Hello everybody,
my Name ist Rafael. I'm from germany and a clusterheadache sufferer for nearly 20 years now.
9 years ago I was completely lost. I had the feeling nobody really takes me seriously and nobody really can help. I wanted to yell it in everyones face and decided to write a book. Because a book is the classic way an individual can reach many.
So I did.
Five years later, in 2013, a small publishing house took the risk and released "Schmerz frisst Seele" (Pain eats soul) in Germany.
The years went by and some people told me that my book had helped them. Something that I did not think it is possible years ago and therefore never expected.
If sharing me experiences and thoughts could help others, I should share it to more people.
So I did, and had the book and several blog posts that were written additionaly after the german release translated to english. This was released on a big online bookstore one year ago.
For it's first anniversary I decided to post it here. Chapter by chapter.
The next will come tomorrow and I try to post one chapter each week.

Introduction

According to one fairly prevalent myth, the Eskimos have a hundred different words for snow. This is actually a tall tale that originated in 1911 with the German linguist, ethnologist, and anthropologist Franz Boas, and it formed from a lack of understanding of the polysynthetic language spoken by Northern peoples. Only in 1986 did anthropologist Laura Martin write an article titled "Eskimo Words for Snow" in American Anthropologist, in which she clarified this myth. Franz Boas had probably only wished to express that the Eskimos had adjusted their language to suit their environment. Someone surrounded by snow will have a more nuanced way of describing it.
Just like the inhabitants of the North Pole know snow, I know different types of headache. Each one has to be addressed differently. The traditional terms for affective (e.g. nagging, agonizing, paralyzing, terrible, severe) and sensory (e.g. pulsating, throbbing, stabbing, dull, pressing, burning) descriptions of pain are not nearly sufficient to comprehensively describe the overall artwork that is cluster headache.
Pain is that which one perceives as such. Suffering from pain can make it incredibly difficult for one to communicate with their environment. Pain is a highly subjective perception. It is difficult to comprehensibly and clearly explain it to other people.
This book documents and describes the effects of a chronic illness, cluster headache, on my life, thoughts, and worldview. I am afflicted, making me a patient and not a doctor. I cannot and do not want to make any diagnoses. Rather, I want to try to put the pain I have endured - and its consequences - down on paper. It's also sort of like I'm explaining to a Majorcan the difference between snow, firn, crusted snow, and corn snow.

When I decided to write down the story of my illness, I was far more bitter than I am now. I've since become mortified by my original ideas for a title, namely: "No Escape - I'd Sell My Soul to Get Rid of the Pain", "The Pain Stays with You", "You Have the Pain", "You Can't Share Suffering", "Nobody Can Help You - You Have to Live with the Ache", and even "Cluster Headache - When You Torture Yourself". I tried to scream the ache away, because nowhere did I feel like I was sufficiently understood. Thankfully I have since opened up my ears, and ultimately learned how to listen to myself.

A great intro,  Rafael,  and I look forward to chapter 1. 

Many ClusterHeads have written poetry and songs about our nightmare and it's my big regret since falling victim to ch.com that I never collected these works as they came along.

I'll be more careful with your contribution to our collective mind.

Quote:


+1

Sehr gut!

Instead of a Foreword

You’ll Never Walk Alone      
by Dr. Astrid Gendolla

I have been a practicing physician in Essen, Germany for twenty years now, and in this time I have worked with so many headache patients that I lost count. I most frequently encounter people with migraines who no longer know where to go about their terrible pain. The most insidious, however, is cluster headache. It manifests in attacks, and comes virtually out of nowhere. Attacks entail extremely severe pain that can last for a long time, and then vanish just as suddenly. The dreadful thing about this disease is the absolute powerlessness against its randomness. Attacks can return at any time, without warning, without abstention. People who live with this disease are simultaneously living in constant fear.
Rafael Häusler has faced this fear. He meticulously describes the stages of the disease, reflects on his life with cluster headache, and tries to find answers. But there is one thing that I would like to firmly disagree with Rafael Häusler on. The title of the book does not apply, at least to the author himself. The pain has not eaten his soul, and as his attending physician I can confirm this. Perhaps it has tried to, perhaps it has gnawed at his soul from time to time. But Rafael Häusler defied it. I am certain that his journey must have been difficult, the road bumpy, but ultimately so successful that he is able to write about all of his experiences. A beneficial process? It is not my place to say. In any case writing is a known way to look at the entirety of a given subject. Rafael Häusler's notes, turned into a book, also have another effect: they help other people better understand the disease and those who suffer from it, and they show other patients one very important message: "You'll Never Walk Alone". There are people who understand you, who feel what you feel, who are with you. That alone makes this book invaluable.
I am happy and grateful that my profession allows me to join Rafael Häusler on this journey, and to speak with him on a regular basis. I can truly recommend this book to you from the bottom of my heart.

Great work,  Rafael.  In getting this story out among the general public you'll be helping countless ClusterHeads in so many ways.

Rafael wrote on Sep 19^th, 2018 at 2:24am:

Truly spoken,  Rafael. 

