cluster headache , which can be anywhere from a few months to 20 years later .
HW : What differentiates cluster headache from migraine ? DR . FREITAG : The intensity of the pain . The strict one-sidedness of the attack . The tendency for headaches to occur in these bunches and then disappear for long periods of time . Most patients with cluster headache don ’ t get nauseous , don ’ t vomit and don ’ t get visual auras before their attacks . They do get intense nasal congestion and a runny nose . They get a red , watery , teary eye and a droopy eyelid on the side of the headache . They get flushed in the face and sweat when they have their attacks — as compared to migraine sufferers , who look pale and sickly . Cluster sufferers ’ behavior during attacks is also dramatically different . While patients with migraine retreat to a dark , quiet place , cluster headache sufferers rock back and forth . They pace . They hold their head . They pound their head on the floor . They put pressure on their head to try to stop the pain .
HW : What causes cluster headache ? DR . FREITAG : We don ’ t know what the cause is . It doesn ’ t seem to have the same kind of genetic predisposition as migraine .
HW : Does this make the condition difficult to diagnose ? DR . FREITAG : The biggest problem is that the symptoms may lead inexperienced physicians astray . When patients have cluster headache , they get intense nasal congestion and a runny nose . So the inexperienced physician might think this to be allergies or sinus headaches , and they may prescribe patients a course of antibiotics . Because of the cyclical nature of cluster , patients take the two to four weeks of antibiotic , and at the end of that time , their clusters are gone . But it ’ s not because they resolved a sinus infection .
HW : What ’ s the best course of treatment ? DR . FREITAG : There are no good techniques we know of that lend themselves to a natural course of treatment . Cleaning up one ’ s act , avoiding caffeine , avoiding alcohol , quitting smoking , keeping a regular schedule — those kinds of things , generally speaking , don ’ t help cluster sufferers gain freedom from their attacks . They really have to rely on medications .
HW : What medications do sufferers take ? DR . FREITAG : Cortical anti-inflammatory steroids will oftentimes stop a cycle of cluster headache within a matter of 24 to 48 hours . But if you just do that , as the dose is reduced , the clusters come back . So we often couple that with a medicine known as a calcium channel blocker — a drug called Verapamil . It ’ s been around for two decades now . It ’ s used in migraine , but it is a drug of first choice for patients with cluster . Antiseizure medications like Depakote , Divalproex and Topiramate are also extremely useful . And an old antidepressant medication called Doxepin can be extremely useful for stopping a cycle of cluster headache .
HW : Are there any promising new treatments on the horizon ? DR . FREITAG : There has been some interesting stuff done out of Harvard where they have looked at hallucinogenic mushrooms as a treatment . There ’ s work being done to try to synthesize the chemical in mushrooms without the hallucinations and other problems . We shouldn ’ t be surprised that these work . When we look at one of the drugs that was the mainstay for treating cluster for about 40 years until it went off the market — Methysergide — it is a chemical cousin to LSD-25 . They are all in the same chemical family . So if researchers could find the right one , they might have themselves a very successful therapy .
HW : When do cluster sufferers need to see a doctor ? DR . FREITAG : If they ’ re getting what seems like cluster headache — brief , very intense headaches , watery eye , red eye , runny or stuffy nose — they need to see somebody . And if they don ’ t get prompt , accurate diagnosis and treatment , they need to seek out a neurologist or headache specialist to start properly addressing their condition . The devastation of these attacks on people ’ s lives is tremendous , and the therapeutics are highly effective for the majority of patients .
HW : If you could tell cluster sufferers one thing , what would it be ? DR . FREITAG : Find a doctor who understands what cluster is and gives you treatment that works quickly and successfully . That way , you have your quality of life restored without the fear of what ’ s going to happen when the next bout of cluster headache hits . HW
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