Anyone who has clusters should recognize the name Peter Goadsby. He is the premier researcher in this field, as well as a professor of clinical neurology at England's Institute of Neurology. When I see his name connected to a study, I know this is reliable, cutting edge information.
Goadsby was a member of a team of researchers who defined this area of the brain which is structurally different in clusterheads. They found increased density in the gray matter of the hypothalamus on the side of the brain where the cluster pain occurs. (See my previous articles about cluster headaches to read about the symptoms and treatments available.) Since the hypothalamus regulates circadian rhythms, this may explain why clusters are usually seasonal and occur in regular patterns.
The hypothalamus is a small part of the brain which also regulates body temperature, thirst, and appetite, and has an effect on aggression and sleep. It also has an effect on sexual behavior and works with the pituitary gland in regulating the production of hormones. Interestingly, researchers have noted lower testosterone levels in men during clusters.
Previously it had been thought that clusters were the result of abnormal activity in a normal brain, but this research shows that is not true, particularly since the physical findings in the hypothalamus were found regardless of whether the patient was experiencing a cluster or not.
Needless to say, this discovery bodes well for ongoing research to discover an effective treatment, or possibly even a cure in the future.
An earlier study using PET scanning had shown nerve activity in the hypothalamus during a cluster, and it appeared on the same side of the head as the pain. No unusual activity was seen in the brain stem during a cluster as would be found during a migraine. Perhaps migraine and cluster headaches aren't as closely related as we have always thought? It would seem the definition of clusters as vascular headaches is not ironclad.
In related research, a study of 200 patients found that 75 of them experienced clusters as a result of elevated body heat. The usual symptoms of pain, tearing of the eye, runny nose, etc., are occasionally found in combination with feeling hot and perspiring heavily. Some clusterheads routinely deal with this by applying a cold pack to the affected side of the face or by going out into the cold air. A few apply heat, which may work as a counterirritant.
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