The intense pain of a cluster headache attack is sometimes described as being worse than passing a kidney stone—or even childbirth.
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Often confused with migraine, a type of headache disorder that can also cause serious discomfort, cluster headache is a relatively rare condition that occurs in about 1 in 1,000 to 1 in 5,000 people, explains Emmanuelle Schindler, MD, PhD, a Yale Medicine neurologist.
“This disorder is characterized by a particularly severe kind of headache, which can happen multiple times a day,” she says. “In some patients, the attacks occur year-round—called chronic cluster headache; in others, the attacks occur for a period of weeks to months—called episodic cluster headache.”
The disorder gets its name because the headache attacks occur in clusters of time, usually at the same time(s) of day. For those with episodic cluster headache, the periods of attacks also occur at the same time each year.
Unfortunately, many people aren’t properly diagnosed with cluster headache, and even when they are, the treatment options are limited and don’t work for everyone, Dr. Schindler adds, which is why she is motivated to continue her research for better therapies.
Below, we talk more with Dr. Schindler about cluster headache and how it differs from other, more common headache disorders.
A cluster headache attack starts suddenly and creates severe pain on one side of the head, around the eye, lasting between 15 minutes and three hours. It may also include other symptoms such as tearing, reddening of the eye, a drooping eyelid, and a stuffy nose. It can occur daily or almost daily for weeks, months, or years at a time. “Patients describe cluster headache attacks as a searing, ripping pain behind and around their eye,” says Dr. Schindler.
The headache attacks can occur as often as eight times a day, but in most cases, people have attacks about twice a day and frequently at night, with a headache that wakes them up from sleep.
Cluster headache is more common in men than in women, tends to run in families, and can happen at any age (though it most often arises in people in their 20s through middle age).
The cause of cluster headache is unknown, but the hypothalamus, a small area deep in the brain that modulates several neurobiological systems, has been shown to be activated during cluster attacks.
Migraine is one of the most widely recognized headache disorders. It is found in about 15% of the population and, like cluster headache, runs in families, Dr. Schindler explains. “In contrast to cluster attacks, migraine attacks last several hours and are often accompanied by light and sound sensitivity, nausea, and sometimes vomiting,” she says. “There are numerous treatments for migraine, though not all are effective.”
While migraine might be the most widely known headache disorder, tension-type headache is the most common, and is estimated to affect up to 80% of people at some point in their life, Dr. Schindler adds. “I think we all know what this feels like—a squeezing pain around your head that happens at the end of a long day,” she says. “These headaches usually aren’t a problem unless they become chronic.”
Headache disorders are managed primarily in two ways—acute treatments targeting the individual headache attack and preventive treatments that reduce the overall frequency and severity of the attacks.
For the acute treatment of cluster headache, the gold standard is high-flow oxygen. This involves breathing oxygen in through a non-rebreather mask (a medical device to assist in oxygen delivery) at 10 to 15 liters per minute.
“High-flow oxygen can be effective in about 75% of patients with cluster headache and can be used at home, though there are several barriers to accessing this important treatment,” says Dr. Schindler. “Sometimes, clinicians aren’t aware of the treatment or don’t know how to order it, and then patients are not instructed on where to obtain the oxygen or how to properly use it.”
Insurance coverage for home oxygen is not uniform, and some patients are unable to have the treatment covered, even after providing scientific literature and letters from their doctors to the company, she adds.
Other options for acute treatment include triptan medications—sumatriptan (brand name Imitrex®) and zolmitriptan (brand name Zomig®), which are also used to treat migraine. “For cluster headache, triptans must be administered via nasal spray or injection just under the skin to get into the body very quickly,” says Dr. Schindler. “Oral pills take too long to get into the bloodstream—about as long as the cluster attack will last on its own.”
Anti-inflammatory medications, such as ibuprofen, are not effective in treating cluster headache, particularly when administered orally, she adds. “Narcotics should also not be prescribed for cluster headache or any other headache disorder as they are not effective and serve to generate more attacks,” she says. “Unfortunately, cluster headache patients are sometimes still prescribed narcotics, and they can become addicted to them.”
Preventive treatments for cluster headache include verapamil (brand name Verelan®), a medication also used to lower blood pressure, and galcanezumab (brand name Emgality®). Other treatments that can shorten a cluster cycle or induce a period of remission in chronic cluster headache include steroids, such as prednisone, and injections of dihydroergotamine (DHE), a medication also used to treat migraine.
