Research

Untangling complex cluster headaches

The actuality of cluster headache therapy, and a novel approach to chronic and episodic cluster headache.

Is there a cure for cluster headaches?

Cluster headache infographic: pain around one eye, lasting 1 to 2 hours, 1 to 3 times per day
Cluster headache: one-sided pain around the eye, often at the same hours each day

If mainstream, conventional treatments are ineffective or cause side effects, should we all accept losing our happiness to the pain? Everyone involved with cluster headaches has asked this question, at Cluster Busters meetings, at international headache and pain conferences, and in our own clinic for 23 years.

In our journey to treat migraine and cluster headaches (CH), we came to different views than the conventional ones. Intense research on the pattern of CH shed light on its cause and suspected trigger. We started empirically with one patient in 2016, and the promising outcome encouraged us to repeat it.

We tested this hypothesis by analysing cluster headache triggers and the path of attacks, and redefined our understanding of cluster headaches by diagnosing a wild neuroma, or nerve bundle, along the zygomaticotemporal nerve and excising it. This procedure is currently available only at our headache clinic.

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Abstract

Theoretical, practical and clinical aspects of a novel approach to the treatment of chronic and episodic cluster headaches.

Importance: Chronic and episodic cluster headaches are a worldwide problem that significantly impairs sufferers' ability to function. Puzzling triggers and treatment approaches are burdensome and costly. A new approach may shed light on long-term, curative treatment and a new understanding of triggers.

Objective: To redefine the cause of cluster headaches by diagnosing evidence of a neuroma in the distribution of the zygomaticotemporal nerve, and to assess long-term outcomes.

Design: A single-center, randomized, interventional, prospective clinical trial. Allocation was selective and ambulatory. All genders and races aged 20–70 participated, without discrimination of comorbidities.

Primary outcome and measures: Evidence of neuroma by histopathologic examination and long-term efficacy in relieving cluster headaches over 270 days.

Results: Collected data showed that nearly 100% of patients responded with complete relief of their cluster headache symptoms. Migraine symptoms on the opposite side after the original procedure were also addressed.

Conclusion and relevance: Data collected over 270 days demonstrated long-term relief of cluster headache symptoms. Resolution of cluster headaches by excision of a single neuroma along the zygomaticotemporal nerve may guide future approaches.

Keywords: cluster headaches, trigeminal neuralgia, cephalalgia, SUNCT, neuroma, diagnostic and curative. Published in the Journal of Recent Advances in Clinical Trials, Volume/Issue 2, May 2024. No conflict of interest.

Registered trials: NCT04845451 · NCT03220113

Individual results vary. Outcomes described on this page reflect the clinic's own experience and published research. See our Disclaimer.

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