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Please respond RE:No Meds Strategy
« on: May 19th, 2005, 10:45am »
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Good morning Friends,
I would like to solicit your opinion on the above subject and would be most appreciative of your responses.  I am rapidly coming to the conclusion that my new friends and fellow sufferers are more knowledgeable than most if not all of the doctors I have seen in my 20 year bout.  Guess you gotta live it to know it.  Here it is:
As I mentioned, just started a cycle after close to 2 PF years.  Am not taking any meds.  Ergostats, prednisone, etc, havent done jack for me in the past.  Im not even sure Verap has.  Sometimes yes sometimes no.  As I said in another thread, have had some success with Verap and Timed released Naproxen, but not every time.  
So far I have been lucky in that I am not getting hits at work, so I can deal with it in the house.  Hits come around bed time, and O2 has knocked it out.  I either get thru the night until around 6 ish (sunrise) and get woken up and breathe or a few nights its the 2 am, 4 am 6 am multi hits, breathe and knock it out.  My question is this:  Do you believe that the breaking of a cycle and HA free period resulting (please G-d for another couple years) will happen when it happens regardless of whether you are on meds during cycle (to control HA), or do you believe that by taking meds it will assist in breaking cycle sooner.  Another issue in question, is, do you believe that the more the vein (by the way, I am a leftie...I get hit on my left side...although several describe as behind the eye, I describe as in my left temple, and can feel that vein constricting and inflammed, etc...), again, the more trauma to the vein (high level Kips) the harder it is to break cycle because the affected area cannot normalize.  If so, take into account in my first question that O2 has knocked out so far before High Kip pain, so even though I am on no meds, I have avoided significant trauma to left side.  Sorry about the length and thanks for reading.  I look forward to your thoughts friends.
 
Jeff
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Re: Please respond RE:No Meds Strategy
« Reply #1 on: May 19th, 2005, 11:19am »
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Jeff,
 
Clusters don't happen because of an inflamed or traumatized vein.
 
It is currently believed that clusters originate from a small bundle of extra nerve tissue on the back of the hypothalamus.  That little bundle of nerves is activated by something (this is the "we're not sure what causes them" thingy).  This activation of the hypothalamus causes a whiole cascaed of things to happen.
 
Substance P is released causing us to be more sensitive to pain.
CGRP is released also causing pain sensitivity.
Serotonin levels change, blood vessels expand, the trigeminal nerve is irritated and since we are now more sensitive to pain, it hurts like a mo-fo.
 
Clusters have nothing to do with any veins being traumatized.
 
We take drugs to constrict the blood vessels so they don't irritate the trigeminal nerve, to stop the release of CGRP and substance P.  We take anti-epileptics like Topomax to stop the little bundle of hypothalamus nerves from activating and causing the cluster cascade.
 
When I was younger my cluster cycles lasted 4-6 weeks.  Now they last 8-16 weeks.  When I was younger the remission times were 8-9 months.  Now they are 3+ years.  I have always taken cafergot for attacks.  ONly recently added verapamil and O2.
 
So, are cycles shorter if you don't take drugs?  Heck if I know!
 
If I have an attack coming on and I have something that will stop it, am I going to take it?  You can bet your sweet patootie I am!
« Last Edit: May 19th, 2005, 11:55am by Bob P » IP Logged

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Re: Please respond RE:No Meds Strategy
« Reply #2 on: May 19th, 2005, 11:35am »
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MY experience was that the condition (CH) advanced more during my 2 years of a 'No Meds Strategy'.  (It wasn't by choice)
 
I still believe in a 'Minimal Meds Strategy', so be careful.
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Re: Please respond RE:No Meds Strategy
« Reply #3 on: May 19th, 2005, 11:53am »
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Natural is the route that I would like to work on.  Starting vit.  I tried Kudzu (not much success for me but others have).  Hate the Imitrex but will take if I have to.  O2 is also a resort I turn to to abort.  This is all I am on for now.
 
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Re: Please respond RE:No Meds Strategy
« Reply #4 on: May 19th, 2005, 11:54am »
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on May 19th, 2005, 11:19am, Bob P wrote:
blood vessels expand, the trigeminal nerve is irritated and since we are now more sensitive to pain, it hurts like a mo-fo.

 
on May 19th, 2005, 11:19am, Bob P wrote:

Clusters have nothing to do with any veins being traumatized.

 
Seems like if you take expanding blood vessels out of the equation.....clusters wouldn't hurt. So, they must have "something" to do with clusters according to you....or not, I guess.
 