Dr. Schindler and colleagues at Yale and the Veterans Affairs (VA) Connecticut Healthcare System in West Haven, CT, are currently studying how psilocybin (a psychedelic found in “magic mushrooms”) can be used to treat cluster headache, migraine, and post-traumatic headache (which can occur after a head injury).
“These studies are very preliminary and aim to determine what effect psilocybin has on cluster headache and if it is safe,” she says. “With migraine, after a single, relatively low dose of psilocybin, patients reported a reduction in the number of migraine attacks by about one-half. We only measured over a two-week period, but that reduction was sustained over those two weeks. So far, there’s no other medication you can take by mouth one time that will give you that much reduction in headache burden.”
With cluster headache, treatment with three doses of psilocybin reduced cluster attack frequency by about 30% over a number of weeks in the trial, she adds. "Another group in Denmark showed a similar effect in their study, which has not yet been peer-reviewed. Other groups in Europe are currently studying the effects of lysergic acid diethylamide [LSD] on cluster headache," she says.
While the use of psychedelics, such as psilocybin for depression, and other compounds, such as methylenedioxyamphetamine (MDMA) for post-traumatic stress disorder, have been widely discussed recently, no psychedelic drugs have been approved for medical use by the U.S. Food and Drug Administration.
What's more, Dr. Schindler cautions that these are powerful substances. “They have to be used responsibly and for the right reason,” she says. “And some people should not take them. So, while there is a lot of excitement around them as a potential treatment, we want to ensure they are safe and effective, which is why we are conducting clinical trials.”
In the meantime, if any headache disorder affects your ability to function on a daily or near-daily basis, or if the headache pain is very severe, you should consider making an appointment with a neurologist or headache specialist, Dr. Schindler advises.
It’s a strange new world if you’ve never gone about buying a dirndl online. I bought my first ever dirndl in person at a store in Munich, Germany and even then I just stood there at the window with trigonometry formulas flying around my head.
If you’ve never bought a dirndl before, figuring out what to wear for Oktoberfest can be overwhelming. You want a great-looking piece, that fits properly, that costs less than open heart surgery, and that doesn’t fall apart after your first Fliegerlied.
So, I’m here to help. I’ve purchased tons of dirndls, both online and in person. I’ve bought them online from retailers in the U.S. and retailers in Europe. One time I walked out of a German H&M with four of them. I may have a problem. (With closet space that is, nothing else.)
Also read my post on Where to Buy Dirndls for Oktoberfest for more on this plus a list of great online shops.
If the last thing you want to do on your trip to Germany is spend hours bouncing between dirndl shops trying on clothes, by all means, buy your dirndl online ahead of time. Just because you’re in Germany doesn’t mean you’ll find one you love or that fits the way it should. And it could take a loooong time to figure that out.
Don’t waste precious sightseeing (ahem, beer drinking) time trying on tracht. Buy your dirndl online before your trip and it’ll be one less thing to worry about while you’re there. (And more time to spend doing all these awesome things in Munich!) Besides, you’ll need all that extra anxiety for when it comes time to drive on the Autobahn.
I know this sounds counterintuitive, but hear me out. If you’re someone who doesn’t fit perfectly into every garment you try on, this may be your best option.
For instance, I’m short and small so I almost always have to get my clothes taken up at the bottom and taken in at the top. Everything I buy is about a foot too long, a foot too wide and, you know, “pre-teen playing dress-up in her mama’s muumuus” is not the Oktoberfest look I’m going for. Let’s just say I’m more popular at my local tailor than the word ‘bespoke.’
Also check out my post on all my top Oktoberfest tips. It’s got everything: outfit tips, money, accommodations, beer tent info, and just about everything else you could want to know about attending Oktoberfest.
Purchasing an authentic dirndl in Germany can be expensive. That’s not to say you can’t find a delightfully decent dirndl in Germany for a great price, it’s just that it’s going to take a little more work and a bit of luck. Regardless, purchasing a dirndl from an online retailer (and doing so in the off-season) is your best bet at saving some cash.
Buying a dirndl online, you’ll be able to really dig into some comparison shopping as well as take advantage of any promo or coupon codes. And if you buy from retailers like Amazon (et al), you potentially have the added benefit of free shipping and free returns.
And for when you do just want to get a simple, inexpensive dirndl online, check out my post on how to upgrade a cheap dirndl with these DIY Oktoberfest outfit hacks!
