After my second attack in3hours last night, I told my husband that my head feels like I'm having a heart attack in my brain. Does this make sense to anyone else?

I mean, we use oxygen for relief (a heart attack is due to oxygen supply being cut off to an area of muscle) we use magnesium or ergots or triptans (which all dilate vessels to improve blood supply) and the pain is the same crushing intense pain I've heard patient describe before.
Desperate to try and find a solution once and for all.... Please share any thoughts

This medical talk says: Cluster is a disorder of the nervous system, not of blood vessels. They are triggered in the hypothalamus, a small section of the brain.
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Interesting to note that he is saying that the primary mode of action is NOT as a vasoconstrictor but on its effect on the central nervous system. Doesn't change our appreciation of this class of meds but suggests we need to change how we think about the nature of CH.
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Handb Exp Pharmacol. 2007;(177):129-43.   


Serotonin receptor ligands: treatments of acute migraine and cluster headache.


Goadsby PJ.

Institute of Neurology, Queen Square, London WC1N 3BG, UK. peterg@ion.ucl.ac.uk

Fuelled by the development of the serotonin 5-HT(1B/1D) receptor agonists, the triptans, the last 15 years has seen an explosion of interest in the treatment of acute migraine and cluster headache. Sumatriptan was the first of these agonists, and it launched a wave of therapeutic advances. These medicines are effective and safe. Triptans were developed as cranial vasoconstrictors to mimic the desirable effects of serotonin, while avoiding its side-effects. IT HAS SUBSEQUENTLY BEEN SHOWN THAT THE TRIPTANS' MAJOR ACTION IS NEURONAL, WITH BOTH PERIPHERAL AND CENTRAL TRIGEMINAL INHIBITORY EFFECTS, AS WELL AS ACTIONS IN THE THALAMUS AND AT CENTRAL MODULATORY SITES, SUCH AS THE PERIAQUEDUCTAL GREY MATTER. Further refinements may be possible as the 5-HT(1D) and 5-HT(1F) receptor agonists are explored. Serotonin receptor pharmacology has contributed much to the better management of patients with primary headache disorders.

PMID: 17087122 [PubMed]
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J Clin Neurosci. 2010 Mar 11.

What has functional neuroimaging done for primary headache ... and for the clinical neurologist?
Sprenger T, Goadsby PJ.

UCSF Headache Centre, Department of Neurology, University of California, 1701 Divisadero St, Suite 480, San Francisco, CA 94115, USA.

Our understanding of mechanisms involved in primary headache syndromes has been substantially advanced using functional neuroimaging.

THE DATA HAVE HELPED ESTABLISH THE NOW-PREVAILING VIEW OF PRIMARY HEADACHE SYNDROMES, SUCH AS MIGRAINE AND CLUSTER HEADACHE, AS BRAIN DISORDERS WITH NEUROVASCULAR MANIFESTATIONS, NOT AS DISORDERS OF BLOOD VESSELS.

PMID: 20227279 [PubMed]

Was merely suggesting that the nature of the pain bears a resembelance to what i have seen with myocardial infarction patients. Am well aware that CH is not an ischaemic event. Strokes are after all painless.

Are we certain that the neurovascular change is as a result of the hypothalamus dysfunction, or could it be a case of chicken and egg?

Everytime i have another headache, i focus on some new nuance i might have missed before. This was just another desperate attempt at understanding a little more... Thank u for indulging me

Thanks, Doc, for the thought.  I, too, have found it curious that the explanations for the disorder seem to be lacking.  Not surprisingly then, the emphasis is on abortive potions and procedures.  I have often used recovery time to think about the explanations that made the rounds about the movement of stars....and wonder if one of us is just going to snap our fingers and say "Hey, I think I've got something".  To that end, I continue to read many of your posts.  I know of few other conditions whose presentation is as consistent as it is with CH sufferers, even though there are consistent inconsistencies (is that possible?).  I know that in my own experience, I am unable to add any tactile input to the afferent flow of the involved facial areas without feeling as though I will, literally, explode.  Yet I am convinced that the problem is not preganglionic.  I like to hold the chicken/egg principle high in my algorithm.  Sleep well.

TJ