Tamed torturer in the head

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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People with cluster headaches have to endure excruciating attacks of pain over and over again. A novel electrical stimulation method can end the torture.

The first attack seems to come out of nowhere: “Like a glowing nail that pierces through the eye from behind,” is how Helmut Kutzera describes the unbearable pain that torments him. For more than two years, the cluster headache has been his daily companion for months. He then has to endure up to eight attacks a day. Usually they attack him in the evenings and at night. Such an attack lasts up to an hour and a half at Kutzera. Then his right eye turns blood red and water. He sweats heavily on his head, squirms, trembles, presses his face into a pillow - nothing helps. The wife and children stand by helplessly. "I do not wish my worst enemy such agony," says the 46-year-old.

Torture-like pain

"The pain can be compared to torture," emphasizes Kutzera's attending doctor, Dr. Holger Kaube from the Neurology and Headache Center Münchner Freiheit, what his patients experience. Some hit their heads against the wall to counter the pain. At Kutzera the illness massively overshadows professional and private life, his family is constantly worried about him. In some cases, the desperation is so great that those affected take their own lives.

Cluster headaches are very rare compared to other types of headache. You meet more men than women - mostly between the ages of 20 and 40. Experts estimate that around 120,000 people in Germany suffer from the seizures. As a rule, these occur at intervals over weeks or months with several attacks a day. How and why the pain attacks hit some and not others is still unknown. “But we know that the disease originates from the hypothalamus,” explains neurologist Kaube. This brain region acts as a control center and controls many important body functions.

Doctor-to-doctor odyssey

Often times, cluster headache patients have gone through a doctor odyssey until they get the correct diagnosis. "Many doctors are not familiar with it," says Kaube. The family doctor also first sends Helmut Kutzera to the ophthalmologist. An ear, nose and throat specialist follows, then a dentist. He has to wait weeks for each appointment. But even the specialists find: nothing.

Until the 46-year-old finally ends up at Kaube. “That was the turning point,” says Kutzera. For the first time he receives help. At the first signs of an attack, for example, he inhales oxygen. If that happens quickly enough, the attacks can usually be averted. "No matter where I go, I now always carry an oxygen cartridge in my rucksack," reports Kutzera.

And then there are emergency syringes that will make the pain subside after a few minutes. They contain the active ingredient sumatriptan. Patients are not allowed to sit down for more than two a day - for someone with far more frequent attacks like Kutzera that is not enough.For this reason too, Kaube recommended a comparatively new process that works with minimal electrical surges.

Pain conduction switched off

The goal of electrical stimulation is a specific nerve node, the sphenopalatine ganglion (SPG). The roughly pea-sized lump sits behind the cheekbones and plays a central role in the pain cascade associated with cluster headaches.

If the node is stimulated electrically, the pain can be switched off. The procedure is called SPG stimulation therapy. For this purpose, a small chip is implanted in the patient below the paranasal sinus, the thread-thin electrodes of which extend to the nerve node. Using a remote control, which the patient holds to the cheek, he can immobilize the nerve node. "It just sizzles a little," says Kutzera. Then the spook is over before the pain can screw itself up completely. Long-term observations show that the procedure can have a preventive effect not only in the event of an acute attack - the time between pain attacks is increased.

Skull model to practice on

The procedure itself is minimally invasive and less stressful for the patient. "A specially trained oral surgeon makes a small incision in the gums of the upper jaw, through which the chip is pushed," explains Kaube. Then it is attached to the bone with three tiny screws. The challenge here is to precisely position the electrical pain killer. To do this, a one-to-one plastic skull model is made for each patient on the basis of a computer tomography. The surgeon can use this to familiarize himself with the patient's anatomy in advance.

"Such a chip can be implanted in three out of four patients - unfortunately in a quarter this is not anatomically feasible," explains Kaube. Sometimes it takes a while for the electronics to be optimally set. But if the procedure is successful, 95 percent of patients can tame the pain with it.

The implantation costs around 30,000 euros. The statutory health insurance companies cover the costs - but only if the phases of pain are long and the usual therapy methods are not sufficient. As with Kutzera. For him, the implant was the salvation. Even if the chip now has to be readjusted again after it was initially very effective, the father of the family says: "I'm slowly starting to live again."

The following treatment centers offer SPG stimulation therapy in Germany: