You are on page 1of 15

Headache © 2008 the Author Journal compilation © 2008 American Headache Society

ISSN 0017-8748 doi: 10.1111/j.1526-4610.2008.01268.x Published by Wiley Periodicals, Inc.

Brief Communications
Response of Cluster Headache to Kudzu
R. Andrew Sewell, MD

Objective.—To describe the self-treatment of cluster headache with kudzu. Background.—Many cluster headache patients take over-the-counter (OTC) kudzu extract in the belief that it helps their cluster attacks. Kudzu’s actual efficacy has not been studied. Methods.—A database of cluster headache patients was questioned about their use of various alternative remedies to treat their cluster headache. Of 235 patients identified, 16 had used kudzu, consented to interviews, and provided medical records. Results.—In total, 11 (69%) experienced decreased intensity of attacks, 9 (56%) decreased frequency, and 5 (31%) decreased duration, with minimal side effects. Conclusion.—Anecdotal evidence suggests that a component in OTC products labeled as kudzu may prove useful in managing cluster headache. This hypothesis should be tested with a randomized clinical trial. Key words: cluster headache, case series, kudzu (Headache 2009;49:98-105)

Cluster headache is a rare disorder, generally considered to be the most painful of all types of headache.1 It occurs predominantly in men (0.4% vs 0.08% of women), typically beginning in the third decade, and is categorized as either episodic, occurring for periods interspersed with pain-free remissions, or chronic, in which the headaches occur constantly for more than a year with no remission longer than one month.2 Ten percent of episodic cluster headaches ultimately evolve into the chronic form, and these are termed secondary chronic. In standard descriptions of cluster headache, an “attack” refers to the actual paroxysm of pain, a “cluster period” to a period of time when attacks occur regularly, and a “remission
From the VA Connecticut Healthcare/Yale University School of Medicine—Psychiatry, West Haven, CT, USA. Address all correspondence to R.A. Sewell, VA Connecticut Healthcare/Yale University School of Medicine—Psychiatry, West Haven, CT 06516, USA. Accepted for publication August 2, 2008.

period” to an interval during which no attacks occur.3 Cluster periods tend to recur at fixed intervals ranging from several months to several years, often occurring at the same time each year, and are marked by recurrent stabbing attacks that increase in intensity over 5 to 10 minutes, last 15 minutes to 3 hours, and then fade away. Attacks typically occur 1 to 3 times a day, usually at strikingly predictable times (often 2 hours after the patient falls asleep) but can sometimes occur as often as every 2 hours. The intensity of the pain is severe enough that patients have been known to commit suicide.4 Standard care for cluster headache includes acute treatments such as triptans or high-flow oxygen taken at the onset of an attack, supplemented with prophylactic treatments such as verapamil or lithium, which are taken on a continuous basis once a cluster period has begun, or before sleep in order to prevent nocturnal attacks in the case of ergotamine.1 Unfortunately,
Conflict of Interest: None


2 (40%) decreased frequency.11 dilates cerebral blood vessels. (3) allowed us to obtain copies of medical records documenting a diagnosis of cluster headache by an MD or DO. Of the 58 . 99 treatments for cluster headache and phrased in such a way that kudzu did not appear to be a topic of undue interest. 159 (68%) had responded. 22 (14%) endorsed using kudzu root or extract to self-treat their cluster headache. the subject was excluded from further analysis. As of October 10. and only 3 of 7 (43%) patients taking kudzu less than 3 times a day showed benefit. Many herbal remedies have been proposed to treat headache. The subjects had been previously recruited for a study unrelated to kudzu14 and came from 3 sources – members of the Clusterbusters patient advocacy group (37). METHODS The study was approved by the McLean Hospital/ Harvard Medical School IRB. If the medical records did not support the diagnosis. 2006. Measured by total dose per day.8 and today its rhizome is a traditionally used component in Chinese medical polyprescriptions for liver diseases. Triptans and ergot alkaloids often cannot be given frequently enough. feverfew5 and cannabis6 have the most empirical support.13 Its use in the treatment of cluster headache has not previously been described. but neither has been specifically evaluated for cluster headache. 1). and allergies. and 2 (18%) experienced a truncated cluster period. Of the 6 who reported no effects or worse effects from kudzu. including kudzu root. and 21 (58%) reported no effect.12 Historically. of the 36 (13%) respondents from the cohort of 285 in the database who endorsed using acupuncture.7 The use of Ge-gen (kudzu root) was described in the Chinese medical book Shang Han Lun – “Treatise on Fever” – 1800 years ago. strokes. of these. and oxygen tanks are unwieldy and inconvenient. 7 (20%) felt it improved their cluster headache. and duration also showed a dose–response relationship. Side effects were mild and infrequent. whereas 8 of 10 (80%) taking the more frequent dose benefitted (Fig. In comparison. 4 (36%) experienced decreased attack length. We restricted our analysis to the 16 (73%) individuals who (1) agreed to be contacted for evaluation by telephone or email. the most common being gastrointestinal effects experienced by 4 (25%). Efficacy for cluster attack in this group showed a clear dose–response relationship: 3 of the 4 treatment nonresponders were taking less than 1000 mg a day (total pill weight. Kudzu refers to any one of a number of vine species of the genus Pueraria that is indigenous to Asian countries. respondents to an online survey about quality of life issues affecting cluster headache patients who had checked a box agreeing to be contacted for future research studies (189). while 1 (20%) had increased attack intensity. and people who had heard on the Internet that we were studying cluster headache and independently emailed us asking to participate (9).10 treats hypertension. whereas its effect on cluster period length did not. Questions were asked on a variety of complementary and alternative RESULTS Results are summarized in the Table. Kudzu contains antioxidants. and has subsequently been used for green manure and fodder and as ground cover to prevent soil erosion. frequency. increases cerebral blood flow. criteria for cluster headache. One subject experienced increased attack intensity. frequency. Of the 5 subjects with chronic cluster headache. 3 (60%) experienced decreased attack intensity.9 has antipyretic and anesthetic effects. actual dose of kudzu is substantially less). and improves brain acetylcholine in a mouse Alzheimer model. 8 (73%) experienced a decrease in the intensity of their attacks. of these. all were taking it less than 3 times a day. and duration. Of the 11 subjects with episodic cluster headache. 4 (11%) felt it made their cluster headache worse. and 1 (20%) decreased attack duration. was imported to the USA in 1876. 7 (64%) experienced a decrease in frequency. 2nd edition. it has had use in the treatment of alcohol-related problems since AD 600.Headache these treatments are rarely entirely effective and often have serious disadvantages. the effect of kudzu on cluster attack intensity. (2) met International Classification of Headache Disorders. A database of 235 cluster headache patients was surveyed via email on their use of a number of complementary and alternative remedies.

