The Devil Behind the Eye: Living with Male Pattern Cluster Headache
Thursday May 8, 2025.
Not a migraine. Not a choice. Just the cruelest headache known to medicine.
A pain so precise it has a schedule.
If you're here, it's likely because someone you love—or you—wakes up in the early morning hours, heart racing, one eye watering, skull imploding from within.
You may have been told it’s a migraine, or sinuses, or anxiety. It’s not.
This is male pattern cluster headache—a neurological disorder so excruciating it has earned the name “suicide headache.” It’s rare, it’s underfunded, and it is catastrophically misunderstood.
This post is here to tell some truth about it, including the latest research on treatments from mainstream medicine to psilocybin micro-dosing, and to give both sufferers and their loved ones practical tools and perhaps a better understanding of this ailment.
I have street cred. I’ve been living with Male Pattern Cluster headache for the past 37 years.
What Is Male Pattern Cluster Headache?
Cluster headache is a primary headache disorder that affects fewer than 0.1% of the population. It’s a shit lottery, if you ask me.
While it occurs in all genders, it disproportionately affects men, especially in their 20s through 40s (López, 2018).
It’s considered an orphan disease—meaning it’s rare, under-researched, and overlooked by the pharmaceutical industry.
Attacks are typically short (15 minutes to 3 hours), brutal, and typically recur at the same time daily for weeks or months in what’s called a cluster period. It may then go into remission—only to return again like fu*king clockwork.
Why Cluster Headaches Keep a Schedule: Blame the Hypothalamus
Most people with cluster headaches can pretty much tell you when the next attack is coming.
That’s not magic. That’s the hypothalamus—the part of your brain responsible for circadian rhythms.
Imaging studies have shown hypothalamic activation during attacks (May et al., 1998), which explains why they often strike during REM sleep or early morning hours and why cluster cycles follow seasonal changes.
It's not psychological. It's anatomical. It’s like the clock in your skull is just a little bit evil.
Clinical Presentation: Beyond Pain
Cluster headache isn’t just pain. It’s a cluster of autonomic symptoms that make it distinct:
One-sided head pain (typically orbital or temporal)
Watery eye (on the same side)
Nasal congestion
Ptosis (drooping eyelid)
Agitation, pacing, and an inability to stay still
Sufferers are often misdiagnosed with migraines, trigeminal neuralgia, or sinusitis—sometimes for years. And unlike migraines, rest and darkness make cluster headaches worse.
Is Cluster Headache Dangerous? Treatment Options: The Best of What Modern Medicine Offers
There’s no cure. Clusters aren’t fatal, but sometimes you wish they were.
But there are treatments—some acute, some preventive, and some experimental.
Abortive Therapies (Stopping an Active Attack)
High-Flow Oxygen Therapy
100% oxygen at 12–15 L/min via a non-rebreather mask can abort an attack within 15 minutes for many. It’s safe, inexpensive, and dramatically underused (Cohen et al., 2009). Works great unless your dipshit neurologist orders the wrong mask.
Sumatriptan Injections or Zolmitriptan Nasal Spray
Triptans are effective, especially in injectable form. Onset of relief is typically under 15 minutes. However, cardiovascular concerns limit use to a few times per week. No thank you please, it only made me sneeze. Your mileage may vary.
Preventive Therapies (Reducing Attack Frequency)
Verapamil
The gold standard for prevention. Requires EKG monitoring at higher doses. Never worked for me, but now I suspect it damaged my nervous system.
Lithium Carbonate
Especially effective in chronic cluster cases. Blood levels must be closely monitored. Never worked for me either.
Galcanezumab (Emgality)
The first and only CGRP monoclonal antibody approved specifically for cluster headache. Monthly injections can reduce attack frequency (Goadsby et al., 2019).
Melatonin (10–15mg nightly)
Useful in modulating the hypothalamic connection, especially for nocturnal attacks. Not in my case, however.
Transitional Therapies (Breaking a Cluster Cycle)
Prednisone Taper
Often used to quickly suppress a cycle while preventives build effectiveness. Usually a 10–21 day taper beginning at 60–80mg.
Occipital Nerve Block
A corticosteroid + anesthetic injection behind the head can reduce attacks for weeks.
Neuromodulation Devices (Experimental but Emerging)
Devices such as gammaCore (non-invasive vagus nerve stimulation) show promise, especially for chronic cluster cases. Access and the absurd cost remain barriers for many.
Psilocybin (Liberty Cap Mushrooms): The Underground Lifeline. This one thing saved me.
Why Patients Are Turning to Mushrooms
Traditional meds fail some cluster sufferers. That’s not opinion—it’s reflected in the high rate of self-treatment with psilocybin and LSD, particularly among those with chronic cluster headache.
I was one of those unlucky souls who did not respond to conventional treatment.
In 1998, I found a Harvard Research neurologist who took pity on me. He was the first to whisper in my ear about Liberty cap mushrooms.
