Encino Clinic Eases Cluster Headache Pain With Oxygen Therapy
The sensation began as a sinister dullness at the base of his skull, but quickly narrowed to a sharp knifelike stab behind the eye. A titanic force slowly pushed through his eye like a red-hot poker, causing it to water, droop and grow crimson. His face turned white as the torment reached its peak.
He screamed, beat the walls with his fists and ripped a door from its hinges. Knowing the attack would last one more hour, his thoughts turned to a gun stashed in a kitchen drawer.
The scene is not from the “Incredible Hulk” TV show--or even from Stephen King’s latest horror novel. It is a description of a cluster headache, a pain so excruciating that victims say it often brings on violent outbursts and thoughts of suicide as ways to manage the anguish.
Since the disorder was first described in 1840, sufferers, who are usually male, have found little recourse to relieve the agony. A handful of medications has been used since the mid-1970s, but significant relief did not arrive until 1979 when Dr. Lee Kudrow, founder of the California Medical Clinic for Headache in Encino, pioneered oxygen inhalation therapy as a way to abort attacks. Today this remedy is used widely.
The 57-year-old Kudrow, himself a victim of cluster headaches since age 22, only last month was finally able to explain why the oxygen treatment worked.
In a study of 20 subjects with whom he used nitroglycerin to induce cluster headaches, he found that oxygen levels in the blood drop just prior to the onset of the headaches. (The number of patients Kudrow used is common for a physiological study, researchers say. He has used as many as 400 subjects in other research projects.)
“It’s going to be a big hit,” Kudrow said of his findings, which he submitted in March to Headache Journal, which has previously published 18 papers by Kudrow.
In June he will present his findings at the annual conference of the American Assn. for the Study of Headaches, to be held this year in Los Angeles.
About 1,200 cluster headache sufferers are treated annually at the Encino center.
Kudrow’s current discovery is linked to a previous study that was much-lauded by fellow researchers in the field. In 1988, Kudrow reported that most cluster headaches occur cyclically in January and July, about one week after the longest and shortest days of the year. The same study, which used 402 subjects, showed that cluster headache periods--a time when the headaches usually occur--diminished two weeks following changes between daylight-saving and standard time.
According to Kudrow’s study, which examined 891 cluster periods, patients’ headaches seemed to occur and fade with changes in circadian rhythms--a person’s inner biological clock--much like the moon causes the rising and falling of the ocean. Tampering with circadian rhythms by using daylight savings and standard time would result in low oxygen levels just prior to attacks, Kudrow suspected, because circadian rhythms are centered in the hypothalamus, a portion of the brain that regulates oxygen levels in the blood.
His research proved his theory, he said.
Portions of the circadian rhythm study were validated last year by a University of Minnesota study that showed the rhythmic nature of cluster headaches.
Kudrow said he next plans to measure minute-to-minute oxygen levels in patients who will wear portable measuring devices.
“Everyone was very impressed with his presentation,” Dr. Egilius Spierings said of Kudrow’s circadian rhythm presentation in Boston last year. Spierings is director of the John E. Graham Headache Centre in Boston. “He’s one of the leading experts. He’s written the only textbook solely dedicated to cluster headaches.”
Dr. Mark Goldberg, chief of neurology at Harbor-UCLA Medical Center in Torrance, said Kudrow “is just one of the outstanding experts in the country. He’s produced very sound studies in an area that’s difficult to study since there are variations within individuals and variations in reaction to pain. It takes enormous clinical experience to make rational evaluations like he does.”
Although Kudrow believes he has established an oxygen link, the exact cause of cluster headaches remains a mystery. “We know they’re not inherited,” said Kudrow, whose clinic is one of 30 centers worldwide that specialize in headache study. “But it must be acquired somehow--perhaps from toxic substances, from a head injury or from something that causes a dysfunction in the hypothalamus--it’s all highly speculative.”
Richard Strop entered Kudrow’s offices one month after suffering his first cluster headache assault in a Santa Monica restaurant in 1979.
“The pain was so intense it felt like I was exploding inside,” said Strop, who had seen several specialists and endured a battery of tests and treatments before going to Kudrow. “It felt like my teeth were being yanked out and like someone was shoving my eye out from inside my skull.
“I got scared.”
Strop, 55, said he downed a few aspirins after his first encounter with the skull-cracking pain, but now takes verapamil and ergotamine to help prevent the headaches. But, he said, he gets the greatest relief with the seven liters of pure oxygen per minute he inhales when a headache begins.
“I carry a portable oxygen tank with me in the car and keep a bigger one at home,” said Strop, a Glendale resident who owns an import automobile parts business. Attacks are aborted within 15 minutes of breathing oxygen in 90% of cases, according to Kudrow.
Strop, who keeps track of his headache attacks, said his cluster periods last for 2 1/2 months and arrive about every two years. He now receives periodic checkups at the Encino center, which treats a variety of headache disorders, including migraine, tension, muscle contraction, systemic and post-traumatic headaches.
Kudrow said he has treated more than 10,000 patients, most of whom live in Southern California and were referred by physicians.
Many of Kudrow’s patients participate in studies performed at the clinic, but Kudrow who considers himself the ideal subject. While in cluster periods, Kudrow said he forgoes medication, but does inhale oxygen at the onset of an attack. The practice, he said, enables him to become a “clean study,” one whose blood is not tainted by drugs.
“I have to kind of tolerate the pain,” said Kudrow, who served as chief of medicine and chief of staff at Encino Hospital in the late 1960s and early 1970s. “I can’t subject other people to what I subject myself to.”
Kudrow, who has been in remission for five years, said he uses himself as a subject only while in cluster periods.
“It’s not customary for researchers to try out studies on themselves,” said Goldberg of Harbor-UCLA Medical Center. “But Jonas Salk just announced he would be the first person to take his new AIDS vaccine, so it’s not unheard of.”
Kudrow, who earned his medical degree from the UC Irvine, and completed an internship at Cedars of Lebanon Hospital in Los Angeles, said he experienced a 13-year remission beginning at age 32--and considers himself lucky, as the average remission period is one year.
“You do anything to get away from the pain,” Kudrow added, recalling the time that he raced to his back yard swimming pool and dunked his head in freezing pool water to numb the pain. “It’s very oppressive. It’s exquisitely excruciating.”
Kudrow experienced his first headache in 1955 while driving to UCLA, where he was completing undergraduate studies. The comparatively mild headaches lasted one week, but the following year, he said, “they came back with a fury.”
After six years of misdiagnosis and ineffective treatment, a common experience for sufferers, Kudrow made a self-diagnosis at age 28, based on years of exhaustive research.
Seated in his nondescript office, Kudrow remembered an especially cruel attack: “One day I was sitting in geology class at UCLA and had to run out of class. I ran to the middle of the quad and started banging my head against the ground, on the concrete, to get the pain to stop.”
The action is typical, victims say. According to Kudrow, one of his patients ripped a door off its hinges and three have broken their arms while hitting walls. Most contemplate suicide, but only one of his patients has killed himself, said Kudrow, who has tracked 75% of his patients through the years.
“Some of my patients tell their spouses to hide a gun if it’s in the house,” said Kudrow, adding that male patients who have endured kidney stones, commonly thought to be among the greatest tortures a man can experience, say cluster headaches are many times more agonizing.