If you buy your dirndl at a brick and mortar shop in Germany, you’re limited to whatever small selection they have. You can only choose from their available sizes, designs, colors, and prices. (And they don’t stock a ton of anything.) You may be stuck with a color you don’t like because it’s the only one in your size. Or an uncomfortable fit because it’s the only style you could stand. And other first world problems.
But buying a dirndl online means you have an entire internet’s worth of selection to choose from. There’s a very small chance you won’t fit a dirndl you absolutely adore when shopping for one online.
Be sure to also check out my entire Oktoberfest outfit guide and my post on Oktoberfest shoes and socks to make sure you wear all the right stuff!
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Now that you know why you should consider buying a dirndl online, you should also know how to. And I’m sure this isn’t your first online shopping rodeo, but it may be your first Bavarian one. (Pro tip: dirndl shopping is better with beer.) Here are 9 solid tips and crucial things to know before buying a dirndl online.
When you’re buying an Oktoberfest outfit online, make sure you’re buying all three pieces. Most of the time you’ll see dirndls sold as “2-piece sets.” This means you’re buying the dirndl and the apron together, and the blouse is almost always “sold separately.”
But yeah, I said almost always. Sometimes it does come with the outfit but this is rare. And this is usually only with cheaper, more costume-y kind of dirndls that come in plastic bags. And not even the good plastic bags. We’re talking the crunchy kind.
Blouses are, you know what I’m just gonna say it, always sold alongside the rest of the dirndl. I’ve never purchased a dirndl anywhere that didn’t also sell blouses to go with them. That would be like selling salsa but no chips. Conditioner but no shampoo; lamps but no shades! Complete anarchy!
Heading to Oktoberfest but don’t drink beer? My guide to Oktoberfest for non-beer drinkers has everything you need to know!
Chances are “midi” is what you want. Obviously you prefer what you prefer, but for Oktoberfestivities and the like, your dirndl dress should fall somewhere between your knee and your ankles.
“Midi” dirndl lengths are the most popular, the most comfortable, and look great on every body of every size, shape, and age. On some of the more authentic dirndl sites you’ll have your choice of length. And on sites that don’t specify the length with a name, midi (or 70cm) is most likely what the dress will be.
“Maxi/long” is primarily seen on “older” women and usually come in more traditional styles. This is not typically what you see at Oktoberfest or any kind of Oktoberfest-style party. Plus, the last thing you need is a dirndl that drags on the beer- and glass-covered floor. We know a thing or two because we’ve seen a thing or two! We Are Drinkers! Ba-ba-bum-bum-bum-bum-bum!
“Mini” dirndls are short. And I gotta say, you’re really taking your life cheeks in your hands with a mini. No one wants to sit bare bum on a beer tent bench. In some photos, mini dirndls look perfectly normal, falling at the knee. In others, the wearer looks like an overgrown child beauty pageant contestant. Toddlers & Tiaras, The College Years: Still Toddlin’
I’ve linked to these to show you what not to buy. Ever. These not-even-dirndls look cheap, smell cheap, and make you feel cheap. Don’t spend less on a dirndl than you did on, say, breakfast.
These Oktoberfest costumes are inauthentic, offensive, downright tacky, and chances are you won’t get more than one use out of them. If that. I’ve seen some midday-at-Oktoberfest stuff.
When shopping for dirndls online, you can still find some on the inexpensive side that don’t look trashy, mocking, or like something out of Carrie Bradshaw’s season 2 closet.
For more on what never to do at Oktoberfest, check out that link. You’d be surprised what kind of rookie mistakes people make all the time!
You’ve bought clothing online before (right?), you know to check the size chart. But buying a dirndl online demands a wee bit more attention.
For starters, determine whether the size chart uses inches or centimeters. It’ll show the dimensions in inches if it’s a U.S. online retailer and centimeters if it’s based in Europe or just about anywhere else in the world. Bravo America.
Next, does the size chart use your personal measurements, or the measurements of the garment? If it’s in human measurements it’ll say things like: chest, waist, hips. And if it uses garment dimensions it’ll say: shoulder to shoulder, length, neck to hem, skirt length, etc.
If it bases its sizes on human measurements, bust out the tape measure. Wear it around your neck when you’re not using it to make it look like you know what you’re doing—a little trick I picked up at the tailor. Then, uhhh, measure where it says to. Pretty simple actually.
When it shows the dimensions of the dirndl, go into your closet and get out your favorite dress. Or at least, the one you feel fits you the best. Measure that dress against the measurements on the size chart and pick the size you think matches the closest.
