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, generallyconsidered to be the most painful of all types of head-ache.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 forperiods interspersed with pain-free remissions, orchronic, in which the headaches occur constantly formore than a year with no remission longer than onemonth.2 Ten percent of episodic cluster headachesultimately evolve into the chronic form, and these aretermed secondary chronic. In standard descriptionsof cluster headache, an “attack” refers to the actualparoxysm of pain, a “cluster period” to a period oftime when attacks occur regularly, and a “remission

period” to an interval during which no attacks occur.3

Cluster periods tend to recur at fixed intervalsranging from several months to several years, oftenoccurring at the same time each year, and are markedby recurrent stabbing attacks that increase in inten-sity over 5 to 10 minutes, last 15 minutes to 3 hours,and then fade away. Attacks typically occur 1 to 3times a day, usually at strikingly predictable times(often 2 hours after the patient falls asleep) but cansometimes occur as often as every 2 hours. The inten-sity of the pain is severe enough that patients havebeen known to commit suicide.4

Standard care for cluster headache includes acutetreatments such as triptans or high-flow oxygen takenat the onset of an attack, supplemented with prophy-lactic treatments such as verapamil or lithium, whichare taken on a continuous basis once a cluster periodhas begun, or before sleep in order to prevent noctur-nal attacks in the case of ergotamine.1 Unfortunately,

From the VA Connecticut Healthcare/Yale University Schoolof Medicine—Psychiatry, West Haven, CT, USA.

Address all correspondence to R.A. Sewell, VA ConnecticutHealthcare/Yale University School of Medicine—Psychiatry,West Haven, CT 06516, USA.

Accepted for publication August 2, 2008. Conflict of Interest: None

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

Headache© 2008 the AuthorJournal compilation © 2008 American Headache Society

98

these treatments are rarely entirely effective andoften have serious disadvantages. Triptans and ergotalkaloids often cannot be given frequently enough,and oxygen tanks are unwieldy and inconvenient.Many herbal remedies have been proposed to treatheadache; of these, feverfew5 and cannabis6 have themost empirical support, but neither has been specifi-cally evaluated for cluster headache.

Kudzu refers to any one of a number of vinespecies of the genus Pueraria that is indigenous toAsian countries, was imported to the USA in 1876,and has subsequently been used for green manureand fodder and as ground cover to prevent soil ero-sion.7 The use of Ge-gen (kudzu root) was describedin the Chinese medical book Shang Han Lun – “Trea-tise on Fever” – 1800 years ago,8 and today its rhizomeis a traditionally used component in Chinese medicalpolyprescriptions for liver diseases, strokes, and aller-gies. Kudzu contains antioxidants,9 has antipyreticand anesthetic effects,10 treats hypertension,11 dilatescerebral blood vessels, increases cerebral blood flow,and improves brain acetylcholine in a mouse Al-zheimer model.12 Historically, it has had use in thetreatment of alcohol-related problems since AD600.13 Its use in the treatment of cluster headache hasnot previously been described.

METHODSThe study was approved by the McLean Hospital/

Harvard Medical School IRB. A database of 235cluster headache patients was surveyed via email ontheir use of a number of complementary and alterna-tive remedies, including kudzu root. The subjects hadbeen previously recruited for a study unrelated tokudzu14 and came from 3 sources – members of theClusterbusters patient advocacy group (37), respon-dents to an online survey about quality of life issuesaffecting cluster headache patients who had checkeda box agreeing to be contacted for future researchstudies (189), and people who had heard on the Inter-net that we were studying cluster headache and inde-pendently emailed us asking to participate (9). As ofOctober 10, 2006, 159 (68%) had responded; of these,22 (14%) endorsed using kudzu root or extract toself-treat their cluster headache. Questions wereasked on a variety of complementary and alternative

treatments for cluster headache and phrased in such away that kudzu did not appear to be a topic of undueinterest. We restricted our analysis to the 16 (73%)individuals who (1) agreed to be contacted for evalu-ation by telephone or email; (2) met InternationalClassification of Headache Disorders, 2nd edition, cri-teria for cluster headache; (3) allowed us to obtaincopies of medical records documenting a diagnosis ofcluster headache by an MD or DO. If the medicalrecords did not support the diagnosis, the subject wasexcluded from further analysis.

RESULTSResults are summarized in the Table. Of the

11 subjects with episodic cluster headache, 8 (73%)experienced a decrease in the intensity of theirattacks, 7 (64%) experienced a decrease in frequency,4 (36%) experienced decreased attack length, and 2(18%) experienced a truncated cluster period. Onesubject experienced increased attack intensity, fre-quency, and duration. Of the 5 subjects with chroniccluster headache, 3 (60%) experienced decreasedattack intensity, 2 (40%) decreased frequency, and 1(20%) decreased attack duration, while 1 (20%) hadincreased attack intensity.

Efficacy for cluster attack in this group showed aclear dose–response relationship: 3 of the 4 treatmentnonresponders were taking less than 1000 mg a day(total pill weight; actual dose of kudzu is substantiallyless), and only 3 of 7 (43%) patients taking kudzu lessthan 3 times a day showed benefit. Of the 6 whoreported no effects or worse effects from kudzu, allwere taking it less than 3 times a day, whereas 8 of 10(80%) taking the more frequent dose benefitted(Fig. 1). Side effects were mild and infrequent, themost common being gastrointestinal effects experi-enced by 4 (25%). Measured by total dose per day, theeffect of kudzu on cluster attack intensity, frequency,and duration also showed a dose–response relation-ship, whereas its effect on cluster period length didnot.

In comparison, of the 36 (13%) respondents fromthe cohort of 285 in the database who endorsed usingacupuncture, 4 (11%) felt it made their cluster head-ache worse, 7 (20%) felt it improved their clusterheadache, and 21 (58%) reported no effect. Of the 58

Headache 99

Tabl

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Eff

ect

ofK

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No.

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(yea

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(mg)

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ns.

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159

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613

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1500

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1500

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536

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100 January 2009

(20%) respondents who endorsed using the “watermethod” – drinking a glass of water every half an hourduring the cluster period – 3 (5%) felt it made theircluster headache worse, 16 (28%) felt it improvedtheir cluster headache, and 37 (64%) reported noeffect (Fig. 2). These data should not be construed asevidence of lack of efficacy of these 2 methods; rather,assuming that the effects of acupuncture and polydip-sia on cluster headache are no different than placebo,then the reported efficacy of kudzu in this cohort ismore than twice as great as would be expected fromchance alone.

REPRESENTATIVE CASES (ALL OTHERSARE INCLUDED IN APPENDIX A,AVAILABLE ONLINE ONLY)

Case No. 2.—A 36-year-old man with no othermedical conditions had suffered from episodic clusterheadache since age 16 years, characterized by 6 weeksof one or two 2-hour attacks per day separated by a 4-or 5-month remission period.The attacks consisted ofa boring pain in his temple and a knot in his neck,along with lacrimation, ptosis, meiosis, conjunctivalinjection, flushing, diaphoresis, and restlessness. Fre-quent absences caused problems at work, and thesecondary depression and fatigue caused strain in hisinterpersonal relationships.

He finds oxygen and sumatriptan to be effectiveabortive medications, and as prophylactic medication,he has tried propanolol and amitriptyline, which areineffective, verapamil and psilocybin, which decreasethe frequency and intensity of attacks, and pred-nisone, which stops the attacks only while he is takingit.

When his last cluster period began, in June of2005, he read on an Internet forum that kudzu treatedcluster headache, so he decided to boil 1.5 ounces ofdried kudzu root and drink it as a tea twice a day.Even though he was using no other medication, hesuffered only 4 attacks during the entire 6-weekcluster period, all mild. The cluster period wasunchanged in length. He also had approximately 10“phantom attacks,” a phenomenon he had experi-enced previously on verapamil. He was able to avoidtaking all conventional prophylactic medication, andsuffered no side effects from the kudzu other thanvivid dreams. He does not smoke or use illicit drugs,but drinks 3 or 4 glasses of wine a week and 2 cups ofgreen tea a day.

Case No. 3.—A 36-year-old man with no significantmedical conditions except for a history of benignfamilial infantile convulsions, which he had outgrownby age 3 years, started to have episodic cluster head-aches at age 28 years and was correctly diagnosed atage 33 years. Each cluster period lasted 8 to 10 weeksseparated by a remission period of 7 or 8 months,occurred usually in autumn or late February, and con-sisted of as many as 6 cluster attacks a day, at all timesof day and night. Each attack was characterized by a

Fig 1.—Percent of patients reporting improvement in clusterattack intensity, frequency, and duration and cluster periodlength, stratified by total daily dose of unstandardized extractconsumed. A dose–response relationship is apparent in kudzu’seffects on cluster attacks, but not on cluster period length.

Fig 2.—Subjective global effect of different “alternative” treat-ment modalities on cluster headache symptoms. There is noevidence to suggest that either acupuncture or polydipsia ismore effective for cluster headache than placebo.

Headache 101

right-sided sharp boring pain radiating into his jawand neck, sweating, ptosis and eyelid edema, conjunc-tival injection, rhinorrhea, phono- and osmophobialasting 45 to 90 minutes. He coped well, suffering nojob or relationship difficulties as a result, but grappledwith persistent fears that there was “somethingdeeply wrong” with his brain.

For 5 years he remained untreated, assuming thathe had a sinus problem or simply trying not to thinkabout it, and then started medication. Verapamil120 mg a day decreased his attack frequency to onceor twice daily, but did not decrease the attack inten-sity and caused him memory and coordination diffi-culties. Valproate triggered 2 of the most painful andprolonged attacks he had ever experienced, so hediscontinued it. Sumatriptan was an effective abor-tive, but side effects that included intensification andprolongation of subsequent attacks as well as a dullpersistent ache at the site of the attacks the next dayprompted him to discontinue it.

In February 2005, he started to experience“twinges” in his right eye, heralding the beginning ofa cluster period, and with his first full-blown attack,he started on Planetary Formulas kudzu extract1500 mg 3 times a day as well as a twice-daily mul-tivitamin. To his surprise, he found that he experi-enced only 8 attacks for the remainder of the clusterperiod, which was half its usual length (only 7weeks), no attack lasting longer than 30 minutes. Theattacks differed from the usual – although they stillcaused agitation and pacing, there were no associ-ated autonomic symptoms, only pain, and the inten-sity of the pain was attenuated – and these occurredonly when he decreased the dose of kudzu to twicea day, forgot, or delayed a dose. He experienced noside effects.