I fell into that vicious spiral once,  which was more a cataclysmic vortex at the time,  until I realised I was the only one who could pull myself back out.

Had all the help in the world from my supporters and ch.com,  which was indispensible,  but it was all still down to me.

I remain ever thankful they were there to back me up.

Important Note

The trade names of medicines are not the same throughout the world.
For example: Imigran is called Imitrex in several other countries.

I used the trade names from Germany. Cause the eBook is available worldwide, there is no chance to translate this in way which is valid everywhere. Therefore, I remain with the original names.


After the Diagnosis

It is abundantly clear to anyone who can no longer walk because of an accident or an illness that they rely on assistance in the form of a wheelchair. Someone who becomes blind will not have any illusions that they will be able to lead the same life they had up until that point. After the firm diagnosis of "cluster headache", however, it took a while for me to accept that it was now, and would remain, a part of my life.
But knowing that I suffer from cluster headache did not mean that I had found the off-switch. It also did not mean that I would perform Step A, take Medication B, and then be able to lead a pain-free life overnight.
For me cluster headache had been a loyal companion for years, a part of my life. But now it had a name, a face. That does not make it disappear, but rather more tangible. I was given prescriptions for every recommended standard medication, and was allowed to experiment to figure out what worked best for me.
Over the years I tried different means and methods for prophylaxis and acute treatment. Not everything worked, but thankfully some did. Cortisone pulse therapies had no effect on me. In terms of prophylaxis, Topamax only had dramatic side-effects, and Imigran Nasal left an absolutely ghastly taste in my throat. All of the triptans administered in tablet form were fruitless.
It became apparent over time that the first-choice medications from the guidelines of the German Neurological Society (GNS) for treating cluster headache and trigeminal autonomic cephalalgias were actually the best choice for me as well. This entailed high to very high doses of Verapamil for prophylaxis. At least 720 mg per day proved effective in my case. However, after 480 mg the side-effects of Verapamil were so strong that I had to overcome a lot just to take a higher dosage. However, the pain relief that came as a result was absolutely worth it.
I successfully took oxygen, which has to be inhaled with a high power density, to acutely curtail the attacks. 12 to 15 litres per minute are absolutely necessary, but the inhalation of oxygen only alleviates and shortens the attacks. A cluster headache attack can actually be eliminated with a subcutaneous injection of Imigran. The shot takes effect within five minutes and actually gets rid of the pain. The day I first took a shot of Imigran will be a special anniversary for the rest of my days.

It was the evening of 16 December 2004, when the very first season of the television show TV Total's high diving competition event Turmspringen was airing. It felt like an inner fire was tearing through all of my veins to the tips of my extremities. After a few minutes it felt like all of the droning in my head vanished in a single breath. I lifted my head and looked around, confused. The pain was gone. The pain that had caused me to writhe on the floor for so many hours, that left me powerless and which was responsible for so many restless nights. Click - it was turned off! I sat alone on the old furniture in my poorly heated flat and, in that moment, I felt simply unbeatable.
The 0.5 ml injection solution, which contains 6 mg of the agent sumatriptan, can have life-changing effects. To this day it is downright euphoric to take an Imigran injection - especially after a long break - and to feel (in the truest sense of the word) the medication in your veins and to just be able to get rid of the pain so easily.
Yet for as clear as it seems, it has many side-effects. I learned this as I started regularly taking too much of it. In my case, "too much" was about ten injections per week. So not during every attack. As a result I wound up in such a state that I felt like I was in the middle of a giant cotton ball. I didn't care about anything, and I did not pay anything any mind. A friend asked what was wrong, and said I looked really dazed. I am still unable to find a better way to describe the way I felt at the time.
Of course I learned that, at the time, I was no longer able to responsibly operate a motor vehicle. I could no longer (or rather, should no longer) drive a car. Everything simply happens too fast out on the road. Thankfully it only took a few close calls to bring me to this conclusion.
There is another memory that burned itself into my brain: I stored letters on my kitchen table for three months. The post piled up. I was horrified, and it proved to me that I still had a lot to learn in order to better live with my disease.

Zomig Nasal joined the medication duo of oxygen and Imigran Inject in 2010. Zomig Nasal is also a triptan with the more recent agent zolmitriptan. Like the injection form of sumatriptan, zolmitriptan as a nasal spray has been approved to treat cluster headache. While Zomig Nasal also leaves an undesirable taste in the throat, it's not as long-lasting and stubborn as Imigran Nasal's aftertaste. In my experience its effects are not as absolutely certain, and it doesn't always work. But when it does, it promises twelve pain-free hours. This makes it life-changing.
Ultimately, I have found fortune in misfortune! I attest to oxygen, and the two medications approved to treat cluster headache - Imigran and Zomig - work as well.