M = male. Freq. Age (years) Sex 1 2 3 4 5 6 7 8 9 10 11 12 12 13 14 15 16 59 36 35 47 36 57 57 32 48 48 43 42 F M M F F M F M M M F M 40 31 49 32 F F M F NW root PF PF NW PF NW PF PF PF NW NW PF NW NSI SW NH 613 ? 1500 1500 1226 1500 1226 1500 1500 1500 613 1226 1500 1226 650 800 100 Tid Bid Tid Tid Qd Qhs Tid Tid Tid Tid Bid Tid Bid Tid Qd-tid Qhs Qd Ø ↓ ↓ ↓ ↑ ↓ ↓ Ø ↓ ↓ ↑ ↓ ↓ ↓ ↓ Ø Ø Ø ↓ ↓ ↓ Ø ↓ ↓ Ø ↓ Ø ↑ ↓ ↓ ↓ ↓ Ø Ø Ø Ø ↓ ↓ Ø Ø ↓ Ø ↓ Ø ↑ ? ↓ ? Ø Ø Ø N/A Ø ↓ N/A N/A ? Ø Ø Ø N/A ? Ø Ø N/A Ø ↓ Ø Ø CNS Ø GI Ø GI Ø GI GI. Dur. 2° = secondary. MS Ø Ø Ø Ø Ø Ø Ø Ø Ø = no effect. = intensity. NSI = Neutraceuticals Science Institute. January 2009 .—Effect of Kudzu on Cluster Headache Effect on attack Headache type 2° chronic Episodic Episodic 2° chronic 2° chronic Episodic Episodic Episodic Episodic 2° chronic Episodic Episodic 1° chronic Episodic Episodic Episodic 2 months 6 weeks 7 weeks 12 months 2 weeks 1 day 12 months 12 months 8 months 2 months 3 weeks 12 months 3 weeks 13 weeks 5 weeks 3 weeks Kudzu brand Dose (mg) Freq. = duration. F = female. PF = Planetary Formula. Period length Side effects No. GI = gastrointestinal. Intens. N/A = chronic cluster headache therefore no cluster periods. SW = StarWest Botanicals. = frequency. MS = musculoskeletal. 1° = primary.100 Table. NW = Nature’s Way. CNS = central nervous system. Trial length Intens. Dur. NH = Nature’s Herb. Freq.

Each attack was characterized by a . then the reported efficacy of kudzu in this cohort is more than twice as great as would be expected from chance alone.—Subjective global effect of different “alternative” treatment modalities on cluster headache symptoms. and as prophylactic medication.—A 36-year-old man with no significant medical conditions except for a history of benign familial infantile convulsions. which are ineffective. rather. and the secondary depression and fatigue caused strain in his interpersonal relationships. all mild. 3. REPRESENTATIVE CASES (ALL OTHERS ARE INCLUDED IN APPENDIX A. and restlessness. he has tried propanolol and amitriptyline. A dose–response relationship is apparent in kudzu’s effects on cluster attacks. He was able to avoid taking all conventional prophylactic medication. Case No. so he decided to boil 1. diaphoresis. but not on cluster period length. stratified by total daily dose of unstandardized extract consumed. he suffered only 4 attacks during the entire 6-week cluster period.5 ounces of dried kudzu root and drink it as a tea twice a day. frequency. he read on an Internet forum that kudzu treated cluster headache. and suffered no side effects from the kudzu other than vivid dreams. The attacks consisted of a boring pain in his temple and a knot in his neck. and consisted of as many as 6 cluster attacks a day.—A 36-year-old man with no other medical conditions had suffered from episodic cluster headache since age 16 years. and prednisone. He finds oxygen and sumatriptan to be effective abortive medications.” a phenomenon he had experienced previously on verapamil. There is no evidence to suggest that either acupuncture or polydipsia is more effective for cluster headache than placebo. 2). at all times of day and night. assuming that the effects of acupuncture and polydipsia on cluster headache are no different than placebo. but drinks 3 or 4 glasses of wine a week and 2 cups of green tea a day. conjunctival injection. meiosis. started to have episodic cluster headaches at age 28 years and was correctly diagnosed at age 33 years. Even though he was using no other medication. AVAILABLE ONLINE ONLY) Case No. These data should not be construed as evidence of lack of efficacy of these 2 methods. The cluster period was unchanged in length. Each cluster period lasted 8 to 10 weeks separated by a remission period of 7 or 8 months. Frequent absences caused problems at work. in June of 2005. which stops the attacks only while he is taking it. which decrease the frequency and intensity of attacks. and duration and cluster period length. along with lacrimation. which he had outgrown by age 3 years. occurred usually in autumn or late February. ptosis.Headache 101 Fig 1.—Percent of patients reporting improvement in cluster attack intensity. and 37 (64%) reported no effect (Fig. verapamil and psilocybin. Fig 2. 2. He does not smoke or use illicit drugs. When his last cluster period began. flushing. He also had approximately 10 “phantom attacks. (20%) respondents who endorsed using the “water method” – drinking a glass of water every half an hour during the cluster period – 3 (5%) felt it made their cluster headache worse. 16 (28%) felt it improved their cluster headache. characterized by 6 weeks of one or two 2-hour attacks per day separated by a 4or 5-month remission period.