His next cluster period began with 4 times dailyattacks in late November 2005, but he delayed takingkudzu until the intensity of the attacks became excru-ciating, in the second week of December, for fear thathe would develop tachyphylaxis. Restarting a dose ofPlanetary Formulas 1500 mg 3 times a day, he foundthat his attacks diminished in both frequency andintensity to zero over the next 2 weeks, and theremainder of the cluster period passed asymptomati-cally until it ended in January.

He smokes a pack of cigarettes every day, drinksone drink of alcohol every few months, and smokescannabis roughly twice a year. He uses no other illicitdrugs but drinks 4 to 5 cups of coffee a day.

DISCUSSIONThe putative mechanism of action by which

kudzu might affect cluster headache should theseresults be verified is unclear. It is thought that theother therapeutic benefits of kudzu are due to phy-toestrogens, particularly isoflavones, which possessboth estrogenic and antiestrogenic properties, can actas selective estrogen receptor modulators,15 and havea long pedigree in the treatment of a number of dis-orders.16 Flavonoids are phenolic compounds widelydistributed in plants, with over 4000 currentlyknown.17 Their astringency probably repels insects,making isoflavonoids the most important group ofplant-protective phytoalexins.18 The isoflavone puer-arin, which is the principal component in kudzu,19

has hypoglycemic properties and increases coronaryblood flow, reducing the frequency of acute anginaevents20 and normalizing endothelin, renin, angio-tensin II post-myocardial infarction in 3 days.21 Puer-arin attenuates mecamylamine-induced deficits ininhibitory avoidance performance in rats, presumablythrough nicotinic-receptor agonism and N-methyl-D-aspartic acid (NMDA) agonism and serotonindecrease.22 It does not act as a beta-blocker or calciumantagonist, however.23 The 3 times daily dosing ofkudzu that appears necessary to ameliorate clusterheadache is consistent with puerarin’s pharmacoki-netic profile.24 Daidzein is a metabolite of puerarinand daidzin, another isoflavone in kudzu. Unlikedaidzin and puerarin, daidzein scavenges free radi-cals25 and is estrogenic,26 albeit thousands of times lesspotent than the synthetic estrogen diethylstilbestrol.

Estrogen and progesterone levels are normal incluster headache, but the dramatically higher preva-lence of the disorder in males, the increase in inci-dence around menopause,27 and the tendency ofcluster headache to remit during pregnancy28 arguefor a protective effect of female reproductive hor-mones that may be replicated by the phytoestrogensin kudzu.

102 January 2009

Kudzu has been reported to decrease alcoholintake in both preclinical29 and clinical trials. Inves-tigators found that over-the-counter (OTC) prepara-tions of kudzu that contain less than 1% or 2%isoflavones are not effective in limiting alcoholintake, but a concentrated (25% isoflavone) form ofkudzu was effective in reducing alcohol intake bybinge drinkers.30 The rate of alcoholism is high incluster headache patients,31 which is surprising asalcohol is a reliable trigger of a cluster attack duringa cluster period, although it may be consumedwithout consequence during a remission period. Inone sample, 91% of cluster headache patients drankalcohol, with 61% falling into the category of mod-erate to excessive drinkers,32 and in another, morethan 90% drank alcohol, with a significant propor-tion being “heavy drinkers.”31 Levi found that 67%of his sample assessed with the Mm-MAST (Michi-gan Alcoholism Screening Test) had scores indica-tive of alcoholism.33 Other studies have found lowerrates of alcohol consumption, but still far higherthan those of noncluster headache controls – 61% vs41% in one sample,34 with daily use reported by36% of cluster headache patients vs 14% of con-trols. However, as alcohol triggers cluster attacks,79% of cluster headache patients dramaticallydecrease their alcohol consumption during a clusterperiod,33 in contrast with smoking, the rate of whichdoes not change. It is thus conceivable that theisoflavones in kudzu are treating a common factorunderlying both alcoholism and cluster attacks.

The use of kudzu to treat cluster headache wasunknown before December 2005, when reports of itstherapeutic effects appeared on the Internet andpropagated rapidly through the cluster headachepatient population. A number of studies have foundthat approximately 50% of patients use the Internetto obtain medical information, and 60% in one studyreported that they felt that information on the Inter-net was the “same as” or “better than” informationfrom their doctors.35 Although Internet medicaladvice is frequently characterized as inaccurate,incomplete, or inconsistent,36 the rapid and wide-spread dissemination of unverified medical informa-tion also permits the trial-and-error discovery of newtreatments by enthusiastic patient groups.

Caution should be applied in interpreting thesefindings, as case series are by their very nature subjectto selection bias, recall bias, and the placebo response.However, several factors mitigate these limitations inthis case series. Recruitment over the Internet selectsfor younger, more educated, and more motivated sub-jects,37 likely leading to increased reported efficacy.This group was not, however, otherwise selected forpositive response to kudzu or alternative medica-tions, and this group did not report a comparablepositive response to acupuncture and other alterna-tive medications.Although it has not been establishedthat acupuncture and polydipsia are ineffective intreating cluster headache, if these methods are actu-ally effective, then that would strengthen, not weaken,our conclusions.

