TMC PULSE

t m c » p u l s e | j u n e 2 0 1 7 26 Headaches You Can Set Your Clock To Researchers are studying the circadian rhythms of cluster headaches B y C h r i s t i n e H a l l M ost people have heard of migraines. But there is a lesser- known type of headache—a cluster headache—that is often referred to as a "suicide headache" because the pain is so intense that patients have taken their own lives to escape it. The pain from a cluster headache is worse than childbirth, patients say. Worse than kidney stones. More like getting shot in the head or being jabbed in the eye by a sharp object. This is where Mark Burish comes in. A neurologist and Ph.D., Burish is director of the Will Erwin Headache Research Center, part of the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center and The University of Texas Health Science Center at Houston. Burish and his team of neurologists, nurses, scientists and industry start- ups hope to demystify and find new treatments for cluster headaches and migraines at the center, which gets its name from a man who suffered from cluster headaches and ended his life when he was unable to find relief. Some 47 percent of adults suffer from some type of headache disorder. Migraines can vary from person to person and tend to incorpo- rate pulsing pain, nausea, vomiting and sensitivity to light. They can last from two to 72 hours. By contrast, cluster headaches, which occur in clusters, or patterns, tend to follow certain rules, Burish says. Typically, an intense pain is felt on one half of the face, and some features of the headache can be outwardly appar- ent. On the painful side of the face, the eye may be droopy, bloodshot, swollen and watery—to the point where the patient may go through an entire box of tissues. "Patients also get agitated and restless and may rock back and forth," Burish said. "That is different from a migraine, where the person wants to lie still in a dark room." Same time every year Cluster headaches have been around for centuries, but only properly diag- nosed over the past 20 years. In part, that's because very little research has been done on them. Between 1997 and 2007, the National Institutes of Health funded just two cluster headache studies. One of the newer pieces of Burish's research relates to the timing and circadian rhythm of cluster headaches. They tend to last three hours or less, Burish said, and might happen many times per day. In addition, most people with cluster headaches get them the same time every year. "A lot of them can say something like, 'On Jan. 1 at 11 a.m., I will get a headache, and it will go on like that for about a month,'" he said. "They go away and come back the next January. You can set your watch to it." Diagnosing cluster headaches is tricky because doctors often take into account the time of year, the runny nose and the watery eye and assume a patient is suffering from a sinus infection, Burish said. Doctors may also prescribe steroids and antibiotics that tend to alleviate cluster headaches for short periods. Burish's team intends to build a laboratory model of a cluster headache to study its patterns. Treatments for cluster headaches include oxygen, certain types of blood pressure and seizure medications, and, more recently, electrical stimulation of nerves in the head and neck, Burish said. In addition, there is a drug for migraine and cluster headaches in clinical trials that blocks the activ- ity of a molecule called calcitonin gene-related peptide. In April, a new non-invasive device to treat headaches called gammaCore was approved by the U.S. Food and Drug Administration. The time of day and time of week matters. Some patients are so worried about when the next headache will occur that they actually trigger a headache. — CORY KENNEDY Co-founder and CEO of SensorRx Mark Burish, M.D., Ph.D., a neurologist and director of the Will Erwin Headache Research Center, demonstrates one of the tools he uses when examining patients with cluster headaches.

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