can act as selective estrogen receptor modulators.24 Daidzein is a metabolite of puerarin and daidzin. Sumatriptan was an effective abortive. reducing the frequency of acute angina events20 and normalizing endothelin. or delayed a dose. for fear that he would develop tachyphylaxis.26 albeit thousands of times less potent than the synthetic estrogen diethylstilbestrol. Valproate triggered 2 of the most painful and prolonged attacks he had ever experienced. Estrogen and progesterone levels are normal in cluster headache.22 It does not act as a beta-blocker or calcium antagonist. . only pain. however. daidzein scavenges free radicals25 and is estrogenic. To his surprise.102 right-sided sharp boring pain radiating into his jaw and neck. which possess both estrogenic and antiestrogenic properties. forgot. and smokes cannabis roughly twice a year. January 2009 He smokes a pack of cigarettes every day. he found that his attacks diminished in both frequency and intensity to zero over the next 2 weeks. heralding the beginning of a cluster period. with over 4000 currently known. He coped well. and then started medication. The attacks differed from the usual – although they still caused agitation and pacing.21 Puerarin attenuates mecamylamine-induced deficits in inhibitory avoidance performance in rats. but grappled with persistent fears that there was “something deeply wrong” with his brain. presumably through nicotinic-receptor agonism and N-methylD-aspartic acid (NMDA) agonism and serotonin decrease.23 The 3 times daily dosing of kudzu that appears necessary to ameliorate cluster headache is consistent with puerarin’s pharmacokinetic profile.17 Their astringency probably repels insects. and the intensity of the pain was attenuated – and these occurred only when he decreased the dose of kudzu to twice a day. It is thought that the other therapeutic benefits of kudzu are due to phytoestrogens. conjunctival injection. sweating.27 and the tendency of cluster headache to remit during pregnancy28 argue for a protective effect of female reproductive hormones that may be replicated by the phytoestrogens in kudzu.and osmophobia lasting 45 to 90 minutes. and with his first full-blown attack.15 and have a long pedigree in the treatment of a number of disorders. In February 2005. ptosis and eyelid edema.18 The isoflavone puerarin. Verapamil 120 mg a day decreased his attack frequency to once or twice daily. which was half its usual length (only 7 weeks). so he discontinued it.19 has hypoglycemic properties and increases coronary blood flow. assuming that he had a sinus problem or simply trying not to think about it. His next cluster period began with 4 times daily attacks in late November 2005. drinks one drink of alcohol every few months. which is the principal component in kudzu. suffering no job or relationship difficulties as a result. For 5 years he remained untreated. there were no associated autonomic symptoms. particularly isoflavones. another isoflavone in kudzu. angiotensin II post-myocardial infarction in 3 days. He experienced no side effects. the increase in incidence around menopause.16 Flavonoids are phenolic compounds widely distributed in plants. he started on Planetary Formulas kudzu extract 1500 mg 3 times a day as well as a twice-daily multivitamin. he started to experience “twinges” in his right eye. phono. but did not decrease the attack intensity and caused him memory and coordination difficulties. He uses no other illicit drugs but drinks 4 to 5 cups of coffee a day. Unlike daidzin and puerarin. and the remainder of the cluster period passed asymptomatically until it ended in January. renin. rhinorrhea. but the dramatically higher prevalence of the disorder in males. Restarting a dose of Planetary Formulas 1500 mg 3 times a day. in the second week of December. he found that he experienced only 8 attacks for the remainder of the cluster period. no attack lasting longer than 30 minutes. but he delayed taking kudzu until the intensity of the attacks became excruciating. but side effects that included intensification and prolongation of subsequent attacks as well as a dull persistent ache at the site of the attacks the next day prompted him to discontinue it. DISCUSSION The putative mechanism of action by which kudzu might affect cluster headache should these results be verified is unclear. making isoflavonoids the most important group of plant-protective phytoalexins.

30 The rate of alcoholism is high in cluster headache patients. In one sample. not weaken. more educated. making differences noticeable. 6 (38%) of the subjects had maintained detailed headache diaries corroborating their retrospective recall of efficacy. several factors mitigate these limitations in this case series. 103 Caution should be applied in interpreting these findings. as alcohol triggers cluster attacks.33 in contrast with smoking. however. or inconsistent. the concentration of isoflavones in OTC kudzu preparations is unstandardized. and 60% in one study reported that they felt that information on the Internet was the “same as” or “better than” information from their doctors. It is thus conceivable that the isoflavones in kudzu are treating a common factor underlying both alcoholism and cluster attacks. and 2 patients (no.36 the rapid and widespread dissemination of unverified medical information also permits the trial-and-error discovery of new treatments by enthusiastic patient groups. A number of studies have found that approximately 50% of patients use the Internet to obtain medical information. Although there was no placebo arm. with a significant proportion being “heavy drinkers. Furthermore.38 capsaicin.”31 Levi found that 67% of his sample assessed with the Mm-MAST (Michigan Alcoholism Screening Test) had scores indicative of alcoholism. when reports of its therapeutic effects appeared on the Internet and propagated rapidly through the cluster headache patient population. However.5% to 3% (Lukas. Recruitment over the Internet selects for younger. cluster headache is known to respond poorly to placebo. 12. However. 79% of cluster headache patients dramatically decrease their alcohol consumption during a cluster period.31 which is surprising as alcohol is a reliable trigger of a cluster attack during a cluster period. Although it has not been established that acupuncture and polydipsia are ineffective in treating cluster headache. this variability should attenuate rather than exaggerate any dose–response relationship. our conclusions. personal communication). the rate of which does not change. 4 and no.39 and melatonin. but a concentrated (25% isoflavone) form of kudzu was effective in reducing alcohol intake by binge drinkers.34 with daily use reported by 36% of cluster headache patients vs 14% of controls. as case series are by their very nature subject to selection bias. with 61% falling into the category of moderate to excessive drinkers.37 likely leading to increased reported efficacy. incomplete. but still far higher than those of noncluster headache controls – 61% vs 41% in one sample. and varies from 0. although it may be consumed without consequence during a remission period. see supplemental cases) used a challenge–rechallenge test to verify that the kudzu was having an effect on their headaches. improvement in symptoms can be difficult to attribute to medication effect. and the placebo response.Headache Kudzu has been reported to decrease alcohol intake in both preclinical29 and clinical trials. then that would strengthen. However. Finally. otherwise selected for positive response to kudzu or alternative medications.40 As cluster attacks typically wax and wane over the course of a cluster period. The use of kudzu to treat cluster headache was unknown before December 2005. further argues for therapeutic effect. recall bias. Investigators found that over-the-counter (OTC) preparations of kudzu that contain less than 1% or 2% isoflavones are not effective in limiting alcohol intake. 91% of cluster headache patients drank alcohol. if these methods are actually effective. This group was not. and more motivated subjects. making it difficult to quantify the actual amount of active ingredient ingested by the subjects. controlled trials have shown a placebo response of 0% to prophylactic medications such as verapamil. However. and the fact that such a relationship was still identifiable despite the variable concentrations of isoflavones present. and this group did not report a comparable positive response to acupuncture and other alternative medications.33 Other studies have found lower rates of alcohol consumption.35 Although Internet medical advice is frequently characterized as inaccurate. more than 90% drank alcohol. a substantial . CONCLUSION Although few subjects were able to completely discontinue conventional medications. each cluster period is generally very similar in pattern and length for a given patient.32 and in another.

