THE AGONY OF CLUSTER HEADACHES. WHO GETS CLUSTERS AND WHEN.
The pain is excruciating, boring into the eye and reaching such intensity that the victim becomes nauseated and vomits. On the affected side, the eye becomes red and swollen. The eyelid droops and the pupil contracts. The face becomes flushed and sweat may appear on the fore-head. Vision may blur on the affected side. Frequently, the .pain is so severe that the victim strides up and down, hand clasped over the painful eye. The pain can be so unbearable that the sufferer bangs his head against a wall or contemplates suicide.
While one headache a day is typical, some sufferers experience as many as three, in the episodic or cyclic type of cluster, the headaches occur only during a bout which typically lasts from two to eight weeks. After that, the headaches go into remission and do not reappear for months or even years. However, chronic clusters continue for a year or more without remission. Any severe one-sided headache involving changes to eyelid or pupil could well be a cluster.
The majority of clusters occur at night. Researchers believe that this may be due to a combination of shallow breathing and the daily low point in adrenal hormone output. (Normally, these hormones keep blood vessels from dilating.) These circumstances, which favor dilation, seem to set a regular time for clusters to appear. During a cluster bout, the victim is often awakened at the same time each night by the same blinding pain.
Whenever instability occurs in the balance of norepinephrine and serotonin, which control pain perception, clusters may also appear during the daytime. In fact, during a cluster bout, any food, substance or circumstance that stimulates vasodilation can trigger a cluster.
Clusters usually begin in men between the ages of 10 and 30, often in teenage boys who smoke. No family history connection has been found. Beyond causing a tendency to peptic ulcers, the pain appears to leave no lasting damage. But signs of suffering are often evident. By raid-die age, many cluster victims have acquired deep furrows in the forehead plus a cleft chin, square jaw and other craggy features, and a coarse, ruddy, wrinkled skin.
Fortunately, cluster headaches are relatively rare. At times, they may be confused with trigeminal neuralgia— tic douloureux. However, tic douloureux strikes in brief, painful jabs seldom lasting more than a few seconds, while clusters last for at least ten minutes.
Breaming pure oxygen is an effective remedy for most clusters at this stage. If oxygen is not available, hyperventilation—taking long, deep, rapid breaths—will often bring sufficient oxygen into the arteries to cause them to constrict and end the pain.
*40\30\4*