Although there was no placebo arm, clusterheadache is known to respond poorly to placebo; con-trolled trials have shown a placebo response of 0% toprophylactic medications such as verapamil,38 capsai-cin,39 and melatonin.40 As cluster attacks typicallywax and wane over the course of a cluster period,improvement in symptoms can be difficult to attributeto medication effect. However, each cluster period isgenerally very similar in pattern and length for agiven patient, making differences noticeable, and 2patients (no. 4 and no. 12, see supplemental cases)used a challenge–rechallenge test to verify that thekudzu was having an effect on their headaches. Fur-thermore, 6 (38%) of the subjects had maintaineddetailed headache diaries corroborating their retro-spective recall of efficacy.

Finally, the concentration of isoflavones in OTCkudzu preparations is unstandardized, and variesfrom 0.5% to 3% (Lukas, personal communication),making it difficult to quantify the actual amount ofactive ingredient ingested by the subjects. However,this variability should attenuate rather than exag-gerate any dose–response relationship, and the factthat such a relationship was still identifiable despitethe variable concentrations of isoflavones present,further argues for therapeutic effect.

CONCLUSIONAlthough few subjects were able to completely

discontinue conventional medications, a substantial

Headache 103

proportion found that kudzu extract in a variety oflow-concentration OTC preparations ameliorated theintensity, frequency, and duration of their clusterattacks, with minimal side effects, although kudzu hadno effect on the length of the cluster period. Shouldthese results be confirmed with a randomized clinicaltrial of standardized extracts, kudzu may prove tohave a role in the management of cluster headache.

Acknowledgments: The author thanks Earth andFire Erowid, Robert Wold and the Clusterbusters, forassistance with data collection; Harrison Pope, ScottLukas, Mehmet Sofuoglu, and Bruce Price for their com-ments on an earlier draft of this article, and JonathanByron for bringing kudzu to the attention of the clusterheadache community. Funding was provided by NIDA,NIH T32-DA07252. No funding source had any role instudy design, collection, analysis, or interpretation of data,writing of the report, or submission of the manuscript.

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SUPPORTING INFORMATION

Additional Supporting Information may be found inthe online version of this article:

SUPPLEMENTAL CASE REPORTS FOR“Response of Cluster Headache to Kudzu” (Case no. 1,4-16).

Please note: Blackwell Publishing is not responsiblefor the content or functionality of any supporting mate-rials supplied by the authors. Any queries (other thanmissing material) should be directed to the correspond-ing author for the article.

Headache 105

Headache ISSN 0017-8748

! 2008 the Author doi: 10.111/j.1526-4610.2008.01268.x

Journal compilation ! 2008 American Headache Society Published by Wiley Periodicals, Inc.

S1

SUPPLEMENTAL CASE REPORTS FOR

Response of Cluster Headache to Kudzu (Case no. 1, 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. She usually suffered three but could have as

many as eight attacks per day lasting 90 minutes

each, following no pattern that she could discern. The

attacks consisted of lacrimation, miosis, ptosis,

rhinorrhea, injected sclera, flushing, diaphoresis,

restlessness, and a boring pain in her temple. Her

social life and marriage deteriorated as a result, and

she became chronically depressed.

Propanolol, verapamil, lithium, and amitriptyline

had no effect on the frequency or intensity of her

attacks, but she found oxygen and sumatriptan to be

effective abortives. In February of 2005, she read on

an Internet cluster-headache forum that kudzu extract

could control cluster headache, so she started taking

Nature’s Way 613 mg capsules three times a day.

After two months, she noted no difference in the

frequency or intensity of her attacks—albeit no side

effects, either—so discontinued the kudzu. She

drinks a glass of red wine two or three times a week,

smokes half a pack of cigarettes a day, drinks 3 or 4

cups of coffee a day, but uses no other drugs.

CASE #4

A 47-year old woman with hypertension, asthma,

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, when she transformed

to secondary chronic following years of misdiagnosis

with migraine, sinus infection, and

temporomandibular joint syndrome. Attacks were

left-sided, could last for as long as an hour, occurred

two to six times a day, and consisted of injected

sclera, ptosis, lacrimation, rhinorrhea, pressure from

nose to temple, neck spasms, and a feeling of having

a hot poker driven into her eyeball combined with an

urge to bang her head into a wall. These attacks made

it difficult for her to care for her newborn and were a

contributing factor in two divorces.

Propanolol, lithium, and verapamil were partially

effective in treating her CH, although she found the

lithium hard to tolerate, and oxygen was effective as

an abortive only 50% of the time. She initially gained

relief with rizatriptan but had to discontinue it

because of concerns following her cerebral

hemorrhage.

