Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

• What does a cluster attack feel like?
• What is the difference between migraine and cluster headache?
• What is the difference between episodic and chronic cluster headache?
• Does cluster headache typically decline in occurrence or stop altogether as you age?
• What are the latest treatments approved for cluster headache?
• How does oxygen work as a treatment for cluster headache?
• How are psychedelics used to treat cluster headache?
• Do triptans, ditans and gepants work for cluster headache?
• What are the biggest advocacy challenges currently facing those with cluster headache?
• How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..

Managing Your Migraine virtual event

The Migraine Trust

Would you like to know more about migraine and how to manage it? Then come along to our virtual Managing Your Migraine event that’s taking place on the morning of Saturday, 23 January. There’ll be talks about new migraine treatments, vestibular migraine, and migraine and hormones. It’s free to attend but places are limited so register now so you don’t miss out. You can find out more about the event and book a place here.

For Osteopathic treatment of Migraines and Headaches

david@theosteopath.net

As we enter yet another few weeks of lockdown I worry for the mental state of us all. So to comfort myself I head towards Wandsworth Common and look at our beautiful trees in fabulous autumnal colours. Here we see a Liquidamber styraciflua, other names are Sweetgum or American Red Gum tree in the middle of the kiddies playground with all the maple like pointed leaves rich colours, orange, crimson and purple.

Osteopaths even had a mention in the Times Newspaper !

“In general, sport, including tennis and golf, is not allowed outside, Personal trainers can continue one-on-one sessions in the park and Osteopaths will remain on hand if the session goes awry.”

http://www.theosteopath.net email david@theosteopath.net

Memories of Travelling

A little reminder that on Sunday the clocks will go back one hour which signals the end of British Summer Time.  That means you can enjoy an extra hour in bed this weekend, which may be very welcome! No matter how you use your extra hour, aim to do something for yourself in that extra magic hour. 

Does anyone else have the twice yearly battle with the oven clock, the alarm clock and the boiler controls or is it just me?!

We are here for you if needed, I can treat patients but we cannot go for a glass of wine or a beer together, unless suitably spaced on the Common.

Have a great week-end and stay safe. Remember your Vitamin D, C and Zinc. Probiotics leafy greens and most importantly get quality sleep to boost those Killer T-Cells in the Immune system

Take care,

David

So many people are slowly developing headaches, neck and back pains after working from home for a long period.

Reduced general movements that were part of the “going to work process” have disappeared from daily routines. No walking for buses or trains, no flights of stairs, no heading out for lunch etc. All this reduction in function is beginning to take its toll on our bodies.

We need movement to transfer fluids around the body. It is necessary to survive. The immune system depends on it. Please take walking breaks, and stretch. Learn Tai Chi which can be done in small spaces, warm up routines of Qi Gong also great. Yoga and Pilates for those who prefer.

All these efforts keep you away from the Osteopath!

Government advice to continue working from home means that many of us have now spent half the year hunched over a laptop at the kitchen table.

This has given rise to the aches and pains of so-called ‘laptop syndrome’; a condition which occurs when we spend hour upon hour in unsuitable positions.

On Mornings, physiotherapist Sammy Margo warned that our increasingly sedentary lifestyle is having a serious impact on our health.

Image: Mimi Thian/Unsplash

She said, “Laptops are not really designed to do an 8-10 hour working day,”.

“[Since lockdown] everyone’s scared of losing their job. They’re sitting for longer periods, they’re not taking regular breaks … they’re barely getting out of their pyjamas.”

For many, the daily commute has been reduced to a short journey from the bedroom to the kitchen.

“They’re literally going from their bed to a C-shaped posture for somewhere in the region of 8-10 hours a day,” said Sammy.

She explained that her profession is seeing an upsurge in headaches and migraine, as well as neck, shoulder, arm and lower back pain from the “day in day out grind of sitting in this position”.

Are you sitting comfortably?

Occupational therapist, Sally Payne, offered advice for everyone working from home.

“Think about posture,” she advised.  “What people should be looking for is a position where they can sit with their shoulders relaxed, their hips, their knees and their ankles all at 90 degrees. If you can get your feet flat on the floor that’s absolutely brilliant.” 

Sally also suggests pushing the laptop a little away from the edge of the table to allow space for wrists to rest. 

Some may find their kitchen set-up works well for them but Sally sounded a note of warning:

“The worst possible position would be to sit on a barstool at a kitchen work surface because you’ll be hovering with your legs dangling and your arms are not resting comfortably.”

It’s easy to dismiss the first grumblings of aches and pains but Sally advised that we pay heed to them.

She said, “If you’re getting pain in your body then that’s going to affect not only your work but the other daily activities that you do, and your mental health and well-being as well,”

The worst possible position would be to sit on a barstool at a kitchen work surface

Sally Payne, Occupational Therapist

Preventative measures

Even those lucky enough to have a perfect home work space can benefit from exercising to prevent aches and strains. Sammy suggested trying regular gentle stretches.

“Ensure you’ve got your B.B.C. – bum into the back of the chair,” she said. “And while you’re doing that turn your head from left to right, look up and down at the ceiling, then [lean your] ear to shoulder followed by [the other] ear to shoulder. Shoulder rolling is another great exercise you can do.”

And, Sammy advised that even though we’re working we don’t have to do it all sitting down.

“Sitting to standing is one of my favourite exercises because it helps to keep your legs strong. If you’re on the phone to one of your work colleagues or you need to have a break [changing from] sitting to standing is a great way to keep yourself mobile.”