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What is a Cluster a headache?

This illustration appeared on the cover of Cephalalgia in 2012, entitled “Location of maximum pain intensity in 209 patients with chronic and episodic cluster headache”.

Cluster headache is reported to be the worst pain known to humankind, with female sufferers describing it as more painful than childbirth. It is so severe that there are frequently reports of sufferers who take their own lives to escape the pain resulting in the morbid term, Suicide Headache.

It is referred to as Cluster Headache because the pain comes in clusters of short, but intense attacks every day for a period of weeks or months at a time and often at the same time of year. The pain is almost always one-sided, and radiates from the upper cheek and around the eye. It has been described as a severe burning or stabbing sensation, and pacing is common during attacks.

There are two types of cluster; episodic cluster and chronic cluster.

According to the  International Headache Society (IHS) definition, episodic cluster is when the attacks occur for a period of time from a few weeks to a few months, and often occurs at the same time of year. Chronic cluster however is when attacks occur for more than a year without remission or with remissions lasting less than a month.

The following are listed in the IHS classification, as additional symptoms that may occur during cluster attacks:

  • extreme pain,
  • red eye,
  • tears,
  • blocked nose,
  • runny nose,
  • constricted (small) pupil on the headache side,
  • drooping eyelid,
  • swollen eyelid.

There is widespread agreement among headache specialists that the symptoms described above occur due to the involvement of what is called the pterygopalatine ganglion, also known as the sphenopalatine ganglion. The pterygopalatine ganglion is a collection of nerves closely associated with the trigeminal nerve, which plays an integral role in headache pain, and  is situated behind the upper jaw under the eye. As depicted below, the maxillary artery is very close to the pterygoganglion.


The Medical Explanation for Dr Shevel’s Cluster Headache Treatment

The Medical Explanation for Dr Shevel’s Cluster Headache Treatment

The drug, Sumatriptan was developed to treat migraine, but as it transpired, it is far more effictive in the treatment of cluster headache than it is in the treatment of migraine. Many cluster sufferers have discovered that Imigran also known as Imitrex injections (which contain sumatriptan) are the most reliable and effective way of aborting cluster headache attacks.

The only action of Imitrex/Imigran is to constrict the painfully dilated extracranial (outside the skull) terminal branches of the external carotid artery. This understanding led to Dr Shevel’s reasoning that, if Imitrex/Imigran works to stop cluster headache attacks, then the painfully dilated extracranial terminal branches of the external carotid artery are clearly involved in generating the pain. When the arteries dilate, they give off pain producing neuropeptides and in some unfortunate people, the painfully dilated maxillary artery impacts the pterygopalatine ganglion (also known as the sphenopalatine ganglion) triggering powerful neural pain impulses to the brain, with the result of cluster headache.

(For those cluster headache sufferers who have not yet tried Imitrex, we recommend that you discuss this with your physician, or contact us to evaluate whether this could help you in the interim.)

Dr Shevel’s scientific approach of questioning and researching resulted in the breakthrough innovation of this unique procedure to close the maxillary artery on the affected side, and achieve a permanent Imitrex or Imigran effect. He sees it as no coincidence that the area of maximum intensity of pain (as pictured in the section above) is the precise area supplied by the maxillary artery.

Without the dilating of the maxillary artery giving off neuropeptides or affecting the pterygopalatine ganglion, this collection point of nerves no longer sends pain impulses to the brain.

All the arteries treated at The Headache Clinic, including the maxillary artery  are permanently closed in medicine every day by Neurosurgeons, Maxillo-Facial Surgeons, Plastic surgeons, and ENT surgeons for a variety of other reasons. Dr Shevel’s technique however is unique and minimally invasive.


Dr Shevel’s Procedure for Cluster Headache Treatment

Dr Shevel operates by making very small incisions for all of his procedures. These operations are done in a daycare facility from which patients can go home on the same day and are in no ways comparable with brain surgery or muscle surgery in the forehead.

He has also recently adopted the use of a fine medical instrument which is a further innovation to this medical breakthrough. This accurate instrument ensures his work is as delicate as possible, minimizing trauma and further increasing the procedure’s success rate.

There are however never guarantees in medicine and some of the reasons that this operation may not work for some patients are discussed here. (hyperlinks to improve CSS underline + bold)

Cluster headache is an exceedingly complex condition treat, especially when it has become chronic, and there are often also other arteries involved besides the maxillary artery. This usually becomes apparent after the first procedure. In some cluster patients cauterizing the maxillary artery is the only procedure needed, yet in others additional superficial arteries may be contributing to their pain and need to be treated. In many patients, muscle pain is also present (this may be indicated by neck pain during the attacks) and that has to be treated too with Dr Shevel’s non-drug, non-surgery method. Therefore, there is an incremental treatment approach that can take as little as a few days or can span a few weeks.

Due to Dr Elliot Shevel’s training as a Maxillo-Facial and Oral Surgeon, he has been fortunate to have had the opportunity to approach the problem of cluster headache from an entirely different perspective to the traditional “conventional wisdom”.  The success rates at The Headache Clinic for this largely un-treatable condition bear testament to this.

Please click here to watch stories of patients who have undergone this cluster headache treatment. Some of them are from when Dr Shevel first started to treat this condition in 2013 and they are still cluster free.

*Treatment results may vary from person to person.

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