Religion

Cluster headache is brutal. It strikes its innocent victim without warning. It's human nature to seek an explanation in religion when rationality cannot provide any.
Why does suffer from cluster headache at all? Why do they exhibit these painful attacks? Physicians differentiate between circadian (daily) and circannual (annual) rhythms. It is certainly not the only, and absolutely not the largest, unsolved puzzle in this world, but for those affected it is by far the most interesting.
In such cases many people, at least in Western Europe, are conditioned to turn to divine counsel as a universal explanation for the unexplainable. Indeed it provides tremendous relief when one is able to simply believe in a higher power in this situation.
In his book Angels & Demons, Dan Brown writes the protagonist Robert Langdon as saying, "Faith is a gift that I have yet to receive." And in his book The Happiness Code (Der Glückscode), the author Dieter Broers - whom I believe to be firmly rooted in the abyss of the esoteric - writes, "The Bible knows that faith can move mountains. Without wanting to compete with the Book of all books, I would like to add one thing: thought can create mountains."
Actually, with each attack the sufferer finds themselves facing the why-me question again. At some point I also began thinking in that direction. Always "why me?". Is it some kind of punishment? It was one claimed in jest that if things aren't going right in life, it must be because of exorbitant misconduct in a past life. So I lose karma points because I used to be a rowing drummer on the Rome-Carthage row galley?
To be honest, there has been a moral transgression in my life that I committed before my cluster headache began. To be prosaic, this transgression also wasn't really that bad. Given a hypothetical proportionality, half of humanity would suffer from headaches in this case, and a not-so-insignificant portion of the population would go up in flames.
I'm not very receptive to esoteric and theological ideas as a matter of principle. In times of weakness, when my brain convulsions have been laying on the grill of pain for too long and too often, I've still sought out those ideas regardless. Whenever the pain subsides a little, the same questions always come back to me: "Why me?", "Why is this happening to me?", and "What am I being punished for?"

Today I know that these questions don't bring anyone a step further. Acceptance and tolerance are the key words. Still, it's not pretty and it's not fun. But nobody ever said it was.
Should I ever again lean toward faith in a higher power or anything God-given instead of naked fate, I will save myself by remembering that God is not infallible, and its ground crew especially aren't.
Marianne Thomas made this same point quite wonderfully during a radio special on Émilie du Châtelet on SWR 2. Émilie du Châtelet and Voltaire subjected the Bible to a thorough analysis and drafted a critical commentary. And because she loves logical reasoning, she addresses the story of the creation with distinct irony: "How amusing that the first three days were marked by night and morning before the sun was even created on the fourth."

The Lord

In 2009 I participated in a rehabilitation programme in Bad Wildungen, in the north of the state of Hessen. While conversing during the psychological consultation, the psychologist at the on-site clinic suggested that I give my pain a name and a shape in order to turn it into a person. Then I should reveal everything from this person's perspective - the entire story from the pain's point of view.
I then envisioned a figure similar to the god Thor. I had never intensely researched Germanic or Nordic mythology, so this was a purely intuitive name. The figure of a sovereign lord, the God of Thunder. It was he who does not suffer anybody beside him, whose power outshines everything, who darkens the sun, or who is the sun itself in which one burns and dies out.
He's not some good lord who is well-disposed toward his people. He is merciless, even sadistic. He lets his host bleed until they are down on their knees, limply following every command. So the lord, who, in the grander scheme of things, is really only there for a short period, is still always present. Omnipresent. He becomes God. The sufferer experiences the pain as religion. They do not seek our religion as an explanation for the recurring hurt, but rather that hurt is the religion.
I very often got the impression that I was a sort of game for the pain. Whenever I felt like I couldn't go on anymore, it took a short break. When I didn't want to go on anymore and there was nothing to be done, the pain would leave for a day. As though it just wanted to use me as its plaything. Like how a cat plays with a mouse it has just caught. Of course, the mouse doesn't stand a chance against the cat. But it can actually influence how interesting it is to the cat. The more intensely it struggles, the more fun it becomes for the cat
I've decided not to let the pain defeat me. But I must comply with it. It is always there, and it picks up on everything. The parallels between it and the omniscient Christian God are surprising, and sometimes terrifying. Prayer would be the wrong term to use, but when I hold an internal dialogue, it's with the pain, not with God.
To this day I don't know what it all looks like from the pain's perspective. Even though I have often thought about it, I can't put together a real sketch of its motives. It doesn't need me for anything. I don't feel that I am ultimately the host for its existence. So I have never found a better model than that of pure despotism.
Still, this thought experiment makes very clear how the behaviour that I consider to be the best way to address the disease actually looks. If I am subjected to pressure, I must promptly build up the appropriate counterpressure. If the pressure is so strong that I can't prepare any sufficient response, then it's important to make myself as unassailable as possible. To speak figuratively, it would be best to become liquid, because the strongest fist cannot hold fast to a liquid - it will simply trickle out between the fingers.
One could imagine the pain as a large fist raining down on me from the sky. I throw myself helplessly onto the ground, try to be as shapeless as possible, and simply wait out the worst of storms. Once the wind subsides - because its power has been exhausted for the moment - I lift myself up to defy the weakening tempest. It's quite practical to imagine things this way. At the moment when the pain is worst, the body instinctively curls into the foetal position. Rolled up to offer as little room for attack as possible. In these moments I always draw back on two different mantras. First I think to myself over and over, "Go away!" Once I feel like the pain is on the retreat, I append it with a little, "I am stronger!" It took a very long time to get used to this autosuggestion, but it works.
If we imagine pain as a tremendous arm pushing down on us, it luckily seems that it has to adhere to the laws of physics. The stronger the muscle pushing down on you, the faster it overacidifies and it can no longer be supplied with oxygen. Indeed, it is too strong for you to defend yourself against it. But it will run out of air and need a break, too. It is during that break that you can decide for yourself whether you will stay lying down or if you will stand up again.