Goadsby P. Pain. Lipton R. Funding was provided by NIDA. 18. London: Martin Duniyz Ltd. Life Sci. Cephalalgia. 7. 1997. 1980. Chen HF. Sewell R. Mehmet Sofuoglu. kudzu may prove to have a role in the management of cluster headache. Pharmacological. Silberstein SD. J Clin Endocrinol Metab. Banks S. 1998. Fitzpatrick LA. 2006. Harada M. collection. Some current study and research approaches relating to the use of plants in the traditional Chinese medicine. [Clinical study of puerarin in treatment of patients with unstable angina]. Roecklein J. Liu B. Pope H. . or submission of the manuscript. Qicheng F. Cephalalgia. Taos. renin activity and angiotensin II in patients with acute myocardial infarction]. January 2009 CYP-catalysed drug metabolism. 19.20:787803. 2000. Leung P. Should these results be confirmed with a randomized clinical trial of standardized extracts. 3. 1999:273. 12. 8. and Bruce Price for their comments on an earlier draft of this article. The international classification of headache disorders. Ueno K. 15.15:120-123. Headache Classification Subcommittee of the International Headache Society. [Effect of puerarin on plasma endothelin. 10. 2004. 22. 1986: 15. Feverfew as a preventive treatment for migraine: A systematic review.76:3-8. Broccoli M. July 22–24. Hsieh MT.25:979-995. I. Some remarks on the terminology of cluster headache. Response of cluster headache to psilocybin and LSD. NY. and Structure-Activity Relationships. Smith D. Halpern J. Pharmacological studies on pueraria root. Middleton E. The biochemistry and medical significance of the flavonoids. Pharmacol Ther. 1999. Zhongguo Zhong Xi Yi Jie He Za Zhi. NM: Paradigm Publications. Sun S. 1998. 6. 66:1920-1922. New York: Alan R. 1998. Biochemical.23:17981805. or interpretation of data. Symposium Proceedings. 1):44-48. Wang WH. Ernst E. with minimal side effects. Speroni E.. Zhang Y.104 proportion found that kudzu extract in a variety of low-concentration OTC preparations ameliorated the intensity. writing of the report. Tradit Chin Med West Med. Cephalalgia. Cody V. Phytochemisty. 1998. 2nd edn. Chem Pharm Bull (Tokyo). epidemiological.17:339-341. 1988. Mayo Clin Proc. Zhongguo Zhong Xi Yi Jie He Za Zhi. No funding source had any role in study design. Cluster headache. Liss. Harborne JB. and duration of their cluster attacks. Havsteen BH. 2. Harrison Pope.8:59-60. Russo E. 4.18:282284. Fractional extraction of pueraria root and identification of its pharmacological effects. 1986. Gardner CD. frequency. et al. Beji-Quianjin-Yaofang. Tsai FH. Haskell WL. A Profile of Economic Plants. 14. Buffalo. 24(Suppl. J Ethnopharmacol. Selective estrogen receptor modulators and phytoestrogens: New therapies for the postmenopausal women. 1975. Translation & Commentaries.2:57-63. Acknowledgments: The author thanks Earth and Fire Erowid. Cannabis for migraine treatment: The once and future prescription? An historical and scientific review. 1985. Tham DM. Wu CR. Vogler BK. Li SM. Chen K. Headache in Clinical Practice. 13. Preliminary basic science research into the treatment of dementia using Chinese herbal medicine [in Chinese]. although kudzu had no effect on the length of the cluster period. 20. 9. analysis. 1995.83:2223-2235. REFERENCES 1. Circa ad 600. Zhang Z. Guerra MC.67:2997-3006. 2000. Clinical review 97: Potential health benefits of dietary phytoestrogens: A review of the clinical. 5. 11.18:704-708. Biosynthesis. elicitation and biological activity of isoflavonoid phytoalexins. 2002:147. Kuo LH. Neurology. Silberstein S. and mechanistic evidence. Yang X. Cephalalgia. Robert Wold and the Clusterbusters. Rozen TD. Comparison between Chinese medical herb Pueraria lobata crude extract and its main isoflavone puerarin antioxidant properties and effects on rat liver 16. Effects of puerarin on scopolamine-.96:67202. Scott Lukas. Goadsby PJ. Pittler MH.74:601607. Dodick DW. Plant Flavonoids in Biology and Medicine. Ekbom K. NIH T32-DA07252. 2002. Zhao Z. 1987:467. and Jonathan Byron for bringing kudzu to the attention of the cluster headache community. Chan K. for assistance with data collection. 21. 17. Shang Han Lun: On Cold Damage. New Brunswick: Transaction Book.

Choo MK. Rapoport A. 54:1382-1385. Perneger TV. Frediani F. Saper J. Griffiths KM. Lukas SE. Nappi G. Reinert SE. Terzano MG.22:94100. 25.. Bussone G. Age at onset and sex ratio in cluster headache: Observations over three decades. 2000. Proc Natl Acad Sci USA. Waldenlind E. Traff H. Park EK. Tracy M. Story CD. Quality of web based information on treatment of depression: Cross sectional survey. Leone M.321:1511-1515. 1974. 1955. 38. Zhongguo Yao Li Xue Bao. 40. Keung WM. J Altern Complement Med. 1993. ed. A comparison of cigarette smokers recruited through the Internet or by mail. 36. Moschiano F. Leone M. Manzoni GC. Cephalalgia. Estrogenic activity of some naturally occurring isoflavones. Waldenlind E.1:167-174. A doubleblind placebo-controlled trial of intranasal capsaicin for cluster headache. 32. Cephalalgia. Episodic cluster headache. p-chloroamphetamineand dizocilpine-induced inhibitory avoidance performance impairment in rats. Marks DR. BMJ. Ma Z. et al.12:543-548. 26.90:1000810012.13:114-116. Vallee BL. Headache. Cluster Headache. 27. 8-9. 2001. 29.5:238-241. Cheng EW. Planta Med. 2005. Verapamil in the prophylaxis of episodic cluster headache: A double-blind study versus placebo.29:756-762. 2002. 39.30:521-525. Yoon HK.3:21-30. II: High tobacco and 105 alcohol consumption in males. Please note: Blackwell Publishing is not responsible for the content or functionality of any supporting materials supplied by the authors. Ekbom K. Int J Epidemiol. Cluster headache in women: Evidence of hypofertility? Headaches in relation to menstruation and pregnancy. 1993. 23. Penetar D. D’Amico D. Svensson DA. J Gen Intern Med. Diaz JA. New York: Spectrum Publications. 2002. Ann N Y Acad Sci. Waldenlind E. Zhang LY. et al.61:652-658. 2002. Daidzin and daidzein suppress free-choice ethanol intake by Syrian golden hamsters. Fraschini F. 4-16). Levi R. Kudrow L. SUPPORTING INFORMATION Additional Supporting Information may be found in the online version of this article: SUPPLEMENTAL CASE REPORTS FOR “Response of Cluster Headache to Kudzu” (Case no. Edman GV. et al. An extract of the Chinese herbal root kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting.32: 184-187. 2002. 31. Cluster headache – clinical findings in 180 patients. Melatonin versus placebo in the prophylaxis of cluster headache: A double-blind pilot study with parallel groups. Etter JF. . [Effect of puerarin and analogues of daidzein on adrenoceptors]. Cephalalgia. 1983. Patients’ use of the Internet for medical information. Kim DH. Martucci N.68:901905. Ekbom K. Biol Pharm Bull. Nonheadache disorders and characteristics of cluster headache patients. 1992. Burroughs W. Berko J. 2006. 1981. Inc. Moulton AW. 24. Cephalalgia.25:1328-1332.16:494-496. D’Amico D. Neurology. Lee D. 1984:31-44. Antithrombotic and antiallergic activities of daidzein. Cephalalgia. Ekbom K. Ng JJ. 33. discussion. Feng YP.13:197-202. 28. Friedmann PD. 1984. Lukas SE.17:180185. 1. Padla D. 35. Bono G. Zeng GY. Any queries (other than missing material) should be directed to the corresponding author for the article.Headache mecamylamine-. Teter C. Griffith RA. Alcohol Clin Exp Res. Christensen H. 2000. Headache. Pharmacokinetic profule of the isoflavone puerarin after acute and repeated administration of a novel kudzu extract to human volunteers. 37. Yoder L. In: Mathew N. a metabolite of puerarin and daidzin produced by human intestinal microflora. Micieli G. Penetar D. 34. Physical and personality characteristics in cluster headache. 30. 1996.

