In this week's episode, we discuss cluster headaches, one of the most severe pain conditions known. This rare condition affects about one in a thousand people  with excruciating, clockwork-like attacks can last for weeks or months, with few effective treatment options. In this episode, we break down the causes, triggers, and latest research on cluster headaches, from abortive therapies like oxygen and triptans to emerging neuromodulation treatments.

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References:

Actual Patient Testimony. (February 3, 2025). As interviewed by the author. 

May, A., Schwedt, T. J., Magis, D., Pozo-Rosich, P., Evers, S., & Wang, S. J. (2018). Cluster headache. Nature reviews Disease primers, 4(1), 1-17. https://www.nature.com/articles/nrdp20186

International Headache Society. (2018). 3.1. Cluster headache. IHS Classification ICHD-3. https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/

Rozen, T. D., & Fishman, R. S. (2012). Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache: The Journal of Head and Face Pain, 52(1), 99-113. https://pubmed.ncbi.nlm.nih.gov/22077141/

Wilbrink, L. A., de Coo, I. F., Doesborg, P. G., Mulleners, W. M., Teernstra, O. P., Bartels, E. C., ... & Rasche, D. (2021). Safety and efficacy of occipital nerve stimulation for attack prevention in medically intractable chronic cluster headache (ICON): a randomised, double-blind, multicentre, phase 3, electrical dose-controlled trial. The Lancet Neurology, 20(7), 515-525. https://pubmed.ncbi.nlm.nih.gov/34146510/

Pringsheim, T. (2002). Cluster headache: evidence for a disorder of circadian rhythm and hypothalamic function. Canadian journal of neurological sciences, 29(1), 33-40. https://doi.org/10.1017/S0317167100001694

Riesenberg, R., Gaul, C., Stroud, C. E., Dong, Y., Bangs, M. E., Wenzel, R., ... & Oakes, T. M. (2022). Long-term open-label safety study of galcanezumab in patients with episodic or chronic cluster headache. Cephalalgia, 42(11-12), 1225-1235. https://pubmed.ncbi.nlm.nih.gov/35633025/

Goadsby, P. J., de Coo, I. F., Silver, N., Tyagi, A., Ahmed, F., Gaul, C., ... & Ferrari, M. D. (2018). Non-invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: a randomized, double-blind, sham-controlled ACT2 study. Cephalalgia, 38(5), 959-969. https://journals.sagepub.com/doi/10.1177/0333102417744362

Silberstein, S. D., Mechtler, L. L., Kudrow, D. B., Calhoun, A. H., McClure, C., Saper, J. R., ... & ACT1 Study Group. (2016). Non–invasive vagus nerve stimulation for the acute treatment of cluster headache: findings from the randomized, double‐blind, sham‐controlled ACT1 study. Headache: The Journal of Head and Face Pain, 56(8), 1317-1332. https://pubmed.ncbi.nlm.nih.gov/27593728/