It was an unusual week at the New York Headache Center. After months of relative calm, my schedule suddenly filled with cluster headache patients—one even consulting me virtually from Saudi Arabia. The influx came right after a G5-level geomagnetic storm, one of the strongest solar events in recent memory.Cluster headaches are among the most agonizing conditions in medicine. Patients often describe the pain as a searing poker behind one eye, with tearing, nasal congestion, and agitation, recurring in relentless, exhausting attacks that can strike several times a day. They come in periods, or “clusters,” that torture patients for weeks or months before disappearing, sometimes for years.What continues to intrigue neurologists is how often these cycles seem to flare up simultaneously around the world. It’s not unusual for patients in different hemispheres—without any link other than their diagnosis—to start their cluster period within days of each other.The Solar ConnectionLinks between geomagnetic storms and headaches have been debated for decades. In a 1987 study, an Israeli neurologist, Arieh Kuritzky found that while geomagnetic activity didn’t alter how often migraines occurred, the intensity of attacks increased in step with geomagnetic disturbances—from 26% of headaches being severe on quiet days to 44% during stormy periods. Other research noted that during strong geomagnetic activity, most participants reported fatigue, unease, and diffuse head pain, along with measurable changes in brain electrical activity.The Circadian Clock ConnectionCluster headaches already have their own remarkable sense of timing. Around 80% of patients report attacks striking at the same hour each day, sometimes down to the minute. Many also find their cluster periods reappear with the changing seasons—most often in spring or autumn—so consistently that some plan their lives around it.This predictable rhythm points directly to the hypothalamus, the brain’s internal clock. It regulates circadian and seasonal cycles, sensitivity to light, and potentially even our physiological responses to geomagnetic shifts.What We Still Don’t KnowA large 2016 study analyzing 63 million Twitter posts found no broad connection between geomagnetic activity and headache frequency. But that study lumped together all headache types and may have missed the unique timing and clustering patterns that define this condition. The authors noted that if only a small subset of patients—perhaps those with cluster headaches—were sensitive to such changes, their data wouldn’t have picked it up.So far, only anecdotal reports suggest that solar storms can trigger simultaneous cluster cycles in patients worldwide. However, the recent severe G5-level storm seems to confirm this connection.What can be doneFor now, our focus stays on the treatment we can provide. Unfortunately, it takes an average of five years for cluster headache sufferers to receive a correct diagnosis. Cluster headaches are often misdiagnosed as migraines or sinus headaches. Some treatments of cluster headaches and migraines are similar, but many are unique.There are three types of treatment. One approach is to try stopping the cluster period as soon as it starts. A tapering course of prednisone can sometimes achieve this. We start with a high dose of 80 mg and reduce it by 10 mg every day. Another treatment is an occipital nerve block with a local anesthetic such as lidocaine and a long-acting steroid such as Depo-Medrol. An intravenous magnesium infusion can also help. Our research has shown that 40% of patients are deficient in magnesium, and those patients tend to respond to an infusion.The second approach is to use a medication that suppresses cluster attacks for the duration of the cluster period, which can be one to three months. The only FDA-approved drug in this category is galcanezumab, or Emgality. This drug is self-injected once a month. It is also approved for the prevention of migraine headaches, but for clusters, the dose is higher. If galcanezumab is ineffective or not available, we prescribe verapamil, a blood pressure medicine. Unlike when treating high blood pressure, the dose is usually much higher. For hypertension, patients take up to 240 mg a day, while for cluster headaches, 480 mg, 720 mg, and even more. Before each increase of the dose, an electrocardiogram is done to make sure the drug does not affect the heart. Epilepsy drugs that are also used for the treatment of migraines can also help. We also try Botox injections, which are approved for the prevention of migraines.The third type of treatment aims to stop each headache attack as it starts. Sumatriptan (Imitrex) injections are FDA-approved for the acute treatment of cluster (and migraine) attacks. The difficult part is getting enough of these shots approved by the insurance. Some patients have one, two, or more attacks each day. Inhalation of pure oxygen through a mask provides relief to at least half of the patients who try it. Oral abortive medications are often ineffective because they take an hour to start helping, while cluster attacks usually begin suddenly and last an hour or two.Knowing that cluster headache sufferers worldwide may be experiencing their attacks in synchrony may offer them some comfort—a reminder that even in their most isolating moments of pain, they are not alone.