She was able to taper and discontinue both the lithium and gabapentin. ptosis. She found the kudzu most effective when taken two hours prior to an expected attack. she noted no difference in the frequency or intensity of her attacks—albeit no side effects. 4-16) CASE #1 A 60-year old woman with no other medical conditions was diagnosed with episodic chronic cluster headaches at age 42 that became chronic at age 43. rhinorrhea. verapamil. Inc.1526-4610. but were different in nature. and consisted of injected sclera. In February of 2005.Headache ! 2008 the Author Journal compilation ! 2008 American Headache Society ISSN 0017-8748 doi: 10. lithium. hidrosis. SUPPLEMENTAL CASE REPORTS FOR Response of Cluster Headache to Kudzu (Case no. Over several weeks she increased her dose to 4500 mg a day. lacrimation. She drinks a glass of red wine two or three times a week. neck spasms. flushing. and verapamil were partially effective in treating her CH. eyelid edema. so decided to selfadminister it. Her social life and marriage deteriorated as a result. Propanolol. could last for as long as an hour. 2 pm and 10:30 pm. injected sclera.01268. The attacks consisted of lacrimation. She initially gained relief with rizatriptan but had to discontinue it because of concerns following her cerebral hemorrhage. In February of 2005. lithium. occurred two to six times a day. sinus infection.and phonophobia. but she found oxygen and sumatriptan to be effective abortives. Starting with a 750 mg tablet of Planetary Formulas kudzu extract she noticed that within 24 hours her attacks ceased. but no pain—roughly three times a day. drinks 3 or 4 cups of coffee a day. began to taper the kudzu by 750 mg daily to 1500 mg daily. photo. and she became chronically depressed. 1800 mg gabapentin and 150 mg lithium carbonate daily. flushing. when she transformed to secondary chronic following years of misdiagnosis with migraine. either—so discontinued the kudzu. asthma. Within four days. she read on an Internet cluster-headache forum that kudzu extract could control cluster headache. smokes half a pack of cigarettes a day. rhinorrhea. Propanolol. and assuming that she had cured her disease. restlessness. and amitriptyline had no effect on the frequency or intensity of her attacks. although she found the lithium hard to tolerate.111/j. She returned to her prior dose S1 . lasting only ten minutes each and lacking the usual autonomic symptoms. and the residual pain that she had suffered for several hours a day was also cut in intensity and duration. and a feeling of having a hot poker driven into her eyeball combined with an urge to bang her head into a wall.x Published by Wiley Periodicals. 1. ptosis. her daily attacks resumed. miosis. and found that her attacks decreased in intensity and frequency to one every three or four days. but remained on verapamil at a reduced dose of 240 mg daily for her hypertension. and oxygen was effective as an abortive only 50% of the time. and a history of ruptured MCA aneurysm had her first cluster attack in October 1973 at age 16 but was not diagnosed until May 2000. These attacks made it difficult for her to care for her newborn and were a contributing factor in two divorces. In May she experienced six pain-free days in a row. following no pattern that she could discern. diaphoresis. After two months. She usually suffered three but could have as many as eight attacks per day lasting 90 minutes each. Attacks were left-sided.2008. CASE #4 A 47-year old woman with hypertension. she read on an Internet site that kudzu had been used in Chinese medicine to treat migraines. rhinorrhea. pressure from nose to temple. while taking 360 mg verapamil. ptosis. but uses no other drugs. and still suffering attacks three times a day at 10 am. so she started taking Nature’s Way 613 mg capsules three times a day. and temporomandibular joint syndrome. and a boring pain in her temple. She also began to experience “phantom attacks”—autonomic attacks consisting of lacrimation.

