Episode 75. Cluster Headache with Amanda Ellison – Author of Splitting

In this episode, Amanda Ellison joins me to explore the intersection of brain science and clinical practice as it relates to cluster headache. Amanda is a neuroscientist and physiologist, professor in the Psychology Department in Durham University and former Director of the Wolfson Research Institute for Health and Wellbeing, and she is interested in understanding how different brain regions communicate to create our behaviour and experience of the world around us.

Our conversation on the history of the understanding of cluster headache used the monickers that have been applied over time as fulcrum, and these included migrainous neuralgia as proposed by Wilfred Harris, and Horton’s cephalalgia. We also explored the emergence of the name cluster headache, and how this coincided with the establishment of the International Headache Society.

The podcast also exhaustively reviewed the biological mechanisms driving cluster headache with references to the emerging role of the hypocretin system in generating the disease, as well as its tendency to manifest in men and in smokers. We also delved into the clinical manifestations of the disease, with Amanda noting both the classical and the non-classical presentations. She also explored the circadian periodicity of the disease in the context of the role played by the suprachiasmatic nucleus and serotonin-melatonin pathway.

The discussion also covered the acute treatment of alcohol especially with triptans and alcohol, a theme that reviewed the scientific contributions of Lisa Kudrow, the star of the television show Friends, and her father – both neuroscientists. We also looked at the history of the use of verapamil and lithium, the main prophylactic drugs of cluster headache. Amanda also explored the how coffee, chocolates and sex are biologically able to mitigate the severity of headaches, and the research into the place of deep brain stimulation of in the treatment of the disorder.