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Topic: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE (Read 1080 times) |
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Hooter
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CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« on: Sep 22nd, 2003, 7:34pm » |
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Dear Wise Ones
My question for today.
How do we know (aside from taking indomethacin) that what we are suffering from is not either 'Hypnic headaches' or CPH. I know the absence of the autonomic features can be an indicator but some cluster sufferers here say that they do not get these anyway.
(Hypnic headaches mimic CH VERY closely and can be treated with Indomethacin or Lithium)
Wendy the Brit
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goaway
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #1 on: Sep 22nd, 2003, 7:40pm » |
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Say what? 
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Cerberus
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #2 on: Sep 22nd, 2003, 7:41pm » |
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I went to the neuro 1 time.......the reason for this is that he gave me Indo and Elavil, lemme tell ya why I havent been since.........He gave me Indo....AND Elavil.
I don't know the answer to these but I DO know that Indo will eat a hole in your belly the size of the Queen Mary........I ate one and thats all she wrote for that med, Besides my GP treats me just fine thanks.
When you get this one fingered out let me know
Ramon
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| « Last Edit: Sep 22nd, 2003, 7:42pm by Cerberus » |
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #3 on: Sep 22nd, 2003, 7:45pm » |
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Ramon
As far as I understand it Indomethacin works almost 100% of the time for CPH but is useless for CH. That is why it seems to me to be a helluva quick way of identifying what the diagnosis is and maybe it should be the first thing a new sufferer is given.
Hypnic headaches are also successfully treated by Indomethacin and Lithium, so again, it seems logical to me that the doctor should try them just once to see how the person responds.
W
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Cerberus
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #4 on: Sep 22nd, 2003, 7:55pm » |
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It Totally makes sense but if you're like me and can't tolerate the gastric distress it causes then what next......thats all I'm sayin. I couldn't take it. Maybe try the reverse and give em proven effective meds fer CH and ifn then they don't work.......Aw HELL I dunno.
On the other foot.....Lithium is a very very volatile substance, if the levels in your system aren't nominal at all times one runs the risk of literally going insane. A buddy of mines wife takes it for something and when her levels droped at the Hospital she literally went nuts until her Doc discovered she hadn't been dosed in two days. ........Kinda scary to be testing with don't ya think?
just a thought,
Ramon
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #5 on: Sep 22nd, 2003, 8:04pm » |
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I see what you are saying, but CH doesn't have one single effective treatment you could try so the reverse theory of treating CH first may not work, you can desperately scrabble around for years to find the best one for your case.
On the other hand if you had one course of Indomethacin and your headaches cleared up, BINGO! It ialmost definitely isn't CH.
or am I missing something here??
P.S. The Lithium option is for Hypnic headaches which are even similar to CH than CPH is (I think) Don't know if Lithium works for CPH.
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Hooter
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HypnicRe: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #6 on: Sep 22nd, 2003, 8:08pm » |
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Just found one answer to my question!
"Hypnic headaches
Hypnic headache, or headache during sleep, is a rare primary headache disorder occurring only in the senior population, with onset typically around the age of 60. Women are more likely to experience hypnic headache than men. To be called "hypnic headache," the headache must occur exclusively at night or during the day during napping. The attacks are very painful, often awakening the afflicted individual at the same time each night. The patient may be awakened during a dream by diffuse pain and nausea.
Hypnic headache is throbbing in quality and occurs 2-4 hours into nighttime sleep, although attacks after daytime napping are reported. The duration is usually short-lived, lasting from 5 to 60 minutes. The throbbing and pain occurs on both sides of the head.
Hypnic headaches typically respond to lithium carbonate at a dose of 300 mg to 600 mg, although caffeine and indomethacin are also helpful. Because hypnic headaches affect only individuals over the age of 50, it has been suggested that there are disturbances to the "biological clock" related to serotonin levels in the brain. The absence of autonomic features that are often seen in migraine or cluster headache distinguishes this illness from these conditions"
i.e. if you aren't old, have pain on one side only, or have autonomic symptoms it aint hypnic headaches
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| « Last Edit: Sep 22nd, 2003, 8:10pm by Hooter » |
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #7 on: Sep 22nd, 2003, 8:38pm » |
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Now I'm confused again. The section here about "Other headaches" says that hypnic headaches CAN be one sided.
and the symptoms for CPH are almost identical to CH.
