Cluster Headaches

Hormonal Treatment with Testosterone

Edward Lichten, M.D.,PC
555 South Old Woodward Suite #700
Birmingham, MI 48009 



Introduction: Cluster Headache is an infrequent vascular headache that is so explosive that it justifies a separate classification. [1] These unilateral headaches are so intense, often recurring in rapid succession, that many men afflicted have committed suicide. Because of the redness in the face, cheek and eye and tearing, they were originally called "histamine" headaches. However, research to date has not found a cause to explain these dramatic and devastating migraine attacks.

These cluster headaches are Gender-Specific in that the occur predominately in men of reproductive age. Kunkle reported 24 of 30 in his original study. [2] Ninety percent of men with cluster have their first attack between ages 17 and 40; half between 21 and 25 years of age. Since most of the attacks begin at night, these men most often jump out of bed in pain. These attacks may occur for days or weeks. They may cycle every year or every few years. In conclusion, for all the research in the last 50 years, no one has proven a cause for this condition. Therefore, the only treatments are pain medication, steroids, possibly Lithium and Sansert.

Interestingly, Kudrow [3] looked at testosterone levels and Luteinizing hormone in five males. He found "these hormones to be significantly depressed during the active phase compared to the remission period."

In a MEDLINE review of all the publications that combine 'CLUSTER HEADACHE' and 'TESTOSTERONE' there are only 15 listings in the last 26 years. However, reading through them, there are interesting hormonal characteristics.

Murilado G. 1989 [4] showed that when testosterone levels alone were considered, researchers missed the significance. The measurement of the Free Androgen Index (FAI) is the ratio of total testosterone divided by Sex Hormone Binding Globulin. This measurement showed strongest correlation: testosterone, free testosterone, LH peak response to LHRH were present only in chronic cluster headaches and not controls.

Facchinetti F 1986 [5] reported that there were changes in the nightly secretion of prolactin, cortisol and testosterone only in episodic cluster headache patients in the active phase. The P factor less than .01 was associated with a) an absence of testosterone circadian rhythm, b) increased concentration of cortisol and 3) subsequently, reduced secretion of testosterone.

Klimek A. 1985 [6] 15 men suffering form episodic (12) and chronic (3) cluster headaches were treated for 7-10 days with testosterone proprionate 25mg IM daily and subsequently 10mg IM daily. The total number of attacks in the week prior to treatment was 308. On Testosterone, the number of attacks in the subsequent week was 94 (2/3 reduction] and the next week only 7 (97% reduction]. In 3 patients with the chronic form of cluster headache testosterone was ineffective.

Our Experience: In three men with cluster headaches, two showed significant prevention of cluster migraines over a treatment period of three years. The other individual proved to be 'drug addicted' and did not have true cluster headaches.

As reported by our patient in the movie above, his severe headaches occurred off the testosterone after almost three years cluster free (a record for him). The resultant cluster lasted for weeks and necessitated Sansert, steroids and work disability.

Interestingly, the arecent research with cluster headaches by Nicolodi M [7,8] showed that suppression of testosterone levels and the circadian release of luteinizing hormone by leuprolide were effective. This is exactly what we showed in our publication 10 years ago with women with migraine. See article.

Then, this year Stillman[9] treated 7 cluster attack males and 2 cluster-attack females with testosterone. This is what we did 10 year previously and his report parallels ours: use continuous treatment (like pellets) to prevent the attacks. See our article on the use of estradiol pellets for migraine.

We hypothesize that these men who develop cluster headaches have both a genetic predisposition and low levels of testosterone. Under 'stress', the increase in cortisol lowers testosterone levels and precipitates the cluster attack. Testosterone supplementation prevents cluster by keeping the level of testosterone 'high' above this threshold. Similarly, Luprolide acetate keeps the LH levels low and the testosterone levels stable below this cluster headache threshold. However, Luprolide acetate will create osteoporosis when used for extended periods of time.

The physiology of cluster headache in men is exactly the same as that of hormonal migraine in women!

If you suffer with cluster headaches, you may contact our office at (248) 593.9999 and read the materials listed below:

For Additional Information:

1.Dalessio DJ. editor. Wolff's Headache and Other Pain. 1980. Oxfore University Press. New York. pages 163-170
2. Kunkle EC, Pfeiffer JB, Wilhoit WM... Recurrent brief headche in "cluster" pattern. Trans. Am. Neurol. Assoc. 1952; 77: 240.
3. Kudrow L. Physical and personality characteristics in cluster headache. Headache 1974; 13: 197-202
4. Murialdo G, Fanciullacci M, et al. Cluster headache in the male: sex steroid pattern and gonadrotropic response to luteinzing hormone releasing hormone. Cephalgia 1989; 9(2): 91-8.
5. Facchinetti F, Nappi G, et al. Reduced testosterone levels in cluster headache: a stress-related phenomenon. Cephalgia 1986; 6(1): 29-34.
6. Klimek A. Use of testosterone in the treatment of cluster headache. Eur Neurol. 1985; 24(1): 53-56.

7. Nicolodi M, Sicuteri F, Poggioni M. Hypothalamic modulation of nociception and reproduction in cluster headache. Therapeutic trials of leuprolide. Cephalgia 1993; 13(4): 253-7.
8. Nicolodi M, et al. Hypothalamic modulation of nociception and reproduction in cluster headache. Tesosterone-induced increase of sexual activity in males with cluster headache. Cephalgia 1993;13(4): 258-60.
Stillman MJ Testosterone replacement therapy for treatment refractory cluster headache. Headache 2006; 46(6): 925-33







Cluster Attack Victim video