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sphenopalatine ganglion

Cluster Headaches Causes

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As with any type of pain, the agony of this super-intense headache raises the question – what exactly are cluster headaches causes? In other words, why am I in such incredible pain?

Cluster Headaches Causes
Based on this image from Matt Brown
There are actually two questions to ask. First, what may actually trigger a cluster headache attack at a certain time? But the other question is – why is it that a certain trigger results in a headache for one person, but not another? In other words, what is the cause of the disease in the first place?

But before we get into cluster headaches causes, make sure you understand what cluster is. Here is a handy infographic contrasting migraine with cluster: cluster headache vs migraine

So why does one person get cluster headache attacks, while another person doesn’t?

There has been some research done into the possibility of a genetic cause, or at least genetic factors that contribute. For many years now, researchers have recognized that family members of a cluster patient are more likely to have cluster themselves. In late 2016, a study from Italy was published in the Journal of Headache and Pain, indicating some possible genetic variants that seem to increase a patient’s risk (A genome-wide analysis in cluster headache points to neprilysin and PACAP receptor gene variants.).

Most often when we talk about cluster headaches causes, we end up discussing the brain and nervous system. We know, through modern imagine techniques, that the hypothalamus is involved, as has long been suspected. The trigeminal nerve in the head seems to be important, especially in the process that causes symptoms such as eye pain, tears and congestion. Other possible indirect cluster headache causes are related to a nerve cluster behind the nose (the sphenopalatine ganglion), histamine, and the blood vessels themselves. Read more about these factors here: What is behind the dreaded Cluster Headache?

All that being said, there is still nothing we can point to with certainty. Cluster may indeed be caused by a number of factors working together – for example, even someone who is predisposed genetically may not get cluster because other physical factors are lacking. There are other behavioural factors, such as a history of smoking, which seem to play a role.

But what actually kicks off a cluster headache attack (or, what triggers a cluster period)?

Cluster isn’t as closely connected to “triggers”, such as food or hormonal changes, as migraine is. There are some factors which have been related to periods of cluster headache attacks, including smoking, sleep apnea, and the season of the year (autumn being the highest risk time of year).

Once the cycle has started, there may be other individual cluster headache causes. Alcohol is commonly reported, as well as strong chemical fumes. A hot day, or getting “overheated” during exercise seems to trigger attacks for some. However, when you’re not in a “cluster period”, these things will not trigger attacks at all.

Cluster is hard to research because it is so rare. However, we are learning more and more about the brain, and the last 30 years has brought us incredible advances in understanding. Many of these new revelations about cluster headache causes have brought new treatments to the forefront, such as deep brain stimulation for chronic cluster headache patients.

Further reading: Cluster headaches causes and treatments (Medical News Today)

Laser Therapy (LLLT) for Migraine

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Yes, there is current interest in using lasers to treat migraine. In this case, low level laser therapy, otherwise known as LLLT.

The idea of adding more light and heat to migraine may not sound appealing at first. But LLLT is a non-invasive and non-painful therapy that has been used for a number of pain conditions including headache disorders. There are specific laser treatment devices that are used for certain conditions.

K-laser
One of the K-Laser devices
In the case of LLLT, the lasers are set at a lower level than what is used for surgeries. This is not a cutting treatment. Instead, it stimulates your cells in certain ways that may promote healing.

The trials of this type of laser therapy for various conditions have not always had spectacular results. However, since the therapy seems to be side effect free and non-invasive, there is some interest in further researching the treatment.

So that brings us to migraine. Currently, The San Francisco Clinical Research Center is putting together a sham-controlled, single attack study to test the effectiveness of LLLT for migraine. Now, this is a very specific and small study, but it might be a place to start.

The LLLT needs to have a target. In this case, it’s the sphenopalatine ganglion (SPG). The SPG, a nerve cluster behind the nose, is already the focus of migraine treatment (and cluster headache treatment). Injections to this site have shown great promise in migraine treatment – could laser therapy do the same thing?

This study won’t give us all the answers, because it will not be a series of treatments (which may be what is needed) but only a single treatment.

However, if this treatment can help with a single attack, it could be another situation where a migraine patient could have a hand-held device at home that would allow them to treat themselves.

If you’re interested, you can talk to a migraine specialist about this treatment. If they have had success with their patients, it might be something to pursue.

Meanwhile, we’ll look forward to hearing about future research.