Two-Class Society

How often is frequent, how intense is severe, and how much is too much?
Pain cannot be measured. It very likely, almost to the point of certainty, differs from one person to the next. Years in the self-help group have shown me that every sufferer has their own cluster headache that can also morph over time. Along with the many minor differences that also cannot be measured on a scale, there is also one major difference.

Have you ever fainted?
All pain patients - pain because of headache, back pain, rheumatic pain, or cancer pain - are asked to measure the severity of their pain on a scale from 0 to 10, whereby 0 always means no pain, and 10 equals the greatest pain imaginable. Now, there should be a certain unanimity about what no pain feels like. But from my own observations I know that the opposite end of the scale behaves quite differently. How is one supposed to know what the greatest pain imaginable is without having experienced it?

My personal scale is ordered as follows:

0.      No pain
1.      More like discomfort than pain
2.      Slight, but distinct pain
3.      Pain
4.      Pain that does not allow me to concentrate on anything else
5.      Pain that still allows me to be social if absolutely necessary
6.      Things get really unpleasant from here on out
7.      The pain begins to eliminate all other perception. I no longer notice whether it's hot or cold, even if it's way too cold
8.      Loss of fine motor skills, I can no longer tie my shoes
9.      I am not receptive, I do not register the sensation of touch
10.      Frenzy, self-harm, fainting

I did not invent these steps in the scale. I have personally experienced them. Each and every one of them, and many more. Experiencing the last step - fainting from pain - splits cluster headache sufferers into two distinct camps. Whether or not the sufferer has woken up on the cold kitchen tiles in the middle of the night or not changes their perspective. This very experience shaped my attitude greatly.
I used to believe that it "has to leave somehow". Slave away until the cows come home. Grit your teeth. I don't have anything anyway. It only hurts. And then it came one time - my acquaintance with the cold kitchen floor. I had no idea how I had gotten to that point, nor how long I had been lying there. It was still dark outside, and it was cold. My eyes opened again and I found myself over-chilled on the floor. I was happy that my head didn't hurt anymore, that I was alone, and that nobody had seen me like that. And I was afraid because I was alone and nobody was there to help me.
"Personal responsibility" is the key phrase. We should be responsible in the way we treat ourselves. Still, we often don't: "Don't make such a fuss! Things will turn out okay!" In the meantime I do make a fuss and pay attention to my strain threshold, because my body has made it clear to me in no uncertain terms that sometimes things don't turn out okay.
That frightening first moment of helplessness permanently helps one find the brakes, and then to step on them when need be.
"The world goes on," as the saying goes. Yet those who have passed out from pain learned that sometimes the world doesn't go on. It's just the end, curtains, end of story.
The German band Wolfsheim expressed the following in their 2003 single "Kein Zurück" ("No Going Back"):

The world is beautiful and full of colours.
Until one day you realise,
That not every goodbye,
Means there will be another hello.

Even though songwriter Peter Heppner's words are certainly about something else entirely, I find them profoundly fitting.

Quo Vadis?

You are what you are and you have what you have. But what good does that do in a normal life? Taking stock, the following is revealed:
I am sick and will remain so. My supply of medication is secured and my doctors even respond to e-mails in an emergency. I am known personally at my pharmacy and medical store. Nobody puts obstacles in my way. The logistics are there. My friends and family also know the score. Stories are shared at the self-help group, and my yoga class also promotes balance. Both also provide social contacts for free.
It almost sounds like a beautiful life. And it would be in an advertisement. The pharmaceutical companies like to use ads to suggest that after you take their medications, you'll feel even better than if you had never been sick at all.
But stepping back from the rosy world of marketing into the not-so-colourful reality, the first sentence always applies: I am sick and will remain so. And a regulated supply does not equal the elimination of symptoms.

There is no doubt that work and relationships are two central elements to any person's life. How does the disease, and working with it, specifically fit into one's professional life? (Observations as to how disease and relationships intermingle will follow in the next chapter.)
To be up front about it, work and cluster headache do not go together in many ways. It is quite exhausting to reconcile the two in some way. And it's hard for me to not get angry about this topic. It's even harder to find out what, or whom, I should even be angry at.