Jeff,
I have always been a believer in the notion that pain promotes more pain. Pain will weaken your entire system. Traumatizing both your physical and mental states.  
Do the blood vessels get weakened a bit from all that expanding and contracting like a old balloon? Is it then easier to expand and cause more irritation to the trigeminal, giving higher levels of pain to an already overly sensitive nervous system? Would it help in the long run, even slightly, if you stop some of the expansion/contraction activity? I think it might.
Why do doctors often prescribe medications that help control blood vessel expansion to help with clusters? hmmm.
 
Do some medications prolong cycles? Who knows. This is a weird disease. Cycle and attack lengths often change for no good (understandable) reason. There have been more and more clinical studies coming out that lead us to believe that some of them DO increase the lengths of cycles. This after years of being told they don't.
 
 
Bobw
 
 
 
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Re: Please respond RE:No Meds Strategy
« Reply #5 on: May 19th, 2005, 12:06pm »
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Bobw (Pink Floyd)  
Thanks for the response. I definitely "visualize" and try and make sense of whats happening inside me in the same manner as you and appreciate your response.  Although I appreciate BobP taking time to respond, I dont process that kind of information, in a how to beat this or ease this way.  ALthough its cerebral (pardon the pun) it is contradictory to everything every neuro and pain mgmt specialist has ever taught me.  I am an ABSOLUTE believer that the vein in my left temple constricts and then explodes and that regulation of that helps the HA's.  I can fell the vein in my left temple all blown up, expanded and pulsating before I breathe o2 and after, when I touch my temple it is gone.  I too believe like Pink F. that pain brings pain and that the constant constriction and inflammation is traumatizing and exacerbates and extends a cycle.  
I'm sure that attempting to visually diagnose and understand what is happening neurologically, physiologically and from a circulatory perspective is impossible, so the cerebral, although perhaps accurate is non-processable to me.  Admission sucks....
 
"Oh by the way, which one's Bobw?"
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Re: Please respond RE:No Meds Strategy
« Reply #6 on: May 19th, 2005, 12:35pm »
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Quote:
the trigeminal nerve is irritated and since we are now more sensitive to pain, it hurts like a mo-fo.

Does this nerve also extend down the side of the neck?
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Re: Please respond RE:No Meds Strategy
« Reply #7 on: May 19th, 2005, 12:37pm »
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For me steve, it extends from my temple, back behind my ear, down the down my neck on that path and in to my shoulder blade.
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Re: Please respond RE:No Meds Strategy
« Reply #8 on: May 19th, 2005, 12:48pm »
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I lean toward the no-meds strategy and, to date, have not used any prescriptive med -- not even o2. But, for the first time, this February/March I gave the Kudzu a try. Having actually felt something make a difference for me I am inclined to now agree with BobP, inasmuch as relief sure beats the hell out of "gutting" it out.
 
So, my plan is this summer to get my o2 in place, have my Kudzu vial ready and wait for the beast to come a knockin' in the Fall. After years of waiting for the dark days of beastie battles the kudzu experience at least gave me the feeling that you don't have to fight it with your hands tied behind your back.  
 
My 2 cents for what its worth....
 
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Re: Please respond RE:No Meds Strategy
« Reply #9 on: May 19th, 2005, 1:06pm »
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Boomer,
Thanks for the reply.  My friend....PLEAAAASSSSEEEE go get an O2 tank.  Im not sure if what you get is what I got, but "gutting it out" is a total impossibility for what I get.  I can only describe the pain as the sickest most intensely penetrating, wanna jump off a tall building kinda pain.  Were it not for O2 which almost always gives full relief, I dont know where I would be.  I have never tried Kudzu..just learned of it as I have been HA free for 2 years and superstition keeps me away from related sites.  Anyway...Dont wait til fall my friend.  Go get a tank now and I promise, if please G-d it works for you, you will wonder how you lived without it....
 
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Re: Please respond RE:No Meds Strategy
« Reply #10 on: May 19th, 2005, 1:29pm »
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Hello you buffoons!  I didn't say the blood vessels weren't involved.  I said clusters weren't caused by a traumatized vein.  Why do neuros give us vaso-constrictors?  So the expanded blood vessels will contract and stop putting pressure on the irritated trigeminal nerve.
 
You drink a beer or go for a run and your face gets flushed because the blood vessels are expanded.  Are they traumatized?  Hell no.  They're made to expand and contract according to the Oxygen needs of what they are feeding.
 