For more information:

Better Nerve Blocks for Migraine and Cluster Headache (videos)

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As patients have found relief from sphenopalatine ganglion (SPG) blocks, researchers have been looking for ways to make the procedure easier for the patient.

The SPG block is not a new procedure. In fact, as Dr. Alexander Mauskop points out in a recent article (Sphenopalatine ganglion block for migraine and cluster headaches), it was used over a hundred years ago.

Today the research is continuing. Although the SPG block is considered a temporary solution, there is some evidence that there may be a longer term benefit, with some patients reporting that their attacks lessen even after the initial benefit of the block wears off.

But there have been problems with the procedure. Some doctors have used long Q-tips inserted in the nose, but the procedure is uncomfortable and it’s unclear how much medication actually reaches the SPG.

Sometimes needs are also used, and anesthetics.

But new devices are being developed to make the procedure a lot easier and more effective. A device is placed in the nose, and a small spaghetti sized catheter is gently released, getting the medication directly to the SPG with a minimum of discomfort.

Here are a couple of videos to check out.. The first is an actual patient with the Tx360, and the third the Tx360 again (a longer video explaining the procedure to doctors).

Pulsante System

Could this small device delete your cluster pain?

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What difference would it make in your life if you could delete some or all of the pain in two thirds of your cluster headache attacks? A small device, smaller than an almond, may be able to do just that.

Pulsante device
Pulsante device
Back in 2013 we discussed a neurostimulation device targeting the sphenopalatine ganglion, a cluster of nerves behind the nose that is closely related to both cluster and migraine pain.

The small device was used on 5000 cluster attacks over 3 years. 33 patients completed the study.

Overall, the device (called the Pulsante SPG Microstimulator System) either eliminated or reduced the pain in 68% of attacks. Within 15 minutes, pain was totally eliminated in 34% of the attacks.

Obviously we want to get rid of every attack, but for a new device treating a very difficult condition, these results are excellent. The device seemed to eliminate or reduce most pain in moderate attacks (78%), with a response rate of 59% in mild attacks and 51% in severe attacks.

So far, the device seems to be fairly safe. However, there have been some challenges – making sure the device is properly implanted, and that it stays there, for example.

But as we continue to use devices like this, we can expect to see improvement. Pulsante is already being used in Europe.

You may remember that we were talking about the sphenopalatine ganglion back in March, related to migraine pain. If minimally invasive treatments like this can significantly decrease the pain of cluster, they may have benefits for headache from migraine and other types of headache pain.

To learn more about how the device works and how it’s controlled, visit the Autonomic Technologies website. Check out information on trials, and whether you can be involved, here.

For more information on this latest report, see AAN: Facial nerve stimulator relieves cluster headaches.

Can this Procedure Teach Your Body to avoid Migraine?

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No one really wants to be tied to taking a pill for the rest of their lives, or paying for a treatment every week for years and years. There are some treatments that are emerging which may lead to longer term solutions.

Back in 2010, we talked about a review that was published in the journal Headache about nerve blocks and trigger point injections. The authors of the study called for more research to be done in this very promising area of research.

You’ll be glad to hear that the research is continuing. One aspect of this type of treatment is injections in the area of the sphenopalatine ganglion. The sphenopalatine ganglion is a nerve cluster behind the nose, that has been related to migraine.

Actually, the sphenopalatine ganglion is a key player in cluster headache, and so a fair bit of research has been done specifically for cluster.
Society of Interventional Radiology
Earlier this month, at the Society of Interventional Radiology‘s annual meeting, researchers reported on a study on image guided intranasal sphenopalatine ganglion blocks. Here’s how it works.

The treatment is “minimally invasive”. There are no cuts, needles, or stitches. A small tube is inserted in the nose and lidocaine is administered to the nerve cluster. That’s it.

In the study, patients started with headache pain averaging 8.25 out of 10. After 30 days, the average had dropped to 5.25.

A miracle cure? Certainly not. But let’s look closer.

For the next month, patients found their pain dropped by 36%. But that’s not all. 88% used less – or even no – migraine medication over that month.

What’s next? The researchers want to know how patients are doing after 6 months.

For such a preliminary study, these are hopeful results. What if the procedure was improved? The medication was adjusted? Would there be a way to improve things for months – a year – five years – ?

If you have chronic migraine, imagine if you could cut your medication in half, while also cutting your pain in half.

Sphenopalatine ganglion blocks remain an important area of research, not only for cluster, but for migraine as well.

For more information:

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