But I'd like to start from the beginning. My academic career was unremarkable and linear. After kindergarten and primary school I attended the Gymnasium, and graduated with a diploma after the normal period. I performed my community service thereafter. Then, with my university entrance qualifications in my pocket I attended the Ruhr University Bochum to study mechanical engineering. The extremely impersonal studies at this grey, concrete palace was not an environment entirely conducive to my own sense of happiness. I also had to involuntarily leave my parents' home around this time, and I was left to digest a not-so-pretty separation.
I counteracted this first bump in my life by changing colleges and attending the Bochum University of Applied Sciences. In retrospect I was not particularly worried about the future for the following period of time, to put it mildly. I worked odd jobs more than I studied. It got to the point that I was only attending classes once per semester, and that was just to enroll again. I was what is referred to as an eternal student. But because I was getting good work at the time, I wasn't much bothered by it.
I led my life away from a regulated nine-to-five office job. I wasn't really a dropout who sails around the world, but more like a soldier of fortune, though not an unhappy one. German TV-Truckers Franz Meersdonk and Günther Willers had had in impact on me. I got my truck driver's license and became the Jobbing King at a forwarding company. I was doing well, my job was fun, and I got the necessary respect in the form of cars fresh out of the factory. It was a nice time. It could have just gone on like that, and I would have stuck with the job. But when the company moved in the late 1990s, things would go differently from then on. I had to commute a very inconvenient distance.
At this time the EDP industry was booming and was now known as IT. Companies were all employing someone who knew how PCs tick. In the current of this IT boom I was easily able to switch from trucker to IT support. I actually knew enough about computers to be able to hold my own at my first job in the field. I also learned quickly on the job and was even able to improve my professional skills.
Admittedly, I was still an officially registered student. Yet I had not seen in the inside of a lecture hall in a long time, and I had taken just as few exams in all that time. I was now nearly 30 years old and was used to my life as a soldier of fortune. Nothing unusual happened to me. To look at it practically, I had at the very least arranged for my own survival, but not my future. I knew that, too, but I masterfully suppressed it. After all, I didn't have the worst job at a large computer retailer in Dortmund.
While this job went very smoothly, and I had a partner in my personal life whom I really wanted to be with, the disease slowly reached its hand out to me. I woke up ever more frequently in the night with infernal headaches. I tried one common headache medication after another, and in greater quantities, to no avail. Despite an entire series of tests, not one doctor was able to say what was wrong with me.
At least I knew that it wasn't a brain tumour, which I originally had a distinct and great fear of. Because these extremely severe pains always struck at the same location, I was certain that it must be something in my head that doesn't belong there. To this very day I still have the MR scans of my brain that thankfully don't show any such foreign bodies.
Three things then happened shortly thereafter. The pain not only came at night, but also during the day. The gold rush of the IT boom was over, and my company slowly began laying off all workers who didn't have children. This left me out on the street. Plagued by pain and unemployed, I no longer offered my partner any serious prospects and in this part of my life, too, I was soon out on a limb. (I will explain why I accepted this decision so easily in a later chapter.)

