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Relieving the Worst Headaches?

How can one treat cluster headaches?

Answer (Published 11/6/2002)

A severe type of headache, cluster headaches are more common in men than women. They affect only one side of the head and typically occur at the same time every day for a period of weeks or months. Then, in most cases, the "cluster" period ends, leaving you headache-free for weeks, months, even years.

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Cluster headaches cause intense, throbbing pain usually concentrated around the eye and temple that typically lasts for 30 minutes to two hours. Symptoms often include nasal congestion on the affected side of the head. The affected eye may tear and redden, the pupil may become smaller and the eyelid may droop. One or more headaches may occur during the "cluster," always at the same times daily. This pattern suggests that the biological clock in the hypothalamus may be responsible, although no one knows for sure what causes this ailment. It doesn’t run in families, but most affected men are heavy smokers. (Quitting doesn’t stop the headaches immediately but may help over time.) Drinking alcohol during a "cluster" period can set off an immediate attack.

If you have cluster headaches, try to find a physician who has experience treating them. A number of approaches are available for both prevention and relief:

  • Oxygen: Inhaling 100 percent oxygen through a mask for 15 minutes relieves headaches in up to 80 percent of all cases.
  • Ergotamine: A prescription medication that narrows blood vessels; the suppository form works faster than pills.
  • Calcium channel blockers: Intended to treat high blood pressure, these drugs (particularly verapamil) also can help prevent cluster headaches.
  • Methysergide maleate: For prevention and relief.
  • Lithium carbonate: For headache prevention during "cluster" periods; dosage must be carefully adjusted to avoid side effects.
  • Prednisone: For both prevention and relief.

If these treatments don’t help alone or in combination, surgery to disable the nerve that carries the pain signals may be recommended. It works in about two-thirds of all cases. Recently, researchers at the Mayo Clinic in Scottsdale, Arizona reported that an implanted device that stimulates the occipital nerve at the back of the head helped one patient remain headache-free for seven months. More research is needed to see how well it works for others. My recommendations would be, first, to eliminate all caffeine and to practice some relaxation technique such as biofeedback. I would also try acupuncture as a treatment and take supplemental magnesium as a preventive (400 milligrams daily).

Andrew Weil, M.D.

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