In February of 2005, while taking 360 mg

verapamil, 1800 mg gabapentin and 150 mg lithium

carbonate daily, and still suffering attacks three times

a day at 10 am, 2 pm and 10:30 pm, she read on an

Internet site that kudzu had been used in Chinese

medicine to treat migraines, so decided to self-

administer it. Starting with a 750 mg tablet of

Planetary Formulas kudzu extract she noticed that

within 24 hours her attacks ceased, and the residual

pain that she had suffered for several hours a day was

also cut in intensity and duration. Over several weeks

she increased her dose to 4500 mg a day, and found

that her attacks decreased in intensity and frequency

to one every three or four days. She also began to

experience “phantom attacks”—autonomic attacks

consisting of lacrimation, rhinorrhea, hidrosis, ptosis,

eyelid edema, flushing, photo- and phonophobia, but

no pain—roughly three times a day. She found the

kudzu most effective when taken two hours prior to

an expected attack. She was able to taper and

discontinue both the lithium and gabapentin, but

remained on verapamil at a reduced dose of 240 mg

daily for her hypertension. In May she experienced

six pain-free days in a row, and assuming that she

had cured her disease, began to taper the kudzu by

750 mg daily to 1500 mg daily. Within four days, her

daily attacks resumed, but were different in nature,

lasting only ten minutes each and lacking the usual

autonomic symptoms. She returned to her prior dose

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of 4500 mg kudzu, but never achieved the same level

of relief again. The only side effect she noted was

excessive flatulence. She rarely drinks, continues to

smoke two packs a day of cigarettes and cannabis

three times a month, but uses no other illicit drugs.

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. At first

her remission periods lasted for two years, but her

cluster periods lengthened over time and she became

secondarily chronic in July of 2003, and has

experienced no more than seven pain-free days

between attacks since. Attacks last between 25

minutes and three hours, average five a day, and

consist of excruciating pain behind her right eye and

temple radiating to the jaw, lacrimation, nasal

congestion and rhinorrhea, conjunctival injection,

forehead and facial sweating, miosis, flushing,

phonophobia, tachycardia, anxiety, rocking, pacing,

and inability to concentrate. They occur reliably at

noon, 2 pm, 10 pm, 4:20 am and between 7 and 9 am,

with additional attacks at 5 pm and 8 pm at peak, and

have adversely affected her marriage, education, and

social life.

Propanolol and amitriptyline were ineffective,

and verapamil caused unacceptable hypotension.

Prednisone was effective but caused weight gain and

extreme mood swings, and she became toxic on

lithium before its efficacy could be determined.

Sumatriptan was effective but caused her attack

pattern to become irregular, and she had to

discontinue it in May 2004 after she developed

Prinzmetal angina. 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. She

has tried over 50 medications in the last five years.

In February 2005, while on a regimen of fentanyl

200 µg twice daily and Tylox (acetamenophen/

oxycodone) 500/5 mg three times a day, she started

taking kudzu as an adjunctive. After ten days of

Nature’s Way 1226 mg in the morning she realized

that her afternoon attacks had doubled in intensity.

She stopped the kudzu but restarted it in the summer

of 2005 without concurrent opiates, and again found

that her afternoon attacks were much more painful.

Taking kudzu before bed caused her to experience

multiple nocturnal attacks—midnight, 2 am, and 4

am—for the first time. She discontinued it and

continues to take fentanyl and Tylox with oxygen for

breakthrough attacks. She smokes 1/2 pack a day,

drinks rarely, and uses no other drugs except topical

steroids for psoriasis.

CASE #6

A 57-year old man with no other medical

problems suffered episodic cluster headaches since

age 20, each cluster period lasting from six to eight

weeks, separated by a remission period of two years,

although his most recent remission period was six

years. Attacks occur up to four times a day, last one

to two hours, and consist of lacrimation, ptosis,

rhinorrhea, pacing, and chills. They cause him

irritability but no serious problems in jobs or

relationships.

Neither methysergide, lithium, indomethacin,

verapamil, prednisone, chlorpromazine, amitriptyline,

melatonin, topiramate, nor naratriptan have had any

effect on the frequency or intensity of his attacks.

Sumatriptan was effective as an acute abortive, but he

was forced to discontinue use after a myocardial

infarction in 1998. Oxygen has been only partially

effective, but he has not used a non-rebreather mask.

A month following the end of his last cluster

period in February 2005, and still experiencing heavy

“shadows” every other day, he read that kudzu was

reputed to treat cluster headache, so he took one dose

of Planetary Formulas Kudzu Recovery 1500 mg at

night. 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. The kudzu gave him an upset stomach. The next

day he began to experience shadows again, at which

point he ingested Hawaiian baby woodrose seeds.

The pain then stopped and did not return.

He drinks a glass of wine on the weekend but

does not smoke, use caffeine or illicit drugs. He

remains on atenolol, pravastatin, and aspirin.

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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, with no remission period longer than three

weeks, with the exception of an interval on

prednisone. These attacks consist of ptosis, nasal

congestion, flushing, sweating, shivering,

osmophobia, and severe pain in her right teeth and

jaw. The pain has severely affected her social life,

and interfered with her and her husband’s sleep and

peace of mind.

Prednisone tapers have twice provided her with a

pain-free period, and sumatriptan is partially effective

in controlling her attacks. Reading that some people

had found relief with kudzu, on February 24, 2005

she began taking Nature’s Way kudzu extract 1226

three times a day, and noticed that the attacks

immediately shortened to five to ten minutes,

occurred twice a week rather than every day, and

became so much less intense that she no longer

needed abortive medication. Her use of triptans

declined from twice a week to none. On kudzu 1226

mg three times a day, a multivitamin, B-50 complex

and B-12, she can now be pain-free for as long as two

weeks between consecutive attacks. She notices no

side effects from the kudzu, smokes one pack a day

but does not drink or use illicit drugs.

