Diagnosing cluster headaches

March 9, 2009 3:33:03 PM PDT
A lot of people are sleepy, especially after springing forward early Sunday and losing an hour of sleep.This time of year can also prompt painful headaches for some people.

They are called cluster headaches, ominously referred to as "suicide headaches" because the pain is so severe that patients have sought the ultimate relief. They're six times more common in men than women, and for some, they started this weekend.

Forty-eight-year-old Olga Candelaria says she's glad she found the Montefiore Headache Center. Since she was 16, she's been told she had migraine headaches. But the symptoms were behind one eye, in her face and jaw.

"Like a train hitting your head," she said. "Your eye starts getting droopy, your nose gets stuffy, hard to breathe."

No, not migraines. Olga had cluster headaches, severe pain lasting an hour, coming several times a day, and clustered in the weeks and months around seasonal changes and man-made time changes.

The cluster periods commonly occur after the longest and shortest days of the year, and also after the resetting of the clock for daylight savings time.

As for the pain?

"One of the most excruciating pain conditions of mankind," Dr. Brian Grosberg said. "I had a woman tell me it's like giving birth to 100 babies at the same time without an epidural."

It's so bad, says Dr. Grosberg, that some patients bang their head against the wall, cry out, and, to end the pain when the clusters hit, some have committed suicide.

During these cluster periods, there are things that trigger the headaches. Alcohol is one. Another is nitrates in hot dogs and medications. Also, a lack of oxygen can be a trigger. That can happen at night in patients with sleep apnea.

Olga takes medications such as verapimil and topamax to prevent attacks and the tryptan drugs to stop them if they break through. Her advice to headache sufferers is to get the right diagnosis.

A lot of people settle for seeing their primary doctor," she said. "See a neurologist to get the right treatment and medication."

Because the pain can be diffused across one side of the face and head, patients get needless surgeries. Some attacks happen in the middle of the night, when sleep apnea can drop a patient's oxygen level in the blood.