Cluster Headaches Responding to New Treatments by Gina Shaw Itís 1:05 a.m. Youíre deep in a peaceful sleep. Itís 1:10 a.m. Youíre jolted out of that peaceful sleep by a blinding pain above one eye that nearly knocks you out of bed. Your eye tears and that side of your face breaks out in a sweat. You canít sit still. The pain is so bad that banging your head against a wall for a few minutes sounds like a reasonable option for relief. If youíve never had a cluster headache, sufferers say, you have absolutely no idea how painful they are. And even if you do have cluster headaches, you may well have no idea what they are. Almost everyone has heard of migraines and tension headaches, but cluster headaches, which make the dull, behind-the-eye throbbing of average tension headaches seem like a gentle massage, are only beginning to get the same kind of attention. Once you know what distinguishes them, cluster headaches are not hard to miss. Their pain has been described as ìexcruciatingly relentless.î Attacks hit as many as seven or eight times a day and last up to several hours, then disappear as quickly as they came on. After a head-searing ìclusterî of attacks, the headaches may disappear for weeks or mo nths before returning with a vengeance. The pain usually begins in or around one eye and often wakes the sufferer in the middle of the night, unlike tension headaches or migraines, which typically occur during the day. And unlike migraines, cluster headaches affect more men than they do women. With pain this severe and unrelentingósome women with cluster headaches say the pain of childbirth is easier to withstandóitís not surprising that aspirin and other common analgesics have little effect. There are several other treatment options, though none has proven to be a ìmagic bulletî for everyone. One of the most common and effective remedies for cluster headaches is simple oxygen. Breathing 100 percent oxygen from a tight-fitting mask for about 15 minutes has been shown to dramatically reduce or eliminate the headache in most patients. Of course, a portable oxygen tank can be more difficult to tote around than a bottle of Advil. Several prescription medications also provide relief for many cluster headache sufferers. Some drugs, including steroids such as prednisone, have also been shown to help stave off cluster attacks. The triptan family of drugs, used to treat migraines, is particularly effective in relieving the symptoms of an acute attack, specialists say. Injections of Imitrex (sumatriptan succinate) are another standard treatment for cluster headaches, and other triptans are also sometimes used. But these drugs arenít without their side effects. Nausea and dizziness are among the most common side effects, and triptans can have more serious cardiovascular complications as well, so people with a history of heart disease, stroke, diabetes or other cardiovascular risk factors shouldnít take them. Within the last several years, scientists have identified another possible trigger for cluster headaches, which in turn points to another potential treatment option. The majority of people with cluster headaches may also have a severe sleep disorder known as obstructive sleep apnea, which appears to trigger the attacks, University of Michigan scientists reported in a study published in 2000 in the journal Neurology. In the study, 25 people with cluster headaches spent nights being evaluated in a sleep laboratory, where researchers found that a full 80 percent of them showed signs of sleep apneaóbrief but repeated disruptions of sleep that occur when the upper airways close and breathing stops for a few seconds or even longer. Oxygen deprivation from sleep apnea, scientists theorize, may trigger cluster headaches. ìNone of these people knew that they had sleep apnea before the study,î said University of Michigan neurologist Dr. Ronald Chervin, an author of the study. ìItís important for sleep apnea to be diagnosed because treatment may reduce or eliminate the headaches, not to mention the other problems that can result from sleep apnea.î However, scientists caution that these results do not mean that sleep apnea directly causes cluster headaches. There may be yet another condition that causes both disorders. ìWe donít think that sleep apnea directly causes cluster headaches, but there is a strong likelihood that it may trigger them during a vulnerable period,î Chervin said. The most common treatment for sleep apnea is a continuous positive air pressure mask, or CPAP, worn during the night to deliver air at a constant pressure and keep the throat open. Extremely effective against sleep apnea, its ability to relieve accompanying cluster headaches is still being tested, but CPAP did show promise among the patients in Chervinís study who agreed to try it. For some cluster headache sufferers, however, none of these remedies works. Their pain, known as intractable chronic cluster headache, seems unresponsive to any medication or other type of treatment. At the April meeting of the American Association of Neurological Surgeons, researchers reported that a surgical treatment option called deep brain stimulation (DBS)óalso being studied in the treatment of some types of epilepsyóhas shown promise in relieving intractable cluster headaches. The small study involved only eight patients, but after four weeks of DBS treatment, all reported progressive relief in their cluster attacks and remained pain-free during two years of follow-up treatment. So if youíre plagued by cluster headaches, you donít have to suffer in silenceóor bang your head against the wall. A referral to a neurologist who specializes in headaches can open the door to a number of treatment options. Gina Shaw is the medical writer for The Washington Diplomat.