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Cluster headache, nicknamed “suicide headache”, is a neurological disease that involves, as its most prominent feature, an immense degree of pain. “Cluster” refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions. The cause of the disease is currently unknown, it affects, approximately 0.1% of the population, and men are more commonly affected than women.
Cluster headaches are excruciating unilateral headaches,[1] of extreme intensity.[2] The duration of the common attack ranges from as short as 15 minutes to three hours or more. The onset of an attack is rapid, and most often without the preliminary signs that are characteristic of a migraine. However, some sufferers report preliminary sensations of pain in the general area of attack, often referred to as “shadows”, that may warn them an attack is imminent. Though the headaches are almost exclusively unilateral, there are many documented as cases of “side-shifting” between cluster periods, or, even rarer, simultaneously (within the same cluster period) bilateral headache. They are often initially mistaken for brain tumors and multiple sclerosis until patients are treated with corticosteroids and then imaged. Trigeminal neuralgia can also bring on headaches with similar qualities.
The degree of pain involved in cluster headaches is markedly greater than in other headache conditions, including severe migraines, and experts believe that it may be the most severe pain known to medical science. It has been described by female patients as being more severe than childbirth.[3] Dr. Peter Goadsby, Professor of Clinical Neurology at University College, London, a leading researcher on the condition has commented, “Cluster headache is probably the worst pain that humans experience. I know that’s quite a strong remark to make, but if you ask a cluster headache patient if they’ve had a worse experience, they’ll universally say they haven’t. Women with cluster headache will tell you that an attack is worse than giving birth. So you can imagine that these people give birth without anesthetic once or twice a day, for six, eight or ten weeks at a time, and then have a break. It’s just awful.” [1] The pain is lancinating or boring in quality, and is located behind the eye (periorbital) or in the temple, sometimes radiating to the neck or shoulder. Analogies frequently used to describe the pain are a red-hot poker inserted into the eye, or a spike penetrating from the top of the head, behind one eye, radiating down to the neck, or sometimes having a leg amputated without any anaesthetic. The condition was originally named Horton’s Neuralgia after Dr. B.T Horton, who postulated the first theory as to their pathogenesis. His original paper describes the severity of the headaches as being able to take normal men and force them to suicide. Indeed, cluster headaches are also known by the nickname “suicide headaches”.
From Horton’s 1939 original paper on cluster headache:
The cardinal symptoms of the cluster headache attack are ptosis (drooping eyelid), conjunctival injection (redness of the conjunctiva – the covering of the eyeball), lacrimation (tearing), rhinorrhea (runny nose), and, less commonly, facial blushing, swelling, or sweating. These features are known as the autonomic symptoms. The attack is also associated with restlessness, the sufferer often pacing the room or rocking back and forth. Less frequently, he or she will have an aversion to bright lights and loud noise during the attack. Nausea is sometimes accompanied with a cluster headache, though it has been reported. The neck is often stiff or tender in the aftermath of a headache, with jaw or tooth pain sometimes present. Some sufferers report feeling as though their nose is stopped up and that they are unable to breathe out of one of their nostrils.
Cluster headaches are occasionally referred to as “alarm clock headaches”, because of its ability to wake a person from sleep, and because of the regularity of its timing in that both the individual attacks and the clusters themselves can have a metronomic regularity; attacks striking at a precise time of day each morning or night is typical, even precisely at the same time a week later. This has prompted researchers to speculate an involvement of the brain’s “biological clock” or circadian rhythm.
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