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.  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  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  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  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  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 most recent 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.
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:
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.