So anyone else out there know how we know what we have !
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surfshi
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #8 on: Sep 22nd, 2003, 8:51pm » |
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What we have here is pain+confusion=Open for discusion
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Ueli
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #9 on: Sep 22nd, 2003, 9:25pm » |
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Hypnic headaches are bilateral headaches and alone on this count can not be confused with CH nor CPH.
The "throbbing quality" does not match either. CH is so intense there is no room left for modulation.
HH are sometimes accompanied by nausea, but by none of the other autonomous symptoms often seen in CH.
Last but not least: "No case of HH has been reported in anyone under age 65."
It is true that Indomethacin helps almost every CPH-head (if she/he can stand the sides) but from this it does not follow that it's useless for CH. Wendy, be careful what you write, or jonny will come after you. ;D He used Indo bullets to abort attacks, back in the time when they were still available.
PFNADs
Ueli
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don
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #10 on: Sep 23rd, 2003, 9:44am » |
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New diagnostic criteria for distinguishing between CH and CPH will be published next month.
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Mark C
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #11 on: Sep 23rd, 2003, 9:51am » |
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on Sep 22nd, 2003, 9:25pm, Ueli wrote: CH is so intense there is no room left for modulation.
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Well put my friend....dead on.
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #13 on: Sep 23rd, 2003, 6:10pm » |
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Cheers Don and Ueli. Knew some of the wise owls here would know the answer.
Sorry about the Indomethacin comment, I just read that it worked for CPH but not for CH and that some GP's used it as a diagnostic treatment.
Wendy
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Prense
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #14 on: Sep 23rd, 2003, 6:28pm » |
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Yes, I have read that as well from several sources Wendy. Additionally, I have read that CH affects one side ONLY. Never say never! It seems to hold true that CH affects one side during any given attack, but there have been several here that have reported attacks on the side opposite of what their "norm" is.
What's the point? There is no point. ;D Be careful what you read...there is alot of outdated info out here.
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Ree
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #15 on: Sep 23rd, 2003, 6:32pm » |
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Maybe we have a few Hypnics in our midst. This is the first I have ever heard of Hypnic headaches... How sad... there are way too many different types of HA to keep track... CPH are usually really short in duration though and are DEFINATELY controlled with INDO right?
so these Hypnic headaches are probably more closely related to CPH except for the idea that they come at night like CH. hmmmmmmmmmmm something to ponder once again... Maybe chronics arent chronic CHers and they are Hypnics.............because Hypnic headaches are chronic... and up until I came here the definition of CH to me was someone that got headaches in CLUSTERS and that they had a remission in between.......... hmmmmmmmm maybe those chronics have something else allllllllllllll together... but we would never know that right. We would have to start another message board for HH and OUHH........... HMMMMMMMMMMM ree
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| « Last Edit: Sep 23rd, 2003, 6:34pm by Ree » |
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #16 on: Sep 23rd, 2003, 6:43pm » |
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on Sep 22nd, 2003, 9:25pm, Ueli wrote:| or jonny will come after you. ;D He used Indo bullets to abort attacks, back in the time when they were still available. |
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Uelis right, I used indo bullets as an abortive and they worked just great takin in time, I also use Lithium.....so?.....LMMFAO
Actually I think I am the only one to ever use indo bullets to abort.