CASE #8

A 32-year old man without other medical

conditions has suffered episodic cluster headache

since age 26, consisting of eight-week cluster periods

separated by four-month remission periods. During a

cluster period, he will experience four to six 90-

minute mostly nocturnal cluster attacks that feel “like

an ice-cream headache only worse”. The attacks start

with a dull ache behind the right eye, slowly increase

in intensity over five minutes to a constant boring

pain that spreads to the upper teeth, and is associated

with ptosis, conjunctival injection, tearing,

photophobia, and a compulsion to press his right

temple. These can be triggered by alcohol or odors of

gasoline, diesel fumes, nail polish, and perfume.

Until he was finally diagnosed in February 2005, he

underwent two courses of antibiotics a year for

presumed sinus infections, and had three healthy

teeth removed. He had to stop working as a train

conductor after he almost caused a derailment during

a cluster attack. During a cluster period, he will get

only two or three hours of sleep a night for weeks,

causing him to be irritable and adversely affecting his

relationship with his wife. Sleep deprivation also

impaired his ability to study and forced him to drop

out of college.

As a prophylactic, prednisone was ineffective,

and valproate doubled the frequency of his attacks,

but verapamil 480 mg reduced both the intensity of

the attacks by a third and the frequency by 20%.

Sumatriptan is effective, and oxygen is completely

effective 75% of the time and reduces the intensity of

remaining attacks the remainder of the time.

Melatonin causes the attacks to shift from diurnal to

nocturnal.

An extended cluster period began in February

2005 that lasted for nine months. In April he tried

Planetary Formulas kudzu extract 1500 mg twice a

day, increasing to three times a day after two months.

After three months of co-administration with

verapamil, melatonin, sumatriptan and oxygen, he

noted no change in the frequency or intensity of his

attacks, but suffered from gastrointestinal distress, so

discontinued it. Subsequently, there was no

noticeable difference in his cluster attacks, which

were occurring three to five times a day. He took

psilocybin mushrooms in October 2005 and the

cluster period stopped. He has been pain-free since.

He smokes a pack and a half and drinks up to two

pots of coffee a day, but does not drink alcohol or use

illicit drugs.

CASE #9

A 49-year old man with no other medical

conditions has endured episodic cluster headache

since age 20, diagnosed at age 35. Every 10 to 13

months he will experience nine months of hour-long

attacks that occur up to four times daily, consisting of

intense non-throbbing pain centered in his right eye,

associated with lacrimation, rhinorrhea, pacing,

irritability, and rocking back and forth. These attacks

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have disrupted his social life, because he often cannot

risk attending social events, and his professional life

as a University administrator, because he lives in fear

of a cluster attack removing his ability to successfully

think through problems.

Propanolol was ineffective in ameliorating his

attacks, while verapamil was effective for about three

years then ceased to work. Prednisone was effective

but caused him unpleasant mood changes, excessive

weight gain and edema, and topiramate caused him

paresthesias and hallucinations. He can reliably abort

acute attacks with sumatriptan and occasionally with

oxygen.

Frustrated with what he considered to be

unacceptable side effects from the prophylactic

agents he had tried, when his current cluster period

began on May 29, 2005, he decided to take kudzu

instead, which he had read about on an online cluster

headache forum. On June 7, he started taking 1500

mg Planetary Formula kudzu three times a day,

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.

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. The

only side effects he suffered were indigestion and a

“looser neck”. He drinks alcohol once or twice a

week when in a remission period, smokes cigarettes

when he drinks, but uses no illegal drugs. He has one

or two cups of coffee a day. He can continue to have

one or two mild attacks a day on kudzu, ergotamine

tartrate 2 mg at night, and melatonin 9 mg at night.

CASE #10

A 49 year old right-handed man has had cluster

headache since age 13, becoming secondarily chronic

at age 25. He had been run over by a car at age 4,

resulting in persistent cognitive deficits from his

brain injury, and also suffers from migraines and

depression. He can have up to 6 attacks a day that are

mostly right-sided but that can alternate within

the same cluster period, consisting of 30 minutes of

lancinating pain, eyelid edema, and ptosis that cause

him to scream, sob, and punch himself in the head

and that have left him with a permanent right eyelid

droop. Attacks occur night and day, making it

difficult for him to keep a job, as he has frequently

quit impulsively while in a cluster period. His mood

is frequently so foul during his worst periods that his

family has to walk around “on eggshells”.

He found amitriptyline and methadone, which he

started in his 30s, to be partially effective at

controlling his attacks, but did not like the mental

dullness or difficulties with orgasm that they gave

him. Lithium was ineffective, and sumatriptan was

effective in controlling his attacks, but becoming less

so with time and eventually causing increased

intensity attacks, anxiety, and confusion that stopped

when he discontinued it. At this time he was forced

to go on permanent disability.

In April 2005 he read on the Internet about the

kudzu treatment for cluster headache. He

discontinued his methadone and alprazolam, but not

his melatonin, suffering five days of withdrawal

symptoms, then started kudzu extract (Planetary

Formulas, Kudzu Recovery) 750 mg three times

daily, noticing no effect. Upon increasing this to

1500 mg three times daily, he noticed an immediate

50% decrease in the intensity of his pain, although

the frequency of the attacks remained unchanged.