she started taking kudzu as an adjunctive. so he took one dose of Planetary Formulas Kudzu Recovery 1500 mg at night. average five a day. They cause him irritability but no serious problems in jobs or relationships. At first her remission periods lasted for two years. and again found that her afternoon attacks were much more painful. ptosis. A month following the end of his last cluster period in February 2005. prednisone. although his most recent remission period was six years. and consist of lacrimation. pravastatin. and has experienced no more than seven pain-free days between attacks since. She smokes 1/2 pack a day. but he was forced to discontinue use after a myocardial infarction in 1998. She discontinued it and continues to take fentanyl and Tylox with oxygen for breakthrough attacks. anxiety. Taking kudzu before bed caused her to experience multiple nocturnal attacks—midnight. The kudzu gave him an upset stomach. and 4 am—for the first time. She stopped the kudzu but restarted it in the summer 2008 of 2005 without concurrent opiates. but never achieved the same level of relief again. and inability to concentrate. while on a regimen of fentanyl 200 µg twice daily and Tylox (acetamenophen/ oxycodone) 500/5 mg three times a day. The only side effect she noted was excessive flatulence. 2 pm. They occur reliably at noon. but he has not used a non-rebreather mask. lacrimation. flushing. but her cluster periods lengthened over time and she became secondarily chronic in July of 2003. pacing. nasal congestion and rhinorrhea. and still experiencing heavy “shadows” every other day. Propanolol and amitriptyline were ineffective. verapamil. indomethacin. each cluster period lasting from six to eight weeks. with additional attacks at 5 pm and 8 pm at peak. separated by a remission period of two years. miosis. chlorpromazine. and uses no other drugs except topical steroids for psoriasis. amitriptyline. . Oxygen has been only partially effective. tachycardia. but uses no other illicit drugs. 4:20 am and between 7 and 9 am. and she became toxic on lithium before its efficacy could be determined. conjunctival injection. and she had to discontinue it in May 2004 after she developed Prinzmetal angina. continues to smoke two packs a day of cigarettes and cannabis three times a month. She rarely drinks. and have adversely affected her marriage. Sumatriptan was effective as an acute abortive. rocking. and social life.S2 of 4500 mg kudzu. he read that kudzu was reputed to treat cluster headache. rhinorrhea. Attacks occur up to four times a day. and aspirin. topiramate. CASE #6 A 57-year old man with no other medical problems suffered episodic cluster headaches since age 20. Attacks last between 25 minutes and three hours. After ten days of Nature’s Way 1226 mg in the morning she realized that her afternoon attacks had doubled in intensity. 10 pm. and chills. nor naratriptan have had any effect on the frequency or intensity of his attacks. CASE #5 A 38-year old woman with “severe sinus headaches” from her teen years had her first clearly identifiable six-week cluster period at age 28. and consist of excruciating pain behind her right eye and temple radiating to the jaw. forehead and facial sweating. She has tried over 50 medications in the last five years. melatonin. pacing. 2 am. education. Oxygen initially worked “miraculously” but decreased in effectiveness as time went by and currently only works 50% of the time if used immediately at the beginning of an attack. Prednisone was effective but caused weight gain and extreme mood swings. In February 2005. lithium. The pain then stopped and did not return. at which point he ingested Hawaiian baby woodrose seeds. The next day he began to experience shadows again. and verapamil caused unacceptable hypotension. He noticed immediate “jabs and jolts”—a phenomenon he had never experienced before—for the rest of the evening but no shadows the following day. He remains on atenolol. drinks rarely. Neither methysergide. phonophobia. use caffeine or illicit drugs. He drinks a glass of wine on the weekend but does not smoke. last one to two hours. Sumatriptan was effective but caused her attack pattern to become irregular.

and a compulsion to press his right temple. but verapamil 480 mg reduced both the intensity of the attacks by a third and the frequency by 20%. diagnosed at age 35. After three months of co-administration with verapamil. and noticed that the attacks immediately shortened to five to ten minutes. B-50 complex and B-12. smokes one pack a day but does not drink or use illicit drugs. He took psilocybin mushrooms in October 2005 and the cluster period stopped. He smokes a pack and a half and drinks up to two pots of coffee a day. These attacks consist of ptosis. conjunctival injection. These can be triggered by alcohol or odors of gasoline. CASE #9 A 49-year old man with no other medical conditions has endured episodic cluster headache since age 20. CASE #8 A 32-year old man without other medical conditions has suffered episodic cluster headache since age 26. there was no noticeable difference in his cluster attacks. sumatriptan and oxygen. but suffered from gastrointestinal distress. irritability. with no remission period longer than three weeks. and valproate doubled the frequency of his attacks. On kudzu 1226 mg three times a day.S3 CASE #7 A 57-year old woman without other medical conditions has suffered from two years of chronic cluster headaches consisting of an irregular pattern of nocturnal right-sided forty-minute cluster attacks that occur once a day within an hour and half of going to sleep. which were occurring three to five times a day. rhinorrhea. he will get only two or three hours of sleep a night for weeks. melatonin. 2005 she began taking Nature’s Way kudzu extract 1226 three times a day. she can now be pain-free for as long as two weeks between consecutive attacks. shivering. consisting of intense non-throbbing pain centered in his right eye. Her use of triptans declined from twice a week to none. In April he tried Planetary Formulas kudzu extract 1500 mg twice a day. causing him to be irritable and adversely affecting his relationship with his wife. flushing. and became so much less intense that she no longer needed abortive medication. osmophobia. sweating. but does not drink alcohol or use illicit drugs. During a cluster period. and rocking back and forth. As a prophylactic. Reading that some people had found relief with kudzu. Sleep deprivation also impaired his ability to study and forced him to drop out of college. prednisone was ineffective. on February 24. and is associated with ptosis. Prednisone tapers have twice provided her with a pain-free period. He had to stop working as a train conductor after he almost caused a derailment during a cluster attack. occurred twice a week rather than every day. with the exception of an interval on prednisone. increasing to three times a day after two months. She notices no side effects from the kudzu. nail polish. he underwent two courses of antibiotics a year for presumed sinus infections. consisting of eight-week cluster periods separated by four-month remission periods. Melatonin causes the attacks to shift from diurnal to nocturnal. and had three healthy teeth removed. diesel fumes. so discontinued it. and severe pain in her right teeth and jaw. he will experience four to six 90minute mostly nocturnal cluster attacks that feel “like an ice-cream headache only worse”. nasal congestion. slowly increase in intensity over five minutes to a constant boring pain that spreads to the upper teeth. 2008 Until he was finally diagnosed in February 2005. Sumatriptan is effective. The pain has severely affected her social life. During a cluster period. tearing. He has been pain-free since. An extended cluster period began in February 2005 that lasted for nine months. he noted no change in the frequency or intensity of his attacks. Every 10 to 13 months he will experience nine months of hour-long attacks that occur up to four times daily. and sumatriptan is partially effective in controlling her attacks. and oxygen is completely effective 75% of the time and reduces the intensity of remaining attacks the remainder of the time. and perfume. pacing. Subsequently. associated with lacrimation. The attacks start with a dull ache behind the right eye. These attacks . and interfered with her and her husband’s sleep and peace of mind. photophobia. a multivitamin.

