Cluster headaches are sudden, severe one-sided headaches that are often Cluster-Headaches-Devilrecurrent. They are also called cluster migraines, but unlike classic migraines, they do not throb, though they are often exacerbated by light and sound like classic migraines.

These headaches are often described with words like “ice pick through the head” or “screwdriver through the eye.” These headaches are cyclical, often occurring at about the same time each day for days, weeks, or even months at a time. Many people with cluster headaches get them a couple of hours after going to sleep at night and wake in pain so severe they cannot sleep. The pain is so intense that it is not uncommon for cluster migraine patients to think about suicide.

Western medicine doesn’t know what causes them, though they can be related to histamine and/or seratonin release and could be related to hypothalamic activity. We also know that the trigeminal nerve is involved most of the time, causing the eye pain and tearing.

Collected data reflects that more men than women are affected, that the are most common in adolescence and in middle age, and that they tend to run in families.

Alcohol and cigarette consumption, high altitudes (like flying or hiking in the mountains, or skiing), bright light, physical activity, heat, nitrites in foods, some medicines and recreational drugs seem to trigger these headaches.

Symptoms of Cluster Headaches:

The Mayo Clinic symptom list gels with my experience of them:

*Excruciating pain, generally located in or around one eye, but may radiate to other areas of your face, head, neck and shoulders
*One-sided pain
*Excessive tearing
*Redness in your eye on the affected side
*Stuffy or runny nasal passage in your nostril on the affected side of your face
*Sweaty, pale skin (pallor) on your face
*Swelling around your eye on the affected side of your face
*Drooping eyelid

The nasal and eye symptoms are often the precursor to the pain. Pain is often described as sharp, penetrating, or burning. As mentioned previously, I’ve heard the ice pick or screwdriver through the head similes as well as the ‘hot poker through the eye’ comparisons.

Western Medical Treatment

From the cluster migraine patients I’ve spoken with (and there have been a lot of them, starting with my father in 2002), the treatments available are often unworkable with daily life (drugged into oblivion) or inaccessible (IV fluids that have to be administered in a hospital) and unaffordable on a daily basis.

CM Perspective and Treatment of Cluster Headaches

You’ll notice I didn’t say TCM treatment. I haven’t found TCM points to be as effective as Master Tung points for these patients.

I often see Liver Yang Rising or Liver Fire Flaring in these patients and blood stagnation and/or stasis as well. Look for Liver Yin deficiencies that could be causing the Liver Yang to rise. Affected channels are often Large Intestine, Gallbladder, and Liver.

Because of the hypothalamic involvement, verified by fMRIs, I find auricular acupuncture on the hypothalamus point and master cerebral points to be helpful.

But my most effective acupuncture treatment so far have been these combinations:

Cup the upper back and shoulders first
Many of my cluster headache patients report pain in the upper shoulders. I cup Gb 21, 1st and 2nd Bladder lines to T7, root of the neck, and even Gb 20 if I can get the cup to stick there. This loosens up any stuck qi and blood in those channels and relaxes the flow through the head and neck.

Master Tung’s Beside Three Miles and Below Beside Three Miles (77.22 and 77.23) 
77.22 is about 1.5 cun lateral to Stomach 36 (which is also called “Three Miles”…hence this point being beside Three Miles), but is located on the anterior border of the fibula. 77.23 is about 2 cun distal from 77.22. If you find a dark accessible blood vessel in this area, bleed it!

Master Tung’s Three Weights (77.05-77.07)
This is at the level of Gb 39, but is between the tibia and fibula (often about 1 cun anterior the fibula. Needle this point, measure 2 cun proximal from it and this is the 2nd Weight. Measure up another 2 cun and this is the 3rd of the Three Weights.

Master Tung’s Four Horses (88.17-88.19)
Awesome points. I could describe how to find them and use them all day, but you’d be better served referencing Susan Johnson’s excellent article on them.

Master Tung’s Shen Guan (Kidney Gate) (77.18)
This is a great point for all chronic issues.

As with many internal issues, acupuncture alone is often not enough unless the patient can come back daily for a while. Evergreen’s Migratrol has proven to be quite effective for my cluster migraine patients. As a rule, dose at 1 pill for every 50 lbs of body weight. You can combine this with Corydalin for greater pain control. You might also have to combine with a formula to descend Liver Yang or extinguish Liver Fire. If there is evidence of blood stasis/stagnation, strongly consider a 2 week course of Circulation SJ to help clear out old stuck blood.

Update: 1/18/2016

Give-bloodIf blood stasis is the issue or you are seeing components of blood stasis (red/purple complexion, red/purple tongue, etc.), have your patient try giving blood on a regular basis. I have had one cluster headache patient in the last 2 months that started doing that and the headaches went away entirely.

This indicates a pretty severe blood stagnation/stasis problem. Diet and exercise modification plus herbs would help a lot, but he won’t do that. Next best thing: be altruistic and give blood!