By Mark W. Green M.D., Leah M. Green M.D. (auth.)

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Let’s define stress. Individuals experience stress in different ways, according to their psychological makeup. What is stressful for one may not be stressful for another. Stress occurs when a person confronts a demand that he feels he cannot 27 28 MAYBE IT’S ALL DUE TO STRESS meet. The result is internal conflict, and stress continues until that conflict is resolved. The nature of those demands may vary widely among individuals. Situations that require a great deal of flexibility may exceed an individual’s capacity to respond.

If temporal arteritis is suspected, a biopsy of the artery in the temple is indicated. A 22-year-old obese woman complained of headaches throughout her head over the past 6 weeks. Her periods had become irregular. She heard pounding noises in her head. The pain was worse in the morning when she arose and tended to get better as the day progressed, although there was some degree of pain throughout the day. Whenever she would cough, sneeze, or bear down to have a bowel movement, the pain worsened.

A half glass of wine or a few sips of beer are likely to induce an agonizing attack during a cluster period. Even the minute amount of alcohol found in “nonalcoholic” beers can be enough. Sleep can trigger a migraine, but with cluster this is very common. You may be awakened from sleep, often at the same time every night. This feature led to an old term for cluster headaches, alarm clock headaches. Even though alcohol triggers cluster headaches, it is astounding that over 50% of people with cluster headaches abuse alcohol, which is much more than the general population.

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