With that, my life collapsed into a shambles astonishingly quickly. Just turned 30, no professional prospects, and suffering from an unknown disease, I sat at home alone every night, knowing less and less what to do with my life. I thus found myself in the middle of a classic spiral of depression. My finances were approaching zero. My bank account was empty, my car was broken, and I had absolutely no idea how I would go on. It took a drastic turn of events in the form of a diagnosis of my disease just for me to get any kind of outlook on the future. After I finally knew what the enemy in my head was years later, I could deal with it first and then come up with ideas for a professional existence.
My CV was, of course, a disaster. With no completed higher education and with holes bigger than Swiss cheese, I had no need to form any realistic expectations of regular employment. Working independently was the fallback. So I tried holding my own by programming websites and repairing computers. It's no surprise that starting out is always difficult. In my case, however, continuing was just as hard. Anyone plagued by severe, constant pain for an average of three out of twelve months in the year cannot generate the finances to survive. I often had to cancel appointments, or hurried to the customer's toilet to take a shot of Imigran.
That was better than banging my throbbing head against the wall. In addition, the question wasn't how well that works, but for how long. Addled from the Imigran, I made more than one mistake and at least one time it would almost not have been able to be hidden or amended. I took this as a red flag, because the very real recourse claims following one serious mistake could not be my objective.
However, this episode was a step in the right direction. Thanks to contacts I had made and my disability which was now recognised, it was possible for me to have an education individually funded by the labour committee. Two years after signing the agreement, I passed my final exams and have since been a digital and print media designer: design and technology.
I had tinkered with computers for years, and in that time I learned that educated technicians are not necessarily more competent than I am. So I spoke before the Chamber of Industry and Commerce and was given the chance to take an external exam. Four months later I passed this test as well. Now I can not only call myself a media designer, but also a system integration technician.
It sounds good, and it also felt very good. Now everything could be good, or at the very least better. But, sadly, it wasn't. After my last exams I felt like I had fallen into a hole. Yet the headache journal quite prosaically revealed that the number of headache attacks had continued to rise one month before. If the exams had been just one or two weeks later, the result probably would have looked different. And although time and feeling would have been kicking off again, my head was very stubbornly thwarting my plans, because what followed was one of the most intense episodes up until that time.
Following my small round of exams was an episode at the epicentre of which I could not sleep for one entire night over 18 straight weeks, and experienced up to six attacks per day. At the end I had a new medication schedule and multiple treatments that helped me get back on my feet. I ultimately landed in competent facilities and was able to learn a lot about coping strategies and acceptance of the disease.
Regardless, it would take well over a year for me to turn my inward perspective back outward. That is where I stand now. Despite my handicap brought on by chronic illness, I now have two professions and am no longer without any higher education.
But my life story is by no means a textbook example. It will surely continue to be a source of furrowed brows and shaking heads among the decision-makers at HR departments. This doesn't bode well for my competitive chances. Not to mention that I misjudged myself with my choice of career. The employers of media designers and IT specialists are quite frequently small agencies who are, in practice, at the mercy of the needs, desires, and moods of the customer. In the advertisement the customer provides the required materials at the last minute at the earliest, but still sets the deadline for "yesterday". Of course this results in irregular work hours and peak periods of stress that I am no longer built for.
The modern world is a society of output that I can't keep up with anymore. Because I was a soldier of fortune in my first decade on the workforce, I unfortunately never put down roots that allow me to remain employed despite my disability. So I try finding a new field to work in. However, what that field exactly is has remained unclear both to myself and to anyone else. My disability cannot be fathomed, not by me and especially not by a third party. After all, pain cannot be seen and I have no way of predicting when the next episode that is so intense that I am completely unemployable once more will occur.
I only know that even in symptom-free times, I can no longer compete with healthy candidates. Even though cluster headache isn't a psychosomatic disease, every form of stress and overstimulation has palpable negative consequences. I have to consider whether that suits me or not in the interest of self-responsibility. I should even try not getting angry at the fact that I can no longer do things the way I would like to. That, too, is a form of stress and it leads to spirals with a current pulling in the wrong direction.
Presently, I'm fascinated by people who don't have a career in order to accumulate as much material profit as possible, but rather who pursue a career that fulfils them. Naturally I would be happy to not depend on material things, but career and wealth don't constitute worthy objectives for me anymore. I can't imagine being any happier with 5,000 euros per month than I would be with 1,500 euros. But someone with 1,500 euros is happier than they would be with 500. With income that low, the person is too close to the poverty line, and by definition they are even below it. Great restrictions have to be set, and a broken washing machine becomes an immense problem, and the result is more stress.
Isn't it wonderful that a severe, chronic disease that causes permanent disability makes one into a more frugal person?
Now to get back to the harsh world of work. Nearly every job ad seeks applicants who are as flexible and durable as possible. I have even found the word "stress-resistant" as a requirement before. The society of output cannot be proclaimed any clearer than that. When I read such ads all I can do is let out a quiet sigh. I cannot meet these requirements without hurting myself in the process. But then I keep on reading until I find the attributes I seek: "diligent" or "thorough".
So why not just go back to school for a new trade? Because I'm not a bricklayer with bad knees, or a construction worker with a bad back. I'm severely disabled. I have actually been invited to such interviews after my benefits expired upon 78 weeks of unemployment. And the problem wasn't that nobody wanted to help out. Rather, it's finding something suitable. To exaggerate slightly, I suffer from a social intolerance.
This situation always results in creative to ludicrous ideas: professions often beyond the realm of most normal people, like glass eye designer, stonecutter, or shepherd suddenly seem quite interesting. But there are far too few open positions in these fields, and so the ideas remain ideas.
For a long time there was no clear solution to this dilemma in sight. The only thing that was certain was that trying nothing is also a conscious decision - and the worst. You can never be one hundred per cent sure that something is going to work. But you can be absolutely certain that doing nothing will never work. Either way, a solution can suddenly appear out of thin air. Things can happen that can neither be planned nor predicted.
This is the fortune that befell me when I ultimately found a suitable job. When all is said and done, my only confession is that I am not built for a full-time, 40-hour workweek, and perhaps I never will be. But this applies to all jobs, and I can't hold that against them. Once it was out of style, I was able to learn that there are still professions in which a human being is treated like one instead of walking capital.

Perspectives

"If you were to be silent, you could be helped," is a phrase the deeper meaning of which has long eluded me. Acceptance of a life-changing disease takes time, but it's necessary.

Men do not stumble over mountains,
but over molehills.
Confucius 

More than Pain

It is documented in a medical assessment written about me that I use uncommon terms and descriptions for my symptoms. One astonishingly long assessment in particular must at least have taken longer to write than the time spent with me on site in person. In any case, my uncommon choice of phrasing, according to the assessment, is that I have described my situation as a "complete artwork", and specifically that I must have coined the term "sleep paranoia". It's not enough for an entire work of art, but I did exhibit some symptoms, it continues.
     The assessment states that sleep disorders, concentration disorders, verbal disorders, forgetfulness, and a long-term loss of libido are direct and indirect consequences of the frequent pain. If the pain just lasts long enough, a decrease in physical and mental performance can hardly be prevented. This is all coupled with anxiety and panic attacks. The resulting depression is almost unavoidable.
The following independent symptoms are listed specifically:
•      Sleep disorder G47.0
•      Concentration, reduced F98.8
•      Light cognitive impairment F06.7
•      Other speaking and linguistic disorders R47.8
•      Phobic disorders F40.-
•      Depressive episode F32.-