OH GOD!!!, Dont tell me I have Meegraines.....LMMFAO ;D....(Sorry Ree)
...............................................jonny
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Prense
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #17 on: Sep 23rd, 2003, 6:48pm » |
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Well, the age issue was brought up...I am WAY under that age. Throbbing? not a chance in hell...throbbing would be cyclic relief. ;D I have seen recently that younger GPs seem to be more familiar with CH/CPH compared to the old school docs. Just today I had a doc tell me that 480mg is the MAX anyone can go on verapamil. Shortly after that, I had a O2 supplier question the need for a non-rebreather mask for CH treatment. Her exact words were..."that's an unusual request for cluster headache treatment." I responded by promptly handing her a printout from OUCH about meds that CLEARLY says to use a non-rebreather mask, and I thought to myself..."that's why you are a supplier, not a doc" 
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #18 on: Sep 23rd, 2003, 6:52pm » |
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Hi Prense and Ree,Ueli, Jonny Don et al
This one does take some unravelling doesn't it, see why I asked!
Just to confuse matters worse:
Prense, as you say some CH sufferers report headaches on both sides, and Ueli, some Hypnic sufferers get one-sided headaches and many CH sufferers report nausea and auras so it isn't quite as straight forward as you say! Unless of course these CH sufferers are misdiagnosed CPH or Hypnic or Migraine headachers.
Lucky I'm not 65 yet so that rules out Hypnics (for now anyway until someone changes the diagnostics again!)
Ree there is some stuff on Hypnics on the 'Other headache' link on the left. HEY WOW, I JUST DIRECTED AN OLD TIMER TO LOOK AT THE LINKS!!!!! ;D ;D
Wendy
P.S. Jonny, if you turned out to have Migraines, I would faint in shock, then offer you the biggest humble pie to eat that the world has ever seen! ;D
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| « Last Edit: Sep 23rd, 2003, 6:53pm by Hooter » |
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jonny
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #19 on: Sep 23rd, 2003, 7:00pm » |
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Dont worry Wendy....6 Neuro's and nearly 30 years of this I think I know what I have.....I just wish it was Meegraines
.......................................jonny
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Ree
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #20 on: Sep 23rd, 2003, 8:47pm » |
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We didnt say you had Migraine we said you had HYPNIC HEADACHES DONT YA READ YA NERD... SHEESH..........REE
Thanks for the link Wendy that is pretty funny... I have probably read that a few years ago... but maybe the information has changed I really have never heard of Hypnic Headaches/ You taught me alot and made me go hmmmmmmmmmmmmmmm...
Jonny if you had Migraine you would just have to find some gorgeous sufferer to support here like the rest of us supporters..................................ree
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| « Last Edit: Sep 23rd, 2003, 8:57pm by Ree » |
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Ueli
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #21 on: Sep 23rd, 2003, 9:28pm » |
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Please Wendy and Ree, do not try to muddle the issue more than it already is. 
Cluster attacks are strictly one-sided PERIOD
That means: An attack starts on one side of the head, increases in intensity, stays for a period at an intense level, and finally subsides again. Throughout the whole attack only one side of the head is affected.
That does not mean that every attack is always on the same side as the previous one, although it is true for 81% of the clusterheads. But for 19% the side has switched at least once. For some the changing side is from one period to the next, for others the switching occurs within one period, only once or more often. We have heard of one attack being immediately followed by another one, on the opposite side. Some poor bastard might get hit by two attacks at the same time, one right, one left. But that would not be a "full head" attack, it would be two one-sided attacks at the same time.
That is why clusters are call one-sided or unilateral. All above also holds for CPH.
For those that didn't get it yet, make the following experiment: Take a hammer and hold it in your favorite hand. Now hit it on your right big toe. This will hurt, but no pain no gain, you'll notice only the right big toe does hurt, the left one not at all. If you are still not convinced, after the pain on the right foot has subsided you can repeat the experiment by hitting your left big toe. Conclusion: Hitting one big toe with a hammer causes one-sided pain, but it can be done on the left or the right side.
I wrote "Hypnic headaches are sometimes accompanied by nausea, but by none of the other autonomous symptoms often seen in CH."