And lastly, at some point in this process, make note whether the sizes listed are in U.S. sizes, Germany sizes, UK sizes, etc. According to the chart below, if you wear a size 6 in the U.S., your ideal dirndl will be a 34 in Germany, and an 8 in the UK. In Italy that’s a 42.
Look, there’s only so much a seamstress can do if you accidentally buy a 42 in US sizes. If the country isn’t listed with the sizes for some strange reason on the site you’re purchasing from, use this clothing size conversion chart.
If you plan to buy your dirndl on Amazon or similar, look for options that offer free shipping and free returns. This way, if you’re between sizes you can get one of each to see which fits best, fee-free.
For some of us, we need a little (ok a lot whatever shut up who asked you) extra boost. Personally, with my dirndls I wear the Victoria’s Secret Bombshell which adds two whole cup sizes (and boy does it ever!).
If this is the case with you too, don’t forget to wear the bra you’ll wear with your dirndl when you take your measurements and choose sizes. Overstuffed sausage is not the new black, honey. Not even in Germany.
These review clues will help you decide which size to ultimately commit to. Reviews are also great for learning if an item’s colors are as pictured, what the material feels like, overall comfort, and more. You can even filter reviews for keywords like: quality, fabric, length, or anything else you’re looking for information on.
On Amazon, user reviews often include actual photos from verified buyers and this is my favorite feature. This way, you can see what the dirndl looks like in real life, on a variety of actual human bodies. You can also take a look at an item’s product questions and answers from buyers (and ask your own if you have them).
Pro tip: And if an item you find or a shop that sells it doesn’t have any reviews at all, I’d stay away.
As always when shopping online, be extra careful from whom you purchase. Just because a website is willing to take your credit card number doesn’t mean you’ll necessarily get anything in return. I’m just saying, I think we all learned a thing or two when that Nigerian prince came a-knocking.
Read all about the most prevalent Oktoberfest scams here. (Yes, even dirndl and lederhosen scams!)
When looking to buy a dirndl online, start with sites you already trust personally and word-of-mouth recommendations. Amazon is a site you already use and trust to store your credit card number, why not start there? If it’s good enough for your dog treats and your shampoo, it’s good enough for your dirndls too. (However, always check reviews for things like “this item never showed up,” etc.)
As for word-of-mouth, if someone you know has purchased a dirndl before and was happy with his/her purchase, that’s another great place to start. (Yes, I’m going to list some of my favorite places to buy dirndls online in just a minute.)
After that, just always be careful who you give your credit card information to. Most sites are legit, some are complete and utter scams. Take special care when navigating a website based in a foreign country—a great time to lean on previous reviewers’ experiences.
And, as always, if something feels too good to be true, it almost certainly is. If you find a dirndl online that’s mysteriously and significantly less expensive on one site over another, take the advice of 90s German Eurodance pop group Real McCoy and Run Away.
Don’t wait until the last minute to buy your dirndl online unless you’re 100% fine wearing whatever you receive. Even if they confuse Oktoberfest with Sausage Fest and you have to attend the party as a giant bratwurst named Frank. At least it’s on-theme.
There are more places to buy dirndls online than there are cities in Germany to wear them. Probably. I have experience with just about a handful of those. Here are the online dirndl retailers I can recommend to you and some dirndl suggestions to get you started:
Amazon is the obvious first choice because Amazon rules all. Beep boop beep… powerless to resist… You can pick up a decently-priced dirndl along with the rest of your Oktoberfest party supplies, a Mother’s Day gift, aaaaand some LED light bulbs. On Amazon you can buy a dirndl that looks traditional but doesn’t cost a ton.
This is the best place to get a bunch of reviews and buyer insights, they’ve already got your credit card number so you don’t have to get off the couch and get your purse, and there’s a good chance you’re all about that ASAP shipping. They offer free returns on most purchases and you already know how the whole operation works.
Rare Dirndl is a fantastic company run by an amazing woman here in the United States. It’s actually the only place I know where you can buy high-quality dirndls in the U.S. Correct me if I’m wrong?
At Rare Dirndl you get beautiful, one-of-a-kind designs, excellent craftsmanship (craftswomanship?), personalized service, free shipping, and 10% off with my promo code (MYWANDERLUSTYLIFE). I have a few Rare Dirndls in my collection including my custom piece that I just love.
These suggestions should at least give you a great place to start your online dirndl shopping! Be sure to check out my full guide to what to wear to Oktoberfest next. As always, feel free to reach out on Instagram or leave a comment below if you have any dirndl questions. Prost!
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