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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.