Ever had headaches so unbearable made you feel like jumping off a roof?

One pleasant evening a young couple entered the consulting room of the Neurosurgeon. On seeing them, the doctor’s heart sank. The husband complained that despite taking all the drugs the doctor had prescribed, he still suffered from a terrible headache. The wife, a volatile young woman, lost her temper and shouted at the doctor, “You ordered so many investigations and all are normal. None of your drugs have given any relief. Do you know my husband wants to commit suicide because of his headaches?”

At these words a relevation struck the doctor – “Of course , the patient was suffering from no ordinary headache, but a suicide eadache!” Immediately he reached for his prescription pad and wrote the names of three drugs – Verapamil, Divalproex and Sumatriptan injection.

The young couple were perplexed – “Doctor, what’s the diagnosis?” The doctor looked at the young man and said, ‘You are suffering from cluster headache – also known as a “suicide headache”. People who are afflicted by this suffer at nights – as sleep triggers this headache and awakens them. The headache takes 5 to 10 minutes to enter the severe phase – and can last from15 minutes to 3 hours.

“Like a hot poker!”

The headache recurs with remarkable regularity each day for 6 to 12 weeks (hence the term “cluster”), followed by complete freedom for months or even years. Generally only males are affected. It is usually localized to the eye and temple but can involve the cheek area and can be associated with nasal congestion. Usually the nasal discharge is clear and colorless in contrast to sinus headaches. Other symptoms can include tears from the eye on side of the face that’s hurting, sweating of the face and forehead, drooping of the upper eyelid, decrease in the size of pupils (miosis). There will be no nausea or vomiting. Sometimes these headaches can be triggered by beer. The intense pain drives patients desperate. Earlier almost 50% of them attempted suicide!

Relief, at last!

Recently Positron Emission Tomographic (PET) studies have shown that posterior inferior hypothalamic gray matter is activated during the episodes of cluster headache and is considered to be the generator of this headache. It can be treated with a single anticipatory dose of ergotamine or sumatriptan at bedtime.Inhalation of 100% oxygen for 10 to 15 minutes at the onset of headache may abort the attack, but is not always practical. Drugs like verapamil, divalproex, topiramate, lithium carbonate, methysergide, prednisone are used to prevent cluster headaches. In cases where there is no response to the drugs, deep brain stimulation has been found to be moderately successful.

A happy ending

The young husband said, “Okay doctor, I trust you and I will take the drugs”. “He better get well, or else..” put in the fiery young woman. “Two months later the doctor noticed the lady sitting outside his chambers. He immediately called his wife on the phone and checked with her how strong her “thali packiam” was! Then, he reluctantly summoned her into the room. Once inside she headed straight towards quaking doctor and … fell at his feet! Her husband had experienced a complete recovery.

DR. U.S. SRINIVASAN Chief Neurosurgeon