There are some here who believe that the pain is good because it tells your body/brain that something is wrong and prompts it to heal, thus shortening the cluster cycle.
 
Dr. Robinson, at the Vancouver OUCH Convention, explained the pain in neck (some even develope a lump) as the terminus of the trigeminal nerve.  Yep Jeff, it extends over the ear, and down the back of the neck.
 
So how do you stop the pain?
 
1.)  Stop the blood vessels from expanding so they don't irritate the trigeminal nerve.
 
2.)  Stop the release of substance P and CGRP so the trigeminal nerve isn't so sensitive.
 
3.)  Stop the hypothalamus from statring the whole thing.
 
4.)  Take enough narcotics so you can't feel a thing.
 
5.)  You could say take an alternate treatment but chances are it does one of the things listed in 1-3 so that would be redundant.
« Last Edit: May 19th, 2005, 1:40pm by Bob P » IP Logged

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Re: Please respond RE:No Meds Strategy
« Reply #11 on: May 19th, 2005, 1:56pm »
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BobP,
We are apparently on two diametrically opposite views of what happens with this affliction.  You keep referring to the meds as vaso-constrictors, in other words the vein is inflammed (dilated) and the constrictor reduces it.  I am of the opposite opinion and education.  See link below.  Verap is a vasodilator.  In other words, quite the contrary, Ihave been educated to belieive that the vein first constricts (tightens and gets smaller) and by taking Verap or other Vasodilators you reduce constriction..and allow blood flow.  We seem to be talking opposites.  Cut and paste:
http://lysine.pharm.utah.edu/netpharm/netpharm_00/druglist/verapamil.htm
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Re: Please respond RE:No Meds Strategy
« Reply #12 on: May 19th, 2005, 2:12pm »
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cafergot - vasoconstrictor
Imitrex - vasoconstrictor
all the triptans - vasoconstrictors
 
alcohol - vaso dialator
 
verapamil - does it work because it blocks the calcium channels in the smooth muscle surrounding the blood vessels, relaxing the muscle and allowing the blood vessels to expand or does it work because it effects calcium neuro receptors?  If it's the later, does that effect the release of CGRP?  Does verap even do anything to the cranial blood vessels?  Your link mentions coronary and peripheral blood vessels.
« Last Edit: May 19th, 2005, 2:15pm by Bob P » IP Logged

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Re: Please respond RE:No Meds Strategy
« Reply #13 on: May 19th, 2005, 3:01pm »
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on May 19th, 2005, 12:35pm, SteCo wrote:

Does this nerve also extend down the side of the neck?
SteCo

 
Its the orange one that turns yellow as it hits the jaws
 

 
Not sure if it goes to the neck
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Re: Please respond RE:No Meds Strategy
« Reply #14 on: May 19th, 2005, 3:18pm »
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on May 19th, 2005, 3:01pm, Jonny wrote:
Not sure if it goes to the neck

 
It doesn't, Jonny.  You're absolutely right.  The trigeminal nerve is facial.  Ear and neck pain are something separate.  
 
Jefferator, I think you're on the wrong track here.  BobP is the one who compiled our library and is among a very learned group of sufferers here who really HAVE spent a lot more time studying this affliction than most doctors.  We have one single focus here:  cluster headache.  Doctors have to be diversified and they just can't spend the time we do, researching - not even the neuros.  We don't deal with migraine, tension or any other kind of headache here at all like they have to.  There are hundreds of years of combined research here and, sadly, WAY too many field trials to prove out the different theories that have been presented to us by medical professionals.  Surprise, surprise, the doctors aren't always right.  
 
So, you see, we really do know what we're talking about here.  The abortive meds ARE vasoconstrictors.  Verapamil is a calcium channel blocker.  Completely different family of meds that do completely different jobs.  
« Last Edit: May 19th, 2005, 3:19pm by Margi » IP Logged