So there's a lot to treat!
But still not enough. Then there's the alternation between aggression and apathy, auto-aggression with a tendency toward self-harm, lack of motivation and other vegetative disorders, as well as photosensitivity and the aforementioned solar intolerance.
This part of the complete artwork is solely based on the foundation of the constant pain. My constant struggle for a tolerable body mass index is not directly based on it. The pain can't do anything for my tendency for obesity, but it weakens the necessary discipline. There are some medications that don't have a positive impact on this either. Quite logically, this leads to a pain episode also manifesting in weight gain. Actually it's entirely unclear whether my rheumatic pain that has primarily arisen during the cold season for some years now is in any way associated with the cluster headache. Still, they don't help my overall well-being in any case.
That alone would be enough, but the complete artwork includes another component. I grew up under a father who was diagnosed with a narcissistic personality disorder that, year after year, met more criteria for somebody with compulsive hoarding. He is also an alcoholic. I am not saying that he would suffer from these diseases, because others do that already.
Most people will be familiar with the notorious image of a garbage hoarder. For us, it started out with a basement piled up to the ceiling, and then the first garage, followed by the second, ultimately ending with the entire house. Shortly before I turned my back on my parents' house my father began storing our regular household trash in the garage so that he could look through it all again.
Not everyone may know what somebody with narcissistic personality disorder looks like, however. Such people have an overblown sense of importance, and they hope to take on and earn a special position. They exhibit exploitative behaviour and a lack of empathy.
People affected by it also show marked sensitivity to criticism, which they often understand globally. This evokes in them a sense of rage, embarrassment, or discouragement. That's why it's not uncommon for a web of intrigue to be woven among the family in particular in order to cast themselves in the "right light". Their perception of actual circumstances is often severely blurred, and is either beautified for the benefit of the narcissistic personality, parts of reality are deliberately falsified, or omitted altogether. The goal is to restore the respect that the narcissist believes has been toppled. This is often done through great self-pity, and combatted with complaining and begging to arouse other peoples' worry and reinforce the narcissist's own innocence. When I learned about the diagnosis and read its symptoms for the first time, it was clear that every trait is present.
So how must one envision such a person? Like someone without pride, and who pays no consideration to anyone and anything! For example, my progenitor got a dog and took it on a visit to his mother - my grandmother. She asked him not to bring the dog into the house. At the time my grandmother was an old lady well over 70 years old, and she simply wasn't comfortable with it. It certainly wouldn't any inconvenience for the dog, since he was allowed to stay out in the yard. My father simply didn't care about his mother's own wishes, and he brought the dog into her home. That in itself isn't the end of the world, but it's a typical example of how people like that behave. Coupled with a propensity for bravado and the tendency to put things in the "right" light, this results in a lack of understanding of circumstances in one's own environment even after decades.
To give another example: in my childhood bedroom my father installed an adjustable panel under the ceiling that could be lowered, and a race car track and model train set were mounted onto it. It was cool, no doubt. Admittedly, it was also something special that nobody else had. So I still have uncles, aunts, and other relatives who believe that my progenitor actually took care of his children.
In this instance I actually got to benefit, but my father did not construct this extraordinary kid's room to make friends out of my sister and me. Rather, it served as a vehicle for his self-presentation. The entire thing was displayed happily. The methodology was actually effective, too, because there are people who still remember it and the thing they actually draw from it is, "You kids actually had it really good."
Yet those same people either forgot, or did not notice at the time, that the same actor would have a drop too much at every family event and then take the wheel with two kids in the back seat. You could also ask them who ended up giving water to the dog. It wasn't him, of course. It was my grandmother.
This lack of empathy was also present in our father-son relationship, and it was very distinct as early as my childhood. No matter what I did and how much I tried, it was not good enough for my father or he simply wasn't interested, regardless what it was about. I even "failed" when sweeping the garage and he would just do it over again. There was simply nothing that met up to his standards. The fact that he treated other people the same way did not make things any more bearable for me as a kid.
Luckily, the worst aggressors are still just people, and they are neither perfect nor infallible. My progenitor was a competent craftsman, but once things got moving he couldn't find where to start. So in my youth I turned to things that he had no reference to and that he couldn't judge. When I was twelve years old I bought my first computer, a Commodore C64. It let me create a world free from my father's criticism.
Yet the ramifications remain frighteningly deeply rooted to this day. When someone acts like my father around me, I have to take a deep breath to prevent any spontaneous acts of defiance from myself.
These experiences didn't exactly work wonders for my self-confidence. Now, with my sickness, I'm no longer able to meet expectations. At least not for the time being. This is where childhood conditioning meets neurological disorder, amplifying all of their psychosomatic effects.

