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        New Message Board Archives >> 2002 Posts >> Thank you all- maybe I don't belong here?
        
(Message started by: Mistory on Aug 15^th, 2002, 7:09am)

Title: Thank you all- maybe I don't belong here?
Post by Mistory on Aug 15^th, 2002, 7:09am

I was finally able to tolerate looking at a screen again today(I've been off migraining) and I followed up on some of your suggestions.
Dark Angel: your suggestion of SUNCT seems to be it! I had six days and nights of repetitions every fifteen minutes to and hour, but now they are only coming every few hours or so. At least I am no longer afraid that I am dying!!!
I am unclear, though; is SUNCT a form of CH?

Title: Re: Thank you all- maybe I don't belong here?
Post by Tom on Aug 15^th, 2002, 4:25pm

Hi M,
posted the same information for Jimbo today:

www.upstate.edu/neurology/haas/hpstab.htm

Idiopathic Stabbing Headache: Non-official terms: jolts and jabs; ice-pick pains
   Clinical presentation:

Each paroxysm strikes the head as quickly as an electric shock, is moderately to severely painful and lasts from a split second to some 10 seconds. Some patients say the pain is akin to a forceful prick or stab, while others say it's like a jolt or smack. The pain is most often felt in the orbital region on one side and it often recurs in the same place, but it may move to other places on the same side of the head or, less commonly, to the opposite side. The frequency of occurrence of the painful paroxysms varies greatly: Some folks may recall but one attack in a year, others may be besieged by 50 per day. Severe sieges don't usually last more than a few days, but paroxysms occurring one or several times on most days can endure for months.
   ---------------------
   Diagnostic criteria of the International Headache Society (198:
1.Pain confined to the head and exclusively or predominantly felt in the distribution of the first division of the trigeminal nerve (orbit, temple and parietal area).

2.Pain is stabbing and lasts for a fraction of a second. It occurs as a single stab or a series of stabs.

3.It recurs at irregular intervals of hours to days.

4.diagnosis depends upon the exclusion of structural changes at the site of pain and in the distribution of the affected cranial nerve.
   Who gets these paroxysms?
Basically healthy people experience idiopathic stabbing headache, for it has not been associated with serious intracranial diseases. Many of the afflicted are migraine sufferers and less suffer from tension-type headache. More of the afflicted are women than men. The incidence of this headache is higher after the age of 40, but children are also afflicted by it.
   DIFFERENTIAL DIAGNOSIS:
Trigeminal neuralgia: The intensly painful paroxysms of this condition are very like those in idiopathic stabbing headache, in their intensity, quality, and duration, but trigeminal neuralgia is rare in the region of the first division of the trigeminal nerve (orbit and forehead) where ISH appears. In addition, the paroxysms of trigeminal neuralgia can be triggered by a mild stimulus to the face or mouth, whereas ISH can not be set off by such stimuli.

Chronic paroxysmal hemicrania (CPH): Attacks of this headache occur multiple times daily, but are much longer in duration than ISH in that they persist for 2 to 25 minutes. Moreover, the pain is accompanied by redness and watering of the ipsilateral eye.

SUNCT syndrome: SUNCT stands for "short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing." Although these attacks often occur more than once a day and in the orbital region, they are longer lasting (15-120 seconds) than ISH, briefer than CPH (see above) and are accompanied by redness and watering of the ipsilateral eye, as are CPH attacks. They have not, in contrast to IHS (see below) and CPH, been suppressed by indomethacin. The only drug reported to prevent their occurrence has been lamotrigine, an anti-epileptic drug which also can suppress trigeminal neuralgia. D'Andrea, et al. (1999) reported the case of a 66-year-old woman whose attacks (up to 15/day) were completely abolished by 150 mg of lamotrigine daily.
   TREATMENT:
Indomethacin is the only drug known to affect idiopathic stabbing headache. According to a recent study by Pareja et al. (1996), one 25 mg capsule three times daily eliminated paroxysms in roughly one third of the treated, lessened them in another third, and was inefffective in the remaining third. If this dose were ineffective, I would double it. If indomethacin were not tolerated, then I would try celecoxib (Celebrex) at a dose of 200 mg twice daily, since this drug has been shown to substitute adequately for indomethacin in another indomethacin-responsive
headache, "chronic paroxysmal hemicrania," (Mathew et al., 2000) and I have a patient whose "hemicrania continua" is suppressed by this drug as well as by indomethacin.
   By David C Haas
   ---------------------------------
ATB ! Thomas

Title: Re: Thank you all- maybe I don't belong here?
Post by Drk^Angel on Aug 15^th, 2002, 6:14pm

SUNCT and clusters are both types of TAC (Trigeminal-Autonomic Cephalgias) The IHS says: "The trigeminal-autonomic cephalgias (TACs) share the clinical features of headache with prominent cranial parasympathetic autonomic features (1). Experimental and human functional imaging suggests that these syndromes activate a normal human trigeminal-parasympathetic reflex (2)."

PFDAN.................... Drk^Angel

Title: Re: Thank you all- maybe I don't belong here?
Post by Drk^Angel on Aug 15^th, 2002, 6:17pm

BTW... Even if it is SUNCT... I'd say you still belong here. SUNCT is a close cousin to CH, and I don't find any reason for a clusterhead to discriminate against any other TAC sufferer. Good luck!

PFDAN.......................... Drk^Angel

Title: Re: Thank you all- maybe I don't belong here?
Post by Mistory on Aug 16^th, 2002, 7:12am

Thank you for the info!
It figures that it is rare for attacks to last so long; if I had to have such rare luck, couldn't it have been winning the lottery? Maybe I'll go buy a ticket, just in case I haven't used up all my alloted luck...I don't want to leave any laying around for the Fates to use; they might decide to let me be struck by lightning!
Just kidding- I'm really not whining. Much.