be performed only once and can have serious drawbacks.
High altitudes with reduced oxygen levels can be to blame. Avoid alcohol, tobacco smoke, cleaning solvents, oil-based paints, gasoline, heavy fumes, foods such as smoked products and some processed meats that contain nitrates, as well as medications such as nitroglycerine.
Anxiety is common with cluster headaches. Your son might benefit from speaking with a therapist or by joining a support group. He should ask his primary-care physician or neurologist for a reference.
To provide related information, I am sending you a copy of my Health Report “Headaches.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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