S4 have disrupted his social life. but not his melatonin. because he lives in fear of a cluster attack removing his ability to successfully think through problems. but uses no illegal drugs. as he has frequently quit impulsively while in a cluster period. 2005. Lithium was ineffective. and ptosis that cause him to scream. He has one or two cups of coffee a day. and his professional life as a University administrator. and chronic pain to worsen. Upon increasing this to 1500 mg three times daily. finding them to be more effective than kudzu. although the frequency of the attacks remained unchanged. He had been run over by a car at age 4. Frustrated with what he considered to be unacceptable side effects from the prophylactic agents he had tried. which he started in his 30s. then started kudzu extract (Planetary Formulas. He remains on morphine SR 60 mg for chronic pain and alprazolam 1 mg. He can continue to have one or two mild attacks a day on kudzu. Each cluster period lasts six to eight weeks separated by a remission period of 7 to 18 months. drink. On June 7. which he had read about on an online cluster headache forum. and also suffers from migraines and depression. ptosis. Attacks occur night and day. and topiramate caused him paresthesias and hallucinations. anxiety. Kudzu Recovery) 750 mg three times daily. when his current cluster period began on May 29. ergotamine tartrate 2 mg at night. smokes cigarettes when he drinks. but becoming less so with time and eventually causing increased intensity attacks. consisting of 30 minutes of lancinating pain. and sumatriptan for breakthrough attacks. he decided to take kudzu instead. He discontinued his methadone and alprazolam. resulting in persistent cognitive deficits from his brain injury. He does not smoke. noticing no effect. His mood is frequently so foul during his worst periods that his family has to walk around “on eggshells”. mostly nocturnal. The only side effects he suffered were indigestion and a “looser neck”. or use recreational drugs. conjunctival . Skipping a dose of kudzu or even changing the timing of a dose results in an immediate increase in the frequency but not the intensity of the attacks. and melatonin 9 mg at night. the discontinuation of his other medications had caused his insomnia. sob. eyelid edema. He therefore discontinued the kudzu and instead took Hawaiian baby woodrose seeds for prophylaxis. making it difficult for him to keep a job. suffering five days of withdrawal symptoms. he started taking 1500 mg Planetary Formula kudzu three times a day. Propanolol was ineffective in ameliorating his attacks. because he often cannot risk attending social events. CASE #10 A 49 year old right-handed man has had cluster headache since age 13. At worst. he decided that although it was more effective for him than sumatriptan or morphine. she will suffer three two-hour attacks per day. He drinks alcohol once or twice a week when in a remission period. and punch himself in the head and that have left him with a permanent right eyelid 2008 droop. to be partially effective at controlling his attacks. After two months on kudzu. He found amitriptyline and methadone. excessive weight gain and edema. Prednisone was effective but caused him unpleasant mood changes. He can have up to 6 attacks a day that are mostly right-sided but that can alternate within the same cluster period. restless leg syndrome. and sumatriptan was effective in controlling his attacks. and noted a slight decrease in the intensity and duration of his attacks and an immediate decrease in their frequency from four a day to two or fewer. He can reliably abort acute attacks with sumatriptan and occasionally with oxygen. while verapamil was effective for about three years then ceased to work. consisting of lacrimation. but did not like the mental dullness or difficulties with orgasm that they gave him. At this time he was forced to go on permanent disability. and confusion that stopped when he discontinued it. becoming secondarily chronic at age 25. CASE #11 A 43-year old right-handed woman in Louisiana with no other medical conditions except for gastroesophageal reflux disease has had episodic cluster headache since age 12. he noticed an immediate 50% decrease in the intensity of his pain. In April 2005 he read on the Internet about the kudzu treatment for cluster headache.

twice a year. and uses no illicit drugs. 2006. he began taking Planetary Formulas 1500 mg twice a day and found it less effective than Nature’s Way but better than nothing—although his cluster attacks were only 10 to 15 minutes in length and aborted by oxygen. he started to suffer cluster attacks that were provoked by vigorous exercise.S5 injection. . These have deprived her of sleep and made her irritable. He notices no side effects from the kudzu. and verapamil and prednisone partially effective in decreasing the frequency and severity of attacks. Oxygen lessens the intensity of attacks but does not truncate them. which began in February 2005. and with it a month of increased stress. stopped smoking nine years ago. CASE #12 A 42-year old man without any other medical problems has had episodic cluster headaches since his late twenties. When her most recent cluster period started that month. he suffers one or two right-sided cluster attacks daily or every other day. although his father’s brother had a seizure disorder. This scenario repeated almost exactly during his next cluster period. These are characterized by rhinorrhea. he continued to have an attack almost every day. Despite the infrequency of attacks. and resigned to remaining in a bad marriage for fear that her condition will make it impossible for her to find another partner. 2008 He had used no medication prior to his most recent cluster period. His father is his only relative known to have cluster headache. but found that her attacks were worse—more intense. drinks one or two servings of alcohol several times a week and three to five cups of coffee a day. She has found propanolol ineffective. In July 2005. restlessness. boring pain in her eye. and the cluster period itself was also longer than normal. heralding the beginning of another cluster period. more frequent during daylight hours. neck stiffness. Discontinuing kudzu increased the frequency to two or three a night. and no electricity or air conditioning. and severe orbital pain that often leaves him unable to do anything but rock back and forth or writhe around on the floor. When his most recent cluster period started on March 12th. In July 2005. which is disruptive and anxiety-provoking for him and his family. however. triptans abort an attack about a quarter of the time. and in a remission period he is able to consume alcohol and run a marathon once or twice a year without triggering an attack. She stopped taking the kudzu when it ran out. which began in January of 2006. she started taking Nature’s Way 613 mg twice a day for the next three weeks. She currently smokes one pack per day of cigarettes. and temple. he is able to tell that he remains in the cluster period by a subtle heaviness in his head and “tickle” behind his eyeball. This coincided with hurricane Katrina’s landfall. her fiancé read an article that said that kudzu could potentially help her cluster headache. mydriasis. He drinks one or two beers or glasses of wine a day. guilty over her inability to be industrious during a cluster period. rhinorrhea. but uses no illegal drugs. 95degree temperatures. He had only two more attacks during that cluster period. and longer. after which he used both oxygen and intramuscular sumatriptan and found them effective in terminating his cluster attacks in less than 15 minutes. and severe. ear. During these periods. Finding a reference online to kudzu in February 2005. lasting one to three hours each. but rather were triggered by aerobic exercise or alcohol. She experienced no side effects from the kudzu. and much less painful in intensity. he is forced to schedule his personal and professional life around anticipated attacks. For four to six weeks. and responded promptly to oxygen. he started taking 1226 mg Nature’s Way kudzu extract three times a day and found that the frequency and intensity of his attacks dropped almost to zero. Neither he nor his father has a history of head injury. He experienced only five or six half-strength attacks for the remainder of the cluster period—four weeks—and these attacks did not occur spontaneously. so he restarted kudzu at the same dose. diaphoresis. embarrassed for repeated cancelling social plans. ptosis.

