Cluster Headache

Cluster headache is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye. The headaches are often accompanied by autonomic symptoms such as eye watering, nasal congestion and swelling around the eye, typically confined to the side of the head with the pain. Unlike migraines, cluster headaches are not typically associated with nausea or vomiting, and they affect more men than women, by a ratio of about 2.5:1 to 3.5:1.

Cluster headache belongs to a group of primary headache disorders, classified as the trigeminal autonomic cephalalgias (or TACs). People who suffer from cluster headaches experience an attack (or episode) one to three times per day during a period of time (the cluster period) that may last from two weeks to three months. The cluster period occurs at the same time each year, such as the spring or fall. Most people get their first cluster headache at age 25 years, although they may experience their first attacks any time from their teens to their early 50s.

The pain of a cluster headache lasts a short time, generally 30 to 90 minutes. It may, however, last from 15 minutes to three hours. The headache will disappear only to recur later that day. Typically, in between attacks, people with cluster headache are headache-free. The attacks appear to be linked to the circadian rhythm (or "biological" clock), as they occur at the same hour each day, and they are usually very similar, varying only slightly from one instance to another.

The headaches may disappear completely (go into "remission") for months or years, only to recur without any warning. In 80%-90% of cluster headache sufferers, the cluster periods are separated by attack-free intervals lasting 14 days or more. However, in about 10%-20% of people with cluster headache, the cluster periods never remit, or they do so for less than 14 days per year. This is known as chronic cluster headache.

The causes of cluster headache are still not completely understood, but nitric oxide has been shown to trigger the attacks. During a cluster period, when cluster headache sufferers are treated with a nitric-oxide-donor such as nitroglycerine, they develop an attack with the characteristics of a cluster headache. Healthy volunteers, on the other hand, experience a much less severe headache pain, without the other symptoms associated with cluster headache. Migraine sufferers, on their part, develop a migraine-like attack. This suggests that cluster headache patients (during cluster periods) and migraine patients overproduce nitric oxide or are more sensitive to it than healthy individuals.

Facts and Figures:

· In 2012, the first US Cluster Headache Survey estimated that approximately 400,000 sufferers live in the US, and something over 7,000,000 worldwide. There is often a significant delay in correct diagnosis, often longer than five years, with only 21% of CH patients receiving a correct diagnosis at the time of initial presentation.

· In an article in the Journal of Neurology & Stroke in 2015, John Fletcher, the president and founder of the Cluster Headache Foundation Inc., USA, notes that the pain of a cluster headache is so intense that the condition is sometimes referred to as "Suicide Headaches". It is a disease with one of the highest incidences of suicide: lack of awareness, respect and urgency, or misunderstanding of the patient's motives in seeking out drug relief, can send a patient over the edge. Living with cluster headaches can be an almost unbearable challenge.

· The pain of a cluster headache is nothing like that of an ordinary headache, but rather like a brutal, violent beating on the inside of the eye and one side of the head, that can last up to two hours. It is almost impossible for a non-sufferer to understand the severity of the pain, or the level of frustration and despair at the lack of effective treatment.
All sufferers of cluster headaches will agree that the pain is unbearable. They may occur like clockwork at specific times, or at any time anywhere. For some, the pain can attack at a frighteningly specific time of day, and for others it can be more of a seasonal issue.

The first thing a cluster headache sufferer must do is to find a sympathetic medical professional who is able to understand the symptoms and the severity of the condition. A competent doctor will work together with the patient to determine the right combination of drugs and behavior that can limit attacks or ease the severity of the pain.

A patient living with the challenge of cluster headaches will be in a continual search for respite from the constant throbbing in part of the head. It is believed that one of the most effective treatments is pure oxygen, which is why many people with cluster headaches keep an oxygen tank in the house. There are a number of self-administered drugs used for migraine, which can also help ease the painful symptoms of this condition.

When a patient is going through a phase of cluster headaches, leaving the house can be a terrifying thought. Sometimes the patient may have already left, thinking that everything is fine, and then feel a sudden intense headache set in rapidly. In extreme cases, surgery to block nerve signals, implants that can stimulate specific centers in the brain, or even psychedelic drugs may be considered as options. It is important not to give up hope, as researchers continue to pursue possible cures and new treatments. Online support groups such as the National Headache Foundation, the American Headache Society, ouch-us.org and clusterheadaches.com are also excellent alternatives for help and ideas for relief.

There is no doubt that experiencing excruciating pain that doesn't go away, no matter what, is a far more serious matter than onlookers may think. It is our fervent hope that TrioxBio's development of Raviclust (MTR-108) nasal spray, will bring significant relief to sufferers of this cruel and painful condition. Patients must not despair, because help is on the way.