Cluster headache versus labor: A comparative perspective on acute pain during and after delivery

Document Type

Conference Proceeding

Publication Date

6-19-2025

Publication Title

Headache

Keywords

sumatriptan, adult, analgesia, case report, childbirth, clinical article, cluster headache, conference abstract, distress syndrome, drug therapy, electronic health record, female, headache, high flow nasal cannula therapy, human, interview, labor, labor pain, nociception, obstetric delivery, pain, pregnancy, protocol, recall bias, recurrent disease, subcutaneous tissue, suicidal ideation, suicide

Abstract

Background: CH, often termed the "suicide headache," is one of the most severe pain experiences known to humans, frequently leading to significant distress and suicidal ideation. Previous research comparing CH pain with other severe pain experiences, such as labor pain, suggests that CH is the most intense. However, the collected data is retrospective, subject to recall bias, and lacks direct, in-the-moment comparisons. Methods: We present the experiences of two patients who faced the unfortunate timing of cluster attacks during active labor (Patient 1) and in the immediate postpartum phase (Patient 2). Clinical details were obtained through direct patient interviews and corroborated by electronic health records. Results: Patient 1, a 30-year-old female with a history of episodic CH, developed a cluster cycle at 40 weeks' gestation, continuing into the days leading up to labor. She experienced an attack during the latent phase of labor, requiring hospital-supplied 100 percent high-flow oxygen therapy and her home subcutaneous sumatriptan. The patient developed a second attack after her first push during the active phase of labor, prompting her to reach for her home sumatriptan again, this time in the presence of the labor and delivery nurses. They expressed shock and uncertainty due to hospital protocol regarding the use of home medication, concern for potential adverse effects, and not fully grasping the seriousness of her head pain and overall state of desperation. She described the overwhelming experience of having to endure both of the worst pains of her life simultaneously and endorsed that the CH pain was much worse than the labor pain. Patient 2, a 28-year-old female, experienced a CH recurrence five days postpartum after delivering a healthy boy at 37 weeks' gestation. She mentioned during our clinic visit that she purposefully chose to undergo labor without an epidural to test whether the pain of CH is indeed worse than labor pain. She came to the conclusion that CH pain is the worst she has ever had and that she would rather give birth 16 times in one day instead. Conclusion: Our first patient provides a unique firsthand, direct, and unprecedented comparison of the "worst human experience" with the pain of active childbirth. This is the first such report, per our review, offering valuable insights into the subjective nature of pain perception and intensity. Our second patient demonstrated remarkable resilience and scientific curiosity, opting to experience childbirth without pain relief to gain deeper insight into her condition. Both patients openly revealed that CH pain is far worse than labor pain.

Volume

65

First Page

11

Last Page

12

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