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        New Message Board Archives >> 2005 Cluster Headache Specific Posts >> Carotid Occlusion Method
        
(Message started by: tidge on Dec 12^th, 2005, 7:14am)

Title: Carotid Occlusion Method
Post by tidge on Dec 12^th, 2005, 7:14am

Carotid occlusion used for relief of cluster headache (CH).

Aim: To close off the common carotid artery (CCA) in the neck on the affected side of the head, in order to reduce blood pressure and pulsation in the blood vessels that supply the affected side of the face and scalp, thereby relieving pain during CH. Intracranial (brain) blood pressure is preserved through collateral supply.

Method:

1. Extend your neck so that your larynx (Adam's apple) protrudes and the CCA straightens. The CCA runs immediately next to the larynx.

2. Put your hand on your cheek with thumb facing downwards. Find the carotid pulse with your thumb at the level of the widest part of the larynx. Keep your thumb well down in your neck – you don't want to massage the carotid body further up at the angle of the jaw.

3. Work the thumb behind the CCA and push it forward onto the larynx, so that it is immobilized against the larynx and you have full control of the amount of thumb pressure and blood flow.

4. Compress slowly until you have completely occluded the CCA on the affected side. Use as much surface area of your thumb as possible and only sufficient pressure to occlude the CCA (+/- 120mmHg). If no pain relief is experienced with total occlusion, there is no benefit from pressing harder.

5. If you hyperventilate, release some pressure until your breathing is corrected and try to increase the pressure again.

6. When you suspect that the CH is over, release pressure slowly. There is a +/- 15 second difference between thumb pressure and effect on pain.

http://https://www.prospect.ac.za/clusterpics/thumb.jpg
Fig. 1. Note the level and direction of the thumb. Middle finger is on the temporal artery and small finger on the nasal artey. This is not essential, but helps assess the effectiveness of the occlusion.

Notes:

1. If you are new to this technique, you will be more susceptible to hyperventilation. This is because the carotid body is above your thumb and therefore also deprived of blood pressure and oxygen. This forces you to breathe more and your blood pressure to rise. However the carotid body on the other side senses the pressure and oxygenation rise and compensates by dropping pressure and breathing rate. Keep trying until you can occlude completely without hyperventilating.

2. You will know that you have complete occlusion when the temporal and nasal pulses disappear.

3. There is no need to worry about your brain not receiving enough blood - you have two vertebral arteries that combine with the carotids at the base of the brain in a circle. So occlusion of one carotid artery (below the carotid body) will result only in decreased blood flow to the external carotid artery on that side. The external carotid provides blood to the face and head outside the skull, where the nerves are that give you the pain (the brain does not have pain receptors). Reducing the pressure in these vessels stimulates a feedback mechanism that tightens the vessels to increase local blood pressure. The vessels constrict and the CH disappears.

4. Start compression at the first sign of a CH - the earlier the better.

5. There are surreptitious ways of using this method: at a desk or dinner table (fig.2) and reclining (fig.3). If you drive on the opposite side of the road to your CHs, you can rest your elbow on the door with the window wound down. In the event that you have to stand, you can put your hand behind your neck with thumb in front, your elbow out to the side (fig.4). It is always helpful to have some fixed object on which to rest your elbow – the carotid pressure must be consistent and constant. Remember to keep your neck slightly extended so that you have the larynx to push against.

http://https://www.prospect.ac.za/clusterpics/thumbdesk.jpg
Fig. 2.

http://https://www.prospect.ac.za/clusterpics/thumbrecline.jpg
Fig. 3.

http://https://www.prospect.ac.za/clusterpics/thumbstand.jpg
Fig. 4.

Title: Re: Carotid Occlusion Method
Post by burnt-toast on Dec 12^th, 2005, 8:50am

Hopefully we can get the Pics. I'll try it during regular CH attacks to see if it actually works.

Tom

Title: Re: Carotid Occlusion Method
Post by Jonny on Dec 12^th, 2005, 5:28pm

"The certificate for "www.prospect.ac.za" expired Dec 6 15:23:48 2005 GMT. The webmaster should update the certificate(s)."

