Transcript: Hot Sauce in the Nose for Cluster Headaches?
If you cut a hot pepper and rub it inside your nostrils, your nose will start running, hurting, and sneezing. (Capsaicin is the burning component of hot peppers). Why would you do this experiment? Anyone who's handled the compound in the lab knows if it gets up your nose it causes an intense burning sensation; however, this phenomenon has not been formally investigated. Therefore it appeared worthwhile to study the effects produced by the topical application of capsaicin in the human nose. It therefore appeared worthwhile because… it had never been done before? OK…
So they took some medical students, dripped some in their nose and they started sneezing burning and snotting. Describing the pain as like 8 or 9 on a scale of 1 to 10. No surprise, but here's the interesting part. What do you think happened when they repeated the experiment the next day? You'd think they might be sensitized to it, still all irritated and so it might hurt even worse, but no, it hurt less. Then they did it again the next day and the next. By day 5 it hardly hurt at all, they didn't even get a runny nose, no sneezing. Came back the next week, day ten and still nothing.
Sheesh, were they permanently numbed? No, after a month or so the desensitization wore off and they were back in agony whenever they tried rubbing it in their nose. What the researchers think is happening is that the pain fibers, the nerves that carry pain sensation, dumped so much of the pain neurotransmitter called substance P that they ran out. Day after day of this the nerves had exhausted their stores and could no longer transmit pain messages until they made more from scratch, which took a couple weeks. This gave researchers an idea.
There's a rare headache syndrome called cluster headache. It has been described as one of the worst pains humans experience. Few, if any, medical disorders are more painful. It's nicknamed the “suicide headache” because patients often consider taking or have taken their lives over it.
It's thought to be caused by arterial dilation putting pressure on the trigeminal nerve in the face Treatments involve everything from nerve blocks to Botox to surgery. But hey, that same nerve goes down to the nose. What if we cause the whole nerve to dump all its substance P? “Preventative effect of repeated nasal applications of capsaicin in cluster headache.”
Same as before, daily capsaicin in the nose and by day 5 they could hardly feel it any more. Note though that these were cluster headache sufferers and so what was rated as an 8 or 9 on the pain scale by the wimpy medical students was like, maybe a 3 or 4 by those used to the violence of the cluster headache attacks. Having achieved desensitization, what happened to their headaches?
Well, cluster headaches are one-sided headaches: you only get pain on one side of your head. So those who had rubbed capsaicin in the opposite nostril, on the wrong side of the head, nothing happened. They started out having like 40 attacks a day and a month later the headaches were still going strong, but those that rubbed the capsaicin in the nostril on the side of the head where the headaches were cut the average number of attacks in half, and in fact half the patients were cured, the cluster headaches were gone completely. All in all 80% responded, at least equal to, if not better than, all the current therapies out there.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.
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