Liberty cap mushrooms (Psilocybe semilanceata) are small, wild, and rich in psilocybin, a serotonin receptor agonist. The serotonin system is central to cluster pathology. Psilocybin binds to 5-HT2A receptors, the same ones targeted (less effectively) by triptans and lithium.
In a pivotal study by Sewell, Halpern, & Pope (2006), psilocybin and LSD both showed preventive and cycle-aborting properties in cluster headache patients.
The majority of those who used psychedelics reported relief that lasted weeks to months. In my case, It’s been about 25 years.
How Patients Are Using Psilocybin
Microdosing
Small, sub-perceptual doses every 3–5 days during or before a predicted cluster period. Common dosing is 0.1–0.3g dried psilocybin mushrooms. I buy mushrooms from whoever is my local drug dealer at the time. My biggest problem is that it’s a dirty dose, and a bag lasts me so long, that eventually the shrooms get’s stale and less effective.
Single Full Dose
1–2g doses at onset of a cluster cycle have been reported to halt the progression entirely in some cases.
Maintenance Dosing
Some sufferers repeat a dose every 1–2 months to delay or prevent future cycles.
Cautions and Contraindications
Do not combine with triptans or SSRIs within 24 hours due to serotonin syndrome risk.
Psychedelics are still federally illegal in the U.S., though decriminalization is expanding. I realize I’ve alluded to some crimes here, but considering the level of pain we’re talking about, fu*k it.
Always start with medical guidance if available. Clinical trials are in motion at Yale and Johns Hopkins.
Psilocybin Microdosing Tracker (Print and Use)
Your Name:
Cluster Season (Expected):
Start Date of First Dose:
Dose Size:
Schedule (e.g., every 3 days):
Observed Effects:
☐ Decreased frequency
☐ Shorter attack duration
☐ Fewer nocturnal attacks
☐ Break in cluster cycle
Side Effects (if any):
Additional Notes:
Use this to communicate with a doctor, support group, or clinical researcher. Shared data builds better care.
The Cluster Attack Emergency Plan (For Partners, Family, and Friends)
What to Do in the Moment:
Stay silent. No questions. No advice.
Get the tools. Non-rebreathing Oxygen mask. Injector. Cold compress. Dark room.
Clear the space. No light, noise, or activity nearby. Light for me was especially painful.
Don’t touch unless asked. Touch can intensify the pain.
Stay close, but invisible. Be present without needing to be seen.
After the storm, offer water, space, and love. No analysis. Just witness.
Living With It—And Not Letting It Win
Cluster headache doesn’t just hurt—it haunts.
People change their jobs, relationships, and sleep patterns to avoid it.
Many live in dread of the next cycle.
Some report PTSD-like symptoms even during remission.
It’s kills Libido, and the desire to connect because the cumulative effects over time fry and frazzle the nervous sysytem.
But you are not powerless. And, if you’ve married well, you are not alone.
There are also communities like ClusterBusters, the r/ClusterHeads forum, and growing networks of people and clinicians who get it.
Your brain has a flaw. You do not.
Final Word
Male pattern cluster headache is a devastating, often invisible illness.
It destroys sleep, relationships, and sanity—but not identity.
Every new treatment, every decriminalization bill, every online post saying “you’re not crazy”—matters.
If you’re the one suffering: Your pain is real. Your resilience is more so.
If you’re the one watching a loved one suffer: You are vital to their survival. And you need care, too..
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Cohen, A. S., Burns, B., & Goadsby, P. J. (2009). High-flow oxygen for treatment of cluster headache: A randomized trial. JAMA, 302(22), 2451–2457. https://doi.org/10.1001/jama.2009.1855
Goadsby, P. J., Dodick, D. W., Leone, M., Bardos, J. N., Ahmed, F., & Camporeale, A. (2019). Trial of galcanezumab in prevention of episodic cluster headache. New England Journal of Medicine, 381(2), 132–141. https://doi.org/10.1056/NEJMoa1813440
López, J. M. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Seminars in Neurology, 38(6), 600–610. https://doi.org/10.1055/s-0038-1676352
May, A., Bahra, A., Büchel, C., Frackowiak, R. S., & Goadsby, P. J. (1998). Hypothalamic activation in cluster headache attacks. The Lancet, 352(9124), 275–278. https://doi.org/10.1016/S0140-6736(98)02470-2
Rozen, T. D., & Fishman, R. S. (2020). Cluster headache in the United States of America: Demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache: The Journal of Head and Face Pain, 60(1), 211–221. https://doi.org/10.1111/head.13721
Sewell, R. A., Halpern, J. H., & Pope Jr, H. G. (2006). Response of cluster headache to psilocybin and LSD. Neurology, 66(12), 1920–1922. https://doi.org/10.1212/01.wnl.0000219761.05466.43