We have a complete artwork, a damn tall and wobbly Jenga tower that is hard to stabilise. But hard is not the same as impossible. Discovering this connection was shocking, but also a source of motivation. My father is the last person I want to see affecting my life. Even today he still terrorises parts of my family, and has disrupted their cohesion for the long term. The last thing I can allow is for him to worm his way back into my life from afar, even though as a child I never learned how to build up the self-confidence that is now required to endure this disease. Now I have to. Thankfully, adversity and anger are powerful motivators!
My personal foundation of the complete artwork is supplemented by some general effects of chronic illnesses and disabilities. The State Self-Help Association of NRW e.V. and the Network Office for Women and Girls with Disability/Chronic Illness NRW are currently conducting a study on depression and psychosomatic disorders caused by disability/chronic illness, funded by the AOK Rheinland/Hamburg and AOK NordWest health insurance companies. So far the study has shown that, regardless of the type of illness, an entire range of effects manifest in all sorts of patients. When the first results of this long-term study were presented during a presentation at the 8th roundtable discussion of the Association of Statutory Health Insurance Physicians Westfalen-Lippe, I was sitting in the auditorium and felt as though it was my story being presented up there.
One physical symptom which I am obviously not the only person subjected to is known as general fatigue. This in itself entails a long list of physical problems:
•      Loneliness and isolation: If the number of attacks is so high that I will most likely have to expect an attack in public, I keep my public presence to a minimum.
•      Overload: If I lose too much time because of frequent pain, this sensation sets in very quickly.
•      Helplessness and fear: I never know when it will begin and when it will stop again. I can no longer act as though I'm reacting to symptoms.
•      Fear that the disease will return: Even in symptom-free times, the sword of Damocles that is the next attack is constantly hanging over me. I have experienced the sudden recurrence of the disease all too often.
•      Fear of becoming a burden to my partner, and a lack of understanding by my partner: Because I learned how to be unimportant when I was still a child, this applies to me far more than I would like.
•      Lack of sensitivity from doctors: I'm fortunate to have left this behind me.
•      Working with officials or bureaucratic structures: This was often quite difficult because of office employees' ignorance of disability- and disease-specific strains and needs. Since I began owning my own disabled person identification, however, these strength-sapping encounters are much more uncommon now. The other person's level of knowledge doesn't increase, but with an ID it's clearly assumed that the impairments are serious.
•      Work and finances: Money generally improves one's scope of opportunities. A lack of money traps one in the opposite situation. Living with chronic diseases is thus distinguished by lifelong limitations, deprivations, and exhausting encounters.

The World Health Organisation (WHO) defines the conditions for health as follows: "The prerequisites for health are peace, shelter, education, social security, social relations, food, income, the empowerment of women, a stable eco-system, sustainable resource use, social justice, respect for human rights, and equity." But under such conditions it's hard to develop and maintain the vital energy and joie de vivre, energy, and optimism that make it easier to deal with sickness-induced stress. I have come to understand it as a challenge to work out and apply my own management strategies despite this.

Headache

When people are worried about something, they like to say, "This is giving me a headache." And so an everyday colloquialism ends up breaking the neck of the seriously, chronically ill. Tumours aren't thrown around quite so lightly. "Tumour is when you laugh regardless," would be considered dark as night.
There are a number of expressions found in everyday speech that all reveal how external influences affect well-being. For example, an uncomfortable conversation can "make your stomach queasy", and a fright can "make your heart go up to your mouth", or even "curdle your blood". If something makes us mad, this can cause make our "veins pop" and we could "jump out of our skin". Then it that doesn't help, we're "sick of it". We also get "pale from fear", "red with rage", and our hair can "stand on end".
These psychosomatic connections have merged into colloquial speech. And yet the headache has been taken a step further. Headaches have become established as an international excuse for the displeasure at physical proximity. This leads to such cheap jokes as, "Here darling, your Aspirin. - But I don't have a headache. - Great, then we can shag." And the schlager song "I've Got a Headache this Evening" by Ireen Sheer stayed on the charts for weeks, and to this day it remains a standard every time you want to go nine-pin bowling.
Headache is an accepted, momentary ailment, but nothing more. It can even serve as an excuse and apology. It is tolerated as the result of excessive alcohol consumption, but is not considered a serious sickness.
It goes without saying that these are indeed headaches in both cases. Yet this terminology, and its sometimes ridiculous social entanglements, are at fault for the trivialisation - and thus the lack of acceptance - of the headache as a serious illness. Personally, I would much prefer it if the WHO were to use the term erythroprosopalgia in its diagnosis classifications instead of "cluster headache".
When somebody is asked what disease they have, the patient experiences clear differences in the intensity of their concern. Cancer always gives way to great concern, as do Parkinson's or multiple-sclerosis. This is where you spontaneously think, "Thank God I don't have that." And that does not happen with the term "headache". The initial thought here is more along the lines of, "Yeah, I've had that." This small change in perception and reaction by the other party has ultimately had a major impact on people suffering from it.
There is no escape from this vicious cycle, let alone the stupid sickness. All the same, public relations work and the associated clarification have improved the situation somewhat.