Title: Re: Carotid Occlusion Method
Post by thomas on Dec 12^th, 2005, 6:11pm

I've tried applying pressure to the carotid artery during a hit before, and it seems to help some, sometimes...... but as soon as I let up on the pressure the CH is more intense. Would like to see the pix you have for this.

Title: Re: Carotid Occlusion Method
Post by Kris_in_SJ on Dec 12^th, 2005, 7:57pm

Hi Tidge,

I believe I was the one who said I'm a visual learner. This description was pretty clear, but I can't load your pictures!

Could you try again?

Kris

Title: Re: Carotid Occlusion Method
Post by tidge on Dec 13^th, 2005, 1:32am

Kris, Jonny

The URLS are displayed where the pics should be.

I only allow secure traffic on this server and don't want to fork out for a certificate every year.

I have asked MJ to sort the post out - if i were to repost with a different server it would be messy. I shall repost in a few weeks if it isn't sorted out.

In the meantime you can download the pics individually, accepting the old ssh certificate.

Title: Re: Carotid Occlusion Method
Post by MJ on Dec 13^th, 2005, 3:17am

Tidge

The method makes sense. And I tried it today.
But I cant even get to the urls. The server doesnt exist when I look for it.
I have no clue as to how to sort it out. I am certainly not the guy to do it.
Glad to see your still here.

MJ

Title: Re: Carotid Occlusion Method
Post by tidge on Dec 13^th, 2005, 9:50am

Here are the pics's. A friend has kindly hosted them.

Fig.1.
http://www.aims.ac.za/~jan/tidge/thumb.jpg

Fig.2.
http://www.aims.ac.za/~jan/tidge/thumbatdesk.jpg

Fig.3.
http://www.aims.ac.za/~jan/tidge/thumbrecline.jpg

Fig.4.
http://www.aims.ac.za/~jan/tidge/thumbstanding.jpg

Title: Re: Carotid Occlusion Method
Post by E-Double on Dec 13^th, 2005, 10:27am

I do that all the time.
Didn't know what it was specifically.

I usually have thumb at base of skull behind ear (nerve or artery? you tell me doc)
little finger on cartoid and index on temple

Title: Re: Carotid Occlusion Method
Post by thomas on Dec 13^th, 2005, 10:43am

Fig.1.
http://www.aims.ac.za/~jan/tidge/thumb.jpg

Fig.2.
http://www.aims.ac.za/~jan/tidge/thumbatdesk.jpg

Fig.3.
http://www.aims.ac.za/~jan/tidge/thumbrecline.jpg

Fig.4.
http://www.aims.ac.za/~jan/tidge/thumbstanding.jpg

Thanks Tidge, always nice when some one tries to help us all out.

Title: Re: Carotid Occlusion Method
Post by Kris_in_SJ on Dec 13^th, 2005, 8:10pm

Thanks, Tidge!

Another tool for my arsenal ....

Kris

Title: Re: Carotid Occlusion Method
Post by Kris_in_SJ on Dec 13^th, 2005, 8:12pm

Edited to add - Thanks also to Thomas!

Kris

Title: Re: Carotid Occlusion Method
Post by stevea on Dec 13^th, 2005, 11:34pm

Thank you, thank you, thank you!!!!!

I was at rehearsal tonight and started in on one. I took my meds (ergotamine), but was still having the shadow despite all. I had to get through rehearsal for the sake of the rest of the cast. So I started pushing on the carotid artery. I had to keep doing it every once and a while, but it worked! I kept it from getting beyond a Kip2 and made it through the whole rehearsal. Between the meds and this method, I think I will be able to get through any waking attack!!

I am SOOOOOO glad I found this site. I never thought I would be able to deal with this pain again. But with the thoughts of everyone, the knowledge that I am not alone with this pain, and the tools I learn here, I fear it so much less than I did before. Here's to PF days for everyone!!

Title: Re: Carotid Occlusion Method
Post by tidge on Dec 14^th, 2005, 4:45pm

Great to hear Steve

You'll find it also works for toothache while the aspirin is taking effect, which says a lot about the cause of the pain.