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        Cluster Headache Help and Support >> Cluster Headache Specific >> Diagnosis Questions
        
(Message started by: krkrbts on Oct 17^th, 2006, 1:13am)

Title: Diagnosis Questions
Post by krkrbts on Oct 17^th, 2006, 1:13am

I am going to my general practitionier tomorrow for my headaches- I can't seem to get in to see any neurologists until three or four months from now. Questions:

1) Am I going to have to get a catscan or MRI? I have read that that is not necessary and don't want to take expensive, irrelevant tests.

2) I went to an urgent care clinic and the person there told me that only a neurologist can prescribe Imitrex-I don't bellieve her at all

3)Urgent care gave me fioricet. I told her I had cluster headaches and read that fioricet is for tension headaches-the medicine is making me ill. I think she screwed up. Any thoughts?

Thanks

Title: Re: Diagnosis Questions
Post by TxBasslady on Oct 17^th, 2006, 1:36am

I had an MRI...but it was for my own peace of mind.

You're correct....any doc can prescribe Imitrex.

I wouldn't take any medication that made me ill.

Have you been diagnosed with CH? There are some links to the left of this page. There's valuable info there, and you should print out what you feel you want, and take it with you to the doc's office.

Oxygen is a great abortive for CH. Check out the link..and again, take this info to the doc.

I wish you good luck with your doc. Let us know how the visit went.

Pf vibes,

Jean

Title: Re: Diagnosis Questions
Post by jon019 on Oct 17^th, 2006, 1:56am

Hi krkrbts,

Welcome. Sorry you are here but it IS the best place to be if you have cluster headache.

I have been a clusterhead for 25 years. Never had catscan or MRI but that could have been for a number of reasons. You don't HAVE to do anything, BUT, there could be other reasons for your problems that can be ruled out or discovered. Ask the GP.

Give us a clue on your history and symptoms. Have you been diagnosed with CH? Take the CH quiz on left. There are lots of folks here that can offer advice, encouragement, references, links, a warm shoulder, whatever. Read everything in all the links on the left and follow the threads. There is bound to be something that will help you.

Most of the meds I have ever taken for this were prescribed by my GP. Imitrex ads are all over the place. I don't think it's only neuros prescribing. Sounds llike baloney to me.

You are right about the fiorocet. Won't do anything but make you dopey, sick and STILL suffer the CH.

Let us know how it goes.

Jon

Title: Re: Diagnosis Questions
Post by BikerBob on Oct 17^th, 2006, 2:07am

1) Maybe. I had to have a MRI to rule out brain tumors, aneurisms, etc.

2) Any M.D. can prescribe Imitrex.

3) "I told her I had cluster headaches". Are you sure? Click on cluster traits and cluster quiz on the left of this page. If you have CH, print this and give it to your GP:

http://www.brightok.net/~mnjday/chtherapy.pdf

The general consensus of cluster headache sufferers is that this article is right (in terms of conventional medications) with 3 minor exceptions:

1) In the Oxygen section, 8-10 l/min should be 10-15 l/min

2) Some have found that Zomig (zolmitriptan) nasal spray is better than Imitrex injections due to its longer lasting results.

3) The Expert Opinion section says if melatonin fails then verapamil should be instituted. There is no reason to wait for melatonin to fail. Melatonin and verapamil should both be started together.

BB

Title: Re: Diagnosis Questions
Post by Bob_Johnson on Oct 17^th, 2006, 9:03am

To scan or not to scan in headache
Some patients with primary headaches may need imaging

Some life threatening brain disorders present with secondary headache, where the headache is caused by the disease. A brain tumour, for example, is best diagnosed by brain imaging early in the course of the disease, which is essential for optimal management of this and other secondary headache disorders. However, brain tumours, as an example, account for less than 0.1% of the lifetime prevalence of headache.1 This contrasts with the fact that most headaches in the community are either associated with mild systemic infection or due to primary headache,1 where the headache is itself the disorder. Dissecting primary from secondary headache is the problem, since, by definition, primary headache does not need brain imaging because no disease process exists that leads to macroscopic change in general terms.

How does one dissect primary from secondary headache? This question can have only a clinical response since no controlled trials have been conducted to identify causes of secondary headache. In clinical practice we generally accept that the so called red flags of headache should trigger a search for secondary headache.2 Thus change in the pattern of headache; new onset of headache in people older than 50; onset of seizures or headache associated with systemic illness, including fever; personality change; or with symptoms suggestive of raised intracranial pressure, such as new onset headache in the early morning; or headache that is worsening with coughing, sneezing, or straining should each be viewed with concern. Acute onset of the worst headache of the patient's life should trigger immediate referral for consideration as a sentinel headache of an intracranial aneurysm. An abnormal neurological finding is a clear indication to investigate, unless the finding is longstanding.2 Fortunately most worsening of headache is probably longstanding primary headache going into a more troublesome period, which mercifully is not a marker of a life threatening problem.

BMJ 28 Aug 2004[Not complete article here.]
====================================================================================================
Imaging Strategies
For the vast majority of patients presenting with a headache, no imaging studies are necessary. It is estimated that only 1 in 250,000 headaches are secondary to a life-threatening condition compared with the 1 in 11 Americans who suffer from migraines.[3] The US Headache Consortium has recently offered guidelines for imaging.[4] Patients with an abnormal neurologic examination should be considered for imaging along with those presenting with an atypical headache. Magnetic resonance imaging (MRI) and computed tomography (CT) are the usual accepted methods of imaging. The Consortium has no evidence-based recommendation regarding the "relative sensitivity of MRI as compared with CT in the evaluation of migraine or other nonacute headache."[4] However, MRI is often preferred to look for suspected underlying structural abnormalities, such as tumors, while CT tends to be preferred for diagnosing subarachnoid hemorrhage.

Dr. Unger discussed headaches at the 2003 AAFP Scientific assembly and presented the following "comfort" and "danger" signs as guides for imaging or other additional testing.[5] Comfort signs that are less likely to be associated with a secondary or life-threatening headache include positive family history of migraine, headaches that are menstrually related, those preceded by typical aura, or those that are periodic and stable over time. The clinician should consider additional testing in the presence of any "headache danger signs:" "the worst headache of my life"; sudden onset of a severe "thunderclap" headache; new onset in a patient older than 50 years of age; fever, confusion, or neck stiffness; loss of consciousness or any focal neurologic finding; or any change in headache pattern, such as progressive headaches without any symptom-free intervals. Dr. Darlow also added that the need for reassurance, either for the patient or clinician, is a possible reason to screen.[6]

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