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        New Message Board Archives >> 2003 Posts >> Can CH's be this mild?
        
(Message started by: drgibson on Mar 9^th, 2003, 9:47pm)

Title: Can CH's be this mild?
Post by drgibson on Mar 9^th, 2003, 9:47pm

I'm an eye doctor and have a patient with symptoms that resemble CH but not exactly. Let me describe, my patient is a 40+ female who is having episodes of flashing lights and eyelid spasms 10 to 15 times a day for the past 10 weeks. Each spasm last 10 to 15 seconds also and occur on the right lid only. In reading about CH, the symptoms don't match well but as I understand the timing is a good match perhaps. I think I read here that CH's may occur more at night while my patients symptoms are mainly daytime. Wine seems to increase the length of the episode and push them closer together. A doctor friend of mine, thought it was CH but I'm having trouble finding reports of CH being anywhere near this mild. I know this could be a real stretch, but has anyone heard of symptoms this mild being related to CH?
David

Title: Re: Can CH's be this mild?
Post by Ted on Mar 9^th, 2003, 9:56pm

Nice to see you here researching, drgibson. There are documented cases of painless clusters and there are what we call shadows, which are lower-level attacks that sometimes proceed an attack, sometimes comes after and sometimes is all that'll occur with no further attack. However, flashing lights and eye spasms aren't cluster symptoms. Are there other symptoms that may have led your friend to think it might be (I'm also not sure how the timing matches. Do you mean they come at certain times of the day each time?)?

Title: Re: Can CH's be this mild?
Post by Charlie on Mar 9^th, 2003, 10:10pm

Welcome to the site.

The eyes spasms you describe sound very different from clusters. Clusters are several minutes to a couple hours and are so painful one cannot sit still. (and almost all manifest in horrible pain) They will wake one out of a sound sleep. No one sleeps away a cluster episode.

Stick around though and maybe tell us more. I'm not the final authority by and means.

Charlie

Title: Re: Can CH's be this mild?
Post by drgibson on Mar 9^th, 2003, 10:11pm

Ted,
Thanks for the reply. By timing, I mean the frequency of occurances. One of my eye texts mentions CH's occuring 10 -12 times a day. Now, that may not be correct as the lead story on this site, seems to suggest that CH's occur mainly at night. So, what is the number of times a day the average CH occurs? Does the term "cluster" refer to the number of times a day they occur or the 10-12 week period they occur in? Straighten me out on this. My textbook reference could be wrong. I know how wrong non-eye med books can get when they throw in a paragraph on eye stuff.
David

Title: Re: Can CH's be this mild?
Post by cootie on Mar 9^th, 2003, 10:11pm

David.......this is an article I copied sum time ago off the net doing research.....could this 'possibly' be what your patient is going thru or close....thought it mite be interesting at least.....I posted it once before......Pam-that-hopes-this-is-of-some-help.............................

Ocular Migraine

Ocular Migraine is a variant of migraine that is not uncommon. It is believed to be caused by the same mechanism as classical migraine; vascular spasm. Instead of the spasm affecting the surface of the brain, these episodes affect the ocular blood supply or the blood supply to the vision center in the brain.

Typically, these episodes begin with a visual disturbance that begins in the peripheral vision. It often consists of a semi-circular, jagged, shimmering light, which enlarges and becomes more central. This disturbance usually obscures the vision within the jagged area. The light is often described a pale pastel in color.

In the typical episode, the visual disturbance lasts 15 – 20 minutes and then disappears. A mild headache may or may not follow the disturbance. Many ocular migraine sufferers complain only of fatigue after the visual disturbance.

Title: Re: Can CH's be this mild?
Post by Karla on Mar 9^th, 2003, 10:12pm

What do you mean the timing matches? Cluster headaches don't last 10-15 seconds. They last several min. to hours. You don't mention any actual headache pain. Migraines/seizures have flashing lights sometimes. Clusters don't. Seizures can also cause eyelid to spasm and person to blink. What other symptoms is she having?

Title: Re: Can CH's be this mild?
Post by drgibson on Mar 10^th, 2003, 1:03am

You guys are great! Now knowing what I have learned here, I don't see how this could be a CH episode. I'm not sure what my friend picked up on except the muliple episodes during the day but CH is 1 to 6 episodes a day while my patient is having 10 - 15 episodes a day of her lid spasm and light show. The med information here says the shortest attack is 10 minutes while my patient is measuring her episodes in seconds. My patient also reports no pain which is why I have been asking if CH's could be this mild and the answer is apparently not, so we'll look for something else. I did reread my textbook and see I confused the number of episodes during the day. It did say generally up to 3 per day lasting 4 -12 weeks and I guess I thought it said 4 - 12 per day.

Cootie - that's a good pickup but that is also the first thing I considered. I have had those myself so I tend not to miss those in my patients. My patients light show is stationary in the temperal field while ocular migraine light show moves. Your article says from peripheral vision to central which happens, while mine move from central to peripheral field. It is this type of varibility that lead me to ask around here to see if perhaps this might be a mild variation of CH, but I guess not.

Karla - the only other symptom I perhaps remember is tearing in the affected eye during the episode. I really need to reread my notes and see if that was occuring or I just read it here. It's been several days since I have seen her so I might be imagining that complaint.

Thanks for the help Charlie. I agree with you. The timing just isn't right.
David

Title: Re: Can CH's be this mild?
Post by cbolony on Mar 10^th, 2003, 4:19am

Hello Doc here is a post from ted a member here of how a cluster headaches feels like

But the other reason "cluster headaches" is a misnomer is because of what a true c-head feels. After you read this try and close your eyes and imagine it. You won't be able to but try. A red hot seering pole being slashed across your cheekbone and returned to destroy your flesh. It remains there for 1-4 hours. It gets pressed against your nostril to equal the pain but the addition of a 300 lb man adds to it by repeatedly kicking your cheekbone and nose.This is your final warning that some real pain is yet to come. Suddenly you feel his steel-toed boots bash your eye in. Molten lead is dripped into your eye as a shrply-fanged viper eats away at the same eye, releasing a strong acid-based venom. His twin eats away at your eye from the inside, also releasing the venom.
This happens several times per day. Every day. Every week. Every month. Every year.

Glad to see that you are doing this for one of your patients not to many doctors like you anymore

Title: Re: Can CH's be this mild?
Post by Riccardo on Mar 10^th, 2003, 9:44am

Hey, dr Gibson, don't forget what is more in your "field".

Sometimes, corneal diseases (like rashes, microscars, etc) give the same symptoms of CH/CPH.

Ciao from Italy, and thanks for the question (is very nice to see that a doctor ask here for info, really!)

Title: Re: Can CH's be this mild?
Post by drgibson on Mar 11^th, 2003, 12:43am

Riccardo,
I suppose what you say could be true however the rash should have an area of redness or irratation which my patient doesn't have. I am not familiar with the term of microscar but assume it and the rash would be causing a fair amount of pain which again doesn't fit my patient. I believe I'm looking for another problem which I haven't figured out yet, but still looking.
David