Both cluster and migraine headaches, when chronic and severe can be very difficult to treat. Cluster headaches are characterized by severe stabbing one sided headaches, with pain behind the eye. They usually occur either the same time every day or are seasonal and when the attacks happen they last a few minutes to and hour. Many people want to move around when they have cluster headaches. Migraines on the other hand, have throbbing pain on one or both sides of the head. Light and sound are painful and nausea and vomiting may happen. Migraineurs as a result, want to be lying down in a quiet room as movement makes the pain worse.
So what do these two headaches have in common that may allow one treatment to work for both? Well, according to research from headache specialists at the American Headache Society, there is an area deep inside the brain responsible for registering headache pain. This part of the brain connects back to the nerves in the upper part of the neck which then connect to the nerves just under the skin at the back of the head. The nerves at the back of the head are called the occipital nerves and if they are over stimulated to the point of blocking impulses, this feeds back to the areas deep in the pain and blocks pain of both cluster and migraine headaches.
Two new systems have been developed recently for occipital stimulation. One is a hand held stimulator that is placed at the back of the head at the onset of a migraine headache. It is supposed to stop the headache through the feedback system. The stimulator is rather bulky and may require two hands to hold it in place. This may be difficult for some people but most should be able to manage it.
The second system involves a surgical procedure. This is a combination of implant stimulators and a battery pack that keeps the stimulator on. Two strips that contain the stimulators are surgically placed over the occipital nerves, just under the skin at the back of the head. Lead wires are run under the skin and connected to the battery. The system allows the patient to control the amount of stimulation depending on their pain levels. The most common problem so far with this type of system is breakage of the lead wires and the fact that the battery only lasts a year or two. Battery and lead wire replacement require another surgery.
As of 2008, two clinics are doing the procedure as a research trial. The clinic sites are the Michigan Head and Pain Institute in Ann Arbor, MI and the Mayo Clinic in Phoenix, Arizona. Both of the trials are closed and are not accepting new patients, however new trials may open elsewhere in the country since the results have been so promising. At this point 67% of cluster patients responded with eradication of their headaches and over 40% of migraineurs responded.
So what to do until the surgery is more readily available? Your doctor may be able to do occipital nerve blocks which may also serve the same purpose in treating the headaches. Similar research from the American Headache Society has indicated that even if you do not have pain at the back of the head, occipital nerve blocks may treat your cluster headaches or migraines effectively. Nerve blocks consist of a small amount of an anesthetic like lidocaine, mixed with a steroid and injected around the nerve.
Generally, with a severe headache profile, it is best to be assessed by a headache specialist to determine if an occipital stimulator or a nerve block is best for you.
Mary K. Betz, MS RPA-C is a practicing Physician Assistant in neurology who specializes in headache medicine. For more information visit http://www.headache-adviser.com