After two months on kudzu, he decided that although

it was more effective for him than sumatriptan or

morphine, the discontinuation of his other

medications had caused his insomnia, restless leg

syndrome, and chronic pain to worsen. He therefore

discontinued the kudzu and instead took Hawaiian

baby woodrose seeds for prophylaxis, finding them to

be more effective than kudzu, and sumatriptan for

breakthrough attacks. He remains on morphine SR 60

mg for chronic pain and alprazolam 1 mg. He does

not smoke, drink, or use recreational drugs.

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. Each cluster period

lasts six to eight weeks separated by a remission

period of 7 to 18 months. At worst, she will suffer

three two-hour attacks per day, mostly nocturnal,

consisting of lacrimation, ptosis, conjunctival

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injection, rhinorrhea, diaphoresis, restlessness, neck

stiffness, and severe, boring pain in her eye, ear, and

temple. These have deprived her of sleep and made

her irritable, embarrassed for repeated cancelling

social plans, guilty over her inability to be industrious

during a cluster period, and resigned to remaining in

a bad marriage for fear that her condition will make it

impossible for her to find another partner.

She has found propanolol ineffective, 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; triptans abort an attack about a quarter

of the time.

In July 2005, her fiancé read an article that said

that kudzu could potentially help her cluster

headache. When her most recent cluster period

started that month, she started taking Nature’s Way

613 mg twice a day for the next three weeks, but

found that her attacks were worse—more intense,

more frequent during daylight hours, and longer, and

the cluster period itself was also longer than normal.

This coincided with hurricane Katrina’s landfall,

however, and with it a month of increased stress, 95-

degree temperatures, and no electricity or air

conditioning. She stopped taking the kudzu when it

ran out. She experienced no side effects from the

kudzu. She currently smokes one pack per day of

cigarettes, drinks one or two servings of alcohol

several times a week and three to five cups of coffee

a day, but uses no illegal drugs.

CASE #12

A 42-year old man without any other medical

problems has had episodic cluster headaches since his

late twenties. For four to six weeks, twice a year, he

suffers one or two right-sided cluster attacks daily or

every other day, lasting one to three hours each.

These are characterized by rhinorrhea, ptosis,

mydriasis, and severe orbital pain that often leaves

him unable to do anything but rock back and forth or

writhe around on the floor. During these periods, he

is forced to schedule his personal and professional

life around anticipated attacks, which is disruptive

and anxiety-provoking for him and his family.

He had used no medication prior to his most

recent cluster period, which began in February 2005,

after which he used both oxygen and intramuscular

sumatriptan and found them effective in terminating

his cluster attacks in less than 15 minutes.

Finding a reference online to kudzu in February

2005, 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.

He had only two more attacks during that cluster

period. In July 2005, he started to suffer cluster

attacks that were provoked by vigorous exercise,

heralding the beginning of another cluster period, so

he restarted kudzu at the same dose. 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, but rather

were triggered by aerobic exercise or alcohol, and

responded promptly to oxygen. This scenario

repeated almost exactly during his next cluster

period, which began in January of 2006. Despite the

infrequency of attacks, he is able to tell that he

remains in the cluster period by a subtle heaviness in

his head and “tickle” behind his eyeball, and in a

remission period he is able to consume alcohol and

run a marathon once or twice a year without

triggering an attack. He notices no side effects from

the kudzu.

When his most recent cluster period started on

March 12th

, 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, and

much less painful in intensity, he continued to have

an attack almost every day. Discontinuing kudzu

increased the frequency to two or three a night.

His father is his only relative known to have

cluster headache. Neither he nor his father has a

history of head injury, although his father’s brother

had a seizure disorder. He drinks one or two beers or

glasses of wine a day, stopped smoking nine years

ago, and uses no illicit drugs.

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CASE #13

A 40-year-old woman with osteomalacia and

collagenous colitis has had chronic cluster headache

since age 38, when she tapered off the prednisone

that she had been taking for her celiac disease over

nine months. If unmedicated, she will have between

three and eight cluster attacks a day, lasting two

hours each, and consisting of a boring pain in her

temple accompanied by an urge to gouge out her eye,

lacrimation, ptosis, miosis, rhinorrhea, and sweating.

She was forced to stop working, and her marriage

ended.

Verapamil caused syncope, lithium was

ineffective, and topiramate caused hallucinations and

delusions, but oxygen will reliably end an attack in

five minutes. Triptans are also effective but

sumatriptan caused tachycardia, nausea, and

dysphoria, and frovatriptan caused the intensity of

her attacks to increase.

In December 2005, having read on the Internet

that kudzu was effective in treating cluster headache,

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. After 13 weeks, the

frequency slowly increased back to baseline, so she

stopped kudzu and switched to verapamil, then

topiramate, then lithium, hoping that they might be

more effective, which turned out not to be the case.

She suffered no side effects from the kudzu.

She does not smoke or use illegal drugs, drinks

alcohol twice a week, and drinks three coffees or

sodas a day. She currently takes only Rivea

corymbosa seeds and oxygen to treat her cluster

headache.