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Re: Please respond RE:No Meds Strategy
« Reply #15 on: May 19th, 2005, 3:50pm »
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Gotcha, and understand fully, but I believe that the vein constricts first and then explodes., so a vasoconstrictor would be causal.  My neuros and 2-3 headache specialists I have visited (Swerdlow, a renowned guy in cluster headache field, and another that I flew to see in Long Island New York) have explained to me that in order to treat CH's, you have to blend a vasodilator (Verapamil) with an anti-inflammatory (Indomethacin, or timed release Naprox, etcc).  This, in effect, regulates the vessel and Ying/Yangs it...in otherwords, the dilator avoids the constriction (Picture your fist closing tightly) and the anti-inflammatory avoids the explosion/inflammation (Picture that close fist opening).  I know when I feel the onset, it is a hard tightening feeling in my left temple, and when it goes high Kip, I can feel that vein all blown up.....you guys know...we Clusterheads put our fingers up to our eyes or temples and loved ones see us and say..."Are you getting one".
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Re: Please respond RE:No Meds Strategy
« Reply #16 on: May 19th, 2005, 3:55pm »
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Pathophysiology: The pathophysiology of cluster headaches is not well understood. Some proposed mechanisms are described here.  
 
Hemodynamic: Vascular dilatation may play a role, but blood flow studies are inconsistent. Extracranial blood flow (hyperthermia and increased temporal artery blood flow) increases but following the onset of pain. Vascular change is considered secondary to primary neuronal discharge.  
 
Trigeminal nerve: The trigeminal nerve may be responsible for neuronal discharge causing cluster headaches. Substance P neurons carry sensory and motor impulses in the maxillary and ophthalmic divisions of the nerve. These connect with the sphenopalatine ganglion and interior carotid perivascular sympathetic plexus. Somatostatin inhibits substance P and reduces the duration and intensity of cluster headaches.  
 
Autonomic nervous system: Sympathetic (eg, Horner syndrome, forehead sweating) and parasympathetic (eg, lacrimation, rhinorrhea, nasal congestion) effects occur.  
 
Circadian rhythm: Cluster headaches often recur at the same time every day, suggesting that the hypothalamus, which controls circadian rhythms, may be the site of activation.  
 
Serotonin: This is not as striking as in migraines but some changes are seen.  
 
Histamine: Although evidence supporting a causative role is inconsistent, cluster headaches may be precipitated with small amounts of histamine. Antihistamines do not abort cluster headaches.  
 
Mast cells: Increased numbers of mast cells have been found in the skin of painful areas of some patients, but this finding is inconsistent.
« Last Edit: May 19th, 2005, 3:55pm by Bob P » IP Logged

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Re: Please respond RE:No Meds Strategy
« Reply #17 on: May 19th, 2005, 4:09pm »
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on May 19th, 2005, 3:50pm, jefferator wrote:
but I believe that the vein constricts first and then explodes., so a vasoconstrictor would be causal.

Then why are triptans (vasoconstrictors) the first line of defense prescribed for aborting the attacks, Jeff?  Think about it.  That theory simply doesn't make sense.
 
on May 19th, 2005, 3:50pm, jefferator wrote:
have explained to me that in order to treat CH's, you have to blend a vasodilator (Verapamil) with an anti-inflammatory (Indomethacin, or timed release Naprox, etcc).  

 
Sorry, but wrong again.  Indo is used to treat CPH (Chronic Paroxysmal Hemicrania) NOT cluster, and anti-inflams don't do squat for cluster.  Verapamil is a preventative, not an abortive as are the vasoconstrictors.  It is thought that by building up the calcium channel blocking properties in the system, this will regulate the seratonin imbalance and prevent attacks.  That's why you have to take verap for a while before you feel any effect from it.  If you're aborting your attacks from taking verapmil, it's the verapamil that you took last week that's helping, not the one you took today.  
 
Read what BobP's writing to you here, Jeff - he really is explaining it well and trying to help you understand that you're getting things backwards.
 
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Re: Please respond RE:No Meds Strategy
« Reply #18 on: May 19th, 2005, 4:10pm »
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Bobby the P,
THanks amigo.  Not sure on the Verap question.  I just posted that link due to the vasodilator language, although in all my reading on this site, it appears Verapamil is the drug of choice.  I apologize for any contradictory language...I just find it hard to believe that these two docs could say the same thing and not have some validity.  I appreciate all that data, as I continue to study and learn.  Now, I'll shut the hell up before I do the exact opposite of the purpose of this board, and give someone a headache.   Thanks friends.
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Re: Please respond RE:No Meds Strategy
« Reply #19 on: May 19th, 2005, 4:18pm »
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Marg...Thanks for the post, and I have read them well.  I am afraid we'll have to agree to disagree on this one.  Whether you believe so or not, and I have read all the posts and research, I believe that "regulation" of the vein right there in the temple and eye region controls and prevents CH's, if responsive.  The notion of vasal constriction and anti-inflammation are quite similar.  They both shrink that which is inflammed, dilated, blown up, traumatized, throbbing...etc...I also believe after much research and traveling the country seeing pain management specialists that the initial onset is a CONSTRICTION of the vessel requiring dilation, not the opposite requiring constriction.  20 years of research has directed me here...maybe Im just old fashioned and cant let go of this theory, but it translates into what I am feeling.
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Re: Please respond RE:No Meds Strategy
« Reply #20 on: May 19th, 2005, 4:36pm »
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Its the orange one that turns yellow as it hits the jaws. Not sure if it goes to the neck
Quote:
It doesn't, Jonny.  You're absolutely right.  The trigeminal nerve is facial.  Ear and neck pain are something separate.
Quote:
we Clusterheads put our fingers up to our eyes or temples and loved ones see us and say..."Are you getting one".  