For those that didn't understand that simple sentence, here's the long version:
Quote: The International Headache Society classification diagnostic criteria require the cluster attacks to be accompanied by at least one of the following, which have to be present on the pain side: conjunctival injection, lacrimation, miosis, ptosis, eyelid oedema, rhinorrhoea, nasal blockage, and forehead or facial sweating. The autonomic features are transient, lasting only for the duration of the attack.
But since none of these stricliy unilateral symptoms are ever observed in hypnic headaches patients the difference should be clear cut enough.
A few clusterheads get nauseous during an attack and a few HH patients nauseous too. But to try to construe a connection on this basis is at least as idiotic as making a connection because cluster attacks come sometimes at night, like the HH attacks.
Indications for Indomethacin (from http://www.rxlist.com/): rheumatoid arthritis, ankylosing spondylitis (whatever that is), osteoarthritis, painful shoulder (bursitis and/or tendinitis), gouty arthritis. Since Indomethacin helps for CPH and HH too, these two kinds of headaches are the same and actually just a manifestation of degenerative joint and tissue diseases, aren't they?
Please stop spreading rumours and callow theories 
Ueli
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Prense
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #22 on: Sep 23rd, 2003, 10:31pm » |
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No arguments there Ueli! ;D
There are neuros out there that will claim "unilateral" means that you cannot have an attack on the otherside. If you do, then ya got something else. I say neuros in a plural sense, but I can definately point you towards one neuro that believed this. Been there, but didn't get the damn T-shirt! Grrrrrr He was also convinced that verap at 360mg was a cure all for CH. And now he's my ex-neuro. ;D
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Azrael
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #23 on: Sep 23rd, 2003, 11:34pm » |
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Interesting read... Very interesting indeed... I'd like to add my answer to the original question posed... What's the difference?
First of all... Hypnic Headache has very little in common with Cluster Headache or Paroxysmal Hemicrania, other than the attacks during sleep, so I'll skip pointing out the differences.
Second... Cluster Headaches and Paroxysmal Hemicrania are both defined as Trigeminal-Autonomic Cephaligias (TACs), along with SUNCT, so I'll describe the TAC symptoms first, and then list the definitive differences as listed by the International Headache Society's diagnosis criteria.
Trigemina-Autonomic Cephaligias share the following characteristics:
#1... Unilateral attacks,
#2... Orbital, supraorbital and/or temporal pain,
#3... Autonomic features on the side of pain (Conjunctival injection and/or lacrimation, Nasal congestion and/or rhinorrhoea, Miosis and/or ptosis, Eyelid Oedema, Facial and/or forehead sweating.) It is these autonomic features that define TACs as a group.
The differences between the various TACs:
Cluster Headaches: 15 to 180 minutes duration,
Paroxysmal Hemicrania: 2 to 30 minutes duration and complete response to indomethacin,
SUNCT: 5 to 240 seconds duration,
It should also be noted that cases of Paroxysmal Hemicrania (As defined by TAC symptoms and duration of attacks) that are unresponsive to indomethacin have been reported, as well as cases of Cluster Headaches that have responded well to indomethacin. Some experts believe that the indomethacin wording in the diagnostic criteria should be removed because of these reports.
Bottom line...
No autonomic features = No TAC...
< ~4 minute duration = SUNCT...
2 to ~30 minutes = Paroxysmal Hemicrania...
15 minutes to 3 hours = Cluster Headache...
PFDAN.............................. Drk^Angel
Edited to include changes made in the International Classification of Headache Disorders 2nd edition, now available on the IHS websire at http://www.i-h-s.org/
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| « Last Edit: Sep 24th, 2003, 12:17am by Azrael » |
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Hooter
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Re: CORRECT DIAGNOSIS-CH/CPH/HYPNIC HEADACHE
« Reply #24 on: Sep 24th, 2003, 12:06am » |
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Thanks Ueli and Dark!
I'm sure I'm NOT stupid and equally I'm sure this was not as easy to grasp as you make it sound. If it were, all these doctors wouldn't get it wrong!
But now I do see the differences and I think I understand, so
THANK YOU.
Wendy
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