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.

At peak, she can have four 50-minute attacks per day,

consisting of severe boring pain, rhinorrhea, ptosis,

rocking, moaning, and compulsively rubbing or

hitting her temple. This leads to sleep-deprivation

and irritability, adversely affecting her relationship

with her husband. She was initially treated for sinus

infections every September during her regular cluster

period, until she finally received the correct diagnosis

in 2000.

Amitriptyline had no effect on the frequency or

intensity of her attacks, and prednisone rendered her

pain-free for only two days. Oxygen worked for half

of her cluster period in 2000, but not subsequent to

that. Injectable sumatriptan works 95% of the time.

In 2004, she read on an Internet forum that

kudzu extract could be used to treat cluster headache,

so at the anticipated beginning of her next cluster

period in September 2005, she began to take

Neutraceuticals Sciences Institute kudzu extract 650

mg daily. During that month, her cluster period did

not begin in its usual fashion; rather, she experienced

three “phantom attacks”, consisting of unilateral

nasal congestion, ptosis, and flushing but without any

pain. These were otherwise identical to her regular

attacks except that they lasted for only two or three

minutes.

In mid-October she discontinued the kudzu, but

when her cluster period began late in December, 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. By themselves, the

attacks were not shorter, but oxygen, which had

ceased to work, became effective again as an abortive

in combination with the kudzu. Her cluster period

remained the same length. She experienced no side

effects other than loose bowels. She remained on

duloxetine, alprazolam, and vitamins during this

period. She stopped smoking a pack a day a year ago,

and drinks two to four glasses of red wine four times

a week, but uses no illicit drugs or caffeine.

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, 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. At worst he will get two left-sided attacks a

day, lasting up to three hours each, characterized by a

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boring pain in his temple with waves of more severe

pain approximately every ten minutes, a “hot knot” in

his neck and throat, miosis, lacrimation, conjunctival

injection, rhinorrhea, flushing, diaphoresis,

restlessness, photophobia, and a feeling “like an alien

in my head wants out”. During the attacks he is

completely incapacitated, and by the second week of

a cluster period, sleep deprivation renders him

irritable and unable to focus or make decisions at

home or at work. His neurologist has recommended

that he eliminate foods such as cheese, nuts,

chocolate, coconut, shellfish, tomatoes, alcohol and

just about anything "aged" from his diet, which

causes inconvenience when eating out or at social

gatherings. He also lost one five-year romantic

relationship in part because of his cluster headache.

Acupuncture has not helped his cluster headache,

nor has prednisone, which instead gave him anxiety,

depression, irritability, and mood swings. Oxygen

and rizatriptan, which he combines with a few drops

of “Bach Flower Rescue Remedy” and a cup of hot

coffee, are effective in aborting individual attacks. He

has also taken Cafergot, codeine, Vicodin, Dilaudid,

melatonin, Chinese herbal medicine and feverfew,

and tried homeopathy, craniosacral therapy, and

“Quantum Energetics” therapy. The Cafergot worked

only occasionally, and only if taken immediately at

the onset of a headache. Dilaudid helps early in the

cluster period, but increasing doses are required as

the cluster period continues.

In November 2005, one week into his most

recent cluster period, he read about kudzu on an

Internet forum, so started taking StarWest Botanicals

Inc. bulk kudzu root 800 mg to 1000 mg at night,

combined with drinking four to five liters of spring

water during the course of the day. He noted no

change in the intensity, frequency, or duration of

attacks, but his cluster period ended after only three

weeks. He experienced no side effects from the

kudzu.

He does not smoke, and while in a cluster period

does not drink alcohol or use illegal drugs, but will

drink coffee to help abort individual attacks. In a

remission period, he smokes prescribed medical

cannabis once or twice a day but uses no illegal

drugs, drinks 2.5 glasses of red wine daily, and drinks

a cup of coffee every morning.

CASE #16

A 33-year old right-handed woman with no other

medical conditions was diagnosed with episodic

cluster headache at age 22, consisting of

progressively longer—currently eight week—cluster

periods separated by nine- to twelve-month remission

periods. She experiences one or two 60-minute

attacks a day, characterized by ptosis, diaphoresis,

restlessness, photo- and osmophobia, and pain that

she describes as like a “lightning storm” or “worms

dipped in acid crawling through the right side of my

head.” She has suffered lost productivity in her job

from lingering headaches and medication side effects,

and since her triggers during a cluster period include

flickering lights and chemical smells, she cannot go

to bars, restaurants, grocery stores or movies,

severely impacting her social life.

Amitriptyline is ineffective as a prophylactic

agent, verapamil and duloxetine are partially

effective, and prednisone prevents attacks while she

takes it. Intranasal sumatriptan effectively aborts her

attacks.

In fall of 2005 she read on the Internet that

kudzu might be effective in treating cluster headache,

so she started taking Nature’s Herb 100 mg daily, but

noted no decrease in the frequency, intensity, or

duration of her cluster attacks and no effect on the

length of her cluster period. She suffered no side

effects from the kudzu, however. She currently

maintains herself on a combination of duloxetine,

verapamil, kudzu, magnesium, and melatonin. She

does not smoke or use illegal drugs, but drinks

occasional alcohol when in a remission period.