In mid-October she discontinued the kudzu. consisting of unilateral nasal congestion. Triptans are also effective but sumatriptan caused tachycardia. rhinorrhea. and her marriage ended. then lithium. adversely affecting her relationship 2008 with her husband. then topiramate. consisting of two-month cluster periods every 18 to 24 months that often started during times of relaxation following stressful periods such as a deadline. CASE #15 A 49-year old man with no medical history other than a concussion from a motorcycle accident at age 16 started to have episodic cluster headache at age 23. Amitriptyline had no effect on the frequency or intensity of her attacks. the attacks were not shorter. but oxygen will reliably end an attack in five minutes. ptosis. She suffered no side effects from the kudzu. and flushing but without any pain. If unmedicated. lasting up to three hours each. At peak. alprazolam. ptosis.S6 CASE #13 A 40-year-old woman with osteomalacia and collagenous colitis has had chronic cluster headache since age 38. hoping that they might be more effective. and compulsively rubbing or hitting her temple. her cluster period did not begin in its usual fashion. She was initially treated for sinus infections every September during her regular cluster period. and topiramate caused hallucinations and delusions. nausea. which turned out not to be the case. she started taking Natures Way 1226 mg three times a day and noted that the intensity of her attacks decreased by 50% and the frequency dropped to two to three attacks per day. which had ceased to work. This leads to sleep-deprivation and irritability. rocking. She was forced to stop working. Injectable sumatriptan works 95% of the time. consisting of severe boring pain. she will have between three and eight cluster attacks a day. when she tapered off the prednisone that she had been taking for her celiac disease over nine months. lasting two hours each. In 2004. CASE #14 A 31-year old woman without other medical conditions suffered from episodic cluster headaches since age 16 that occurred for five week periods separated by 11 month to 3-year remission periods. Her cluster period remained the same length. In December 2005. ptosis. she can have four 50-minute attacks per day. These were otherwise identical to her regular attacks except that they lasted for only two or three minutes. she read on an Internet forum that kudzu extract could be used to treat cluster headache. but oxygen. and consisting of a boring pain in her temple accompanied by an urge to gouge out her eye. but not subsequent to that. but when her cluster period began late in December. She does not smoke or use illegal drugs. rather. After 13 weeks. Verapamil caused syncope. and vitamins during this period. drinks alcohol twice a week. lacrimation. but uses no illicit drugs or caffeine. and dysphoria. she began to take Neutraceuticals Sciences Institute kudzu extract 650 mg daily. She remained on duloxetine. At worst he will get two left-sided attacks a day. and drinks three coffees or sodas a day. Oxygen worked for half of her cluster period in 2000. lithium was ineffective. characterized by a . She experienced no side effects other than loose bowels. and prednisone rendered her pain-free for only two days. She stopped smoking a pack a day a year ago. she restarted kudzu at 650 mg one to three times a day and for the remainder of the six weeks of her cluster period noted that both the intensity and frequency of subsequent attacks were lessened. rhinorrhea. and frovatriptan caused the intensity of her attacks to increase. so she stopped kudzu and switched to verapamil. By themselves. and drinks two to four glasses of red wine four times a week. She currently takes only Rivea corymbosa seeds and oxygen to treat her cluster headache. she experienced three “phantom attacks”. miosis. so at the anticipated beginning of her next cluster period in September 2005. During that month. became effective again as an abortive in combination with the kudzu. moaning. having read on the Internet that kudzu was effective in treating cluster headache. until she finally received the correct diagnosis in 2000. the frequency slowly increased back to baseline. and sweating.

and mood swings. depression. are effective in aborting individual attacks. combined with drinking four to five liters of spring water during the course of the day. and pain that she describes as like a “lightning storm” or “worms dipped in acid crawling through the right side of my head. conjunctival injection. and drinks a cup of coffee every morning. craniosacral therapy. but increasing doses are required as the cluster period continues. Dilaudid. She currently maintains herself on a combination of duloxetine. and only if taken immediately at the onset of a headache. She experiences one or two 60-minute attacks a day. alcohol and just about anything "aged" from his diet. In November 2005. He experienced no side effects from the kudzu. which causes inconvenience when eating out or at social gatherings. or duration of attacks. diaphoresis. He does not smoke. Amitriptyline is ineffective as a prophylactic agent. and by the second week of a cluster period. He also lost one five-year romantic relationship in part because of his cluster headache. sleep deprivation renders him irritable and unable to focus or make decisions at home or at work. nor has prednisone. Chinese herbal medicine and feverfew. and a feeling “like an alien in my head wants out”. She suffered no side effects from the kudzu. consisting of progressively longer—currently eight week—cluster periods separated by nine. diaphoresis.5 glasses of red wine daily. miosis. he smokes prescribed medical cannabis once or twice a day but uses no illegal 2008 drugs. The Cafergot worked only occasionally. which instead gave him anxiety. Oxygen and rizatriptan. which he combines with a few drops of “Bach Flower Rescue Remedy” and a cup of hot twelve-month remission periods. and melatonin. photophobia. irritability. and tried homeopathy. CASE #16 A 33-year old right-handed woman with no other medical conditions was diagnosed with episodic cluster headache at age 22. restaurants. During the attacks he is completely incapacitated. He noted no change in the intensity. Intranasal sumatriptan effectively aborts her attacks. grocery stores or movies. In fall of 2005 she read on the Internet that kudzu might be effective in treating cluster headache. she cannot go to bars. but noted no decrease in the frequency. shellfish. Dilaudid helps early in the cluster period. melatonin. tomatoes. but drinks occasional alcohol when in a remission period. a “hot knot” in his neck and throat. In a remission period. flushing. he read about kudzu on an Internet forum. Vicodin. and prednisone prevents attacks while she takes it.” She has suffered lost productivity in her job from lingering headaches and medication side effects. She does not smoke or use illegal drugs. verapamil. He has also taken Cafergot. Acupuncture has not helped his cluster headache. and since her triggers during a cluster period include flickering lights and chemical smells. so she started taking Nature’s Herb 100 mg daily. and “Quantum Energetics” therapy. severely impacting her social life. photo. codeine.S7 boring pain in his temple with waves of more severe pain approximately every ten minutes. . or duration of her cluster attacks and no effect on the length of her cluster period. nuts. characterized by ptosis. coconut. however. one week into his most recent cluster period. verapamil and duloxetine are partially effective. rhinorrhea. magnesium. but will drink coffee to help abort individual attacks. but his cluster period ended after only three weeks. and while in a cluster period does not drink alcohol or use illegal drugs. restlessness.and osmophobia. chocolate. drinks 2. bulk kudzu root 800 mg to 1000 mg at night. intensity. restlessness. frequency. kudzu. His neurologist has recommended that he eliminate foods such as cheese. lacrimation. so started taking StarWest Botanicals Inc.