Man is that statement ever true LOL
 
Thank you Jonny and Margi!
Okay.. This leads to another question...when I start putting my hand over my eye and rubbing my temple....Then right after that I move my hand to my neck (at this point I know I am screwed and a hit follows almost immediately). What am I attempting to rub? maybe another nerve or muscles tightening up or ???
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Re: Please respond RE:No Meds Strategy
« Reply #21 on: May 19th, 2005, 4:48pm »
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Not sure on this one SteCo although I get the same thing.  My neck, near where you would feel for a carotid pulse is sore at times.  During a cycle the over the ear and down the back corner of the neck is always sore.
 
Not sure if it's vascular, nerve or muscle.
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Re: Please respond RE:No Meds Strategy
« Reply #22 on: May 19th, 2005, 5:13pm »
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With bad hits im moving that ice bag like it didnt have a home, forehead, eye, cheeck, back of neck, side of neck and the top of my head.
 
All the while turning and bending my neck to try and find any reliefe....dont know why...but I do it.
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Re: Please respond RE:No Meds Strategy
« Reply #23 on: May 19th, 2005, 10:39pm »
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Hi Jeff.  
How about trying a few Hawaiian Baby Woodrose seeds and busting "completely" out of clusters and shadows. I was chronic for over 20 years...The opioids caused addiction and rebound headaches and the triptans (vasoconstrictors), coffee (too much) also can cause the rebound. Been completely pain free for 6 weeks now and also got Restless Leg Syndrome under control with LSA, and that is all I take now. Small cup of tea every couple of weeks and NO worries. I guess what I'm saying is there are some answers out there...at least there was for this guy. Best wishes, Joe
ps BobW and Pink Floyd are 1 in the same and a great guy Wink.
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Re: Please respond RE:No Meds Strategy
« Reply #24 on: May 20th, 2005, 12:32am »
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on May 19th, 2005, 4:09pm, Margi wrote:

 
 and anti-inflams don't do squat for cluster.  
 
Read what BobP's writing to you here, Jeff - he really is explaining it well and trying to help you understand that you're getting things backwards.
 

 
Maybe Bobp would like to explain to Jeff which very potent anti-inflammatory is often used for clusters and why it's used if it doesn't do squat? I would but margi doesn't think the rest of us are worth reading  Cry
 
Sorry Margi, couldn't resist.
 
I have a sneaking feeling that Jeff's docs are prescribing less effective anti-inflammatories because they are trying to avoid the use of the ones that many times cause more problems than they solve. Sounds like a safety issue move and one to hopefully help a little and to buy time until the cycle ends on it's own, IMHO.
I think most of us have been tossed out of an office at one time or another with a couple of scripts that the docs know won't do squat but it does get us out of the office for another 30 days. Sent home to suffer out of earshot of the doctor.
 
Today at 10:19am, Bob P wrote:
Clusters have nothing to do with any veins being traumatized.

 
I know you never said traumatized veins "cause" clusters. Don't put words in this buffoons mouth. All I did was quote the words you DID use.
 
I agree....they are not the root "cause" of clusters.
 
If "simply" (as in singularly treating) the involved connection between the traumatized vascular system and the hypersensitive neurological system is not medically considered a treatment for clusters, why do people put their lives on the line for Microvascular Decompression?
 
 
BTW Margi, Congrats.   Smiley
 
Bobw
P.S....are Buffoons those big monkeys with the pink butts? Wink
IP Logged

"Nothing is so firmly believed as what we least know."
"There is no passion so contagious as that of fear."
[Michel de Montaigne
www.clusterbusters.com
www.obscuredview.blogspot.com
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