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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> New to CH - have many questions
        
(Message started by: sistersue on Aug 26^th, 2007, 4:07pm)

Title: New to CH - have many questions
Post by sistersue on Aug 26^th, 2007, 4:07pm

My friend had severe pain in his left sinus next to the nose for several months before his first CH bout, which lasted about 10 weeks. Is this sinus pain common? He was on many antibiotics which didn't work. Now that the "CH bout" is over he still has this severe sinus pain on the CH side. He has to use Lidocaine spray every day. He's also now on Verapamil. There's no more CH attacks, but this daily sinus pain. Is this sinus pain what is called a "shadow?" Any opinions are welcome.

Title: Re: New to CH - have many questions
Post by Ray on Aug 26^th, 2007, 4:18pm

It's complicated. It could be that there's a sinus problem and CH. Shadows to me are the feeling like a major CH is only a few minutes away, however the big "hit" does not come. More anxiety producing than pain producing. I hope this helps.

With regards,

Ray

Title: Re: New to CH - have many questions
Post by brauer100 on Aug 26^th, 2007, 4:23pm

Is the "sinus" pain on the same side as the clusters? The trigeminal nerve, which causes cluster headaches, affects three primary regions--the eye area, the nasal area, and the jaw. The sinuses can easily get mixed in with that configuration, especially the area between the eye and the nose.

From my experience, I'd say it's probably just the shadows of cluster pain. I was always diagnosed with sinusitus for years and years, but it turns out my sinuses are fine.

Your friend might want to push his doctor for a CT scan of his sinuses. Certainly his medical history warrants it, and his insurance would likely cover most of the costs, if he has good coverage (it would be something he might want to check first). It is a conclusive way to tell once and for all if his sinuses are actually involved. Mistreating CH as sinusitus is really common, and can be detrimental because the medications for sinusitus can potentially just cause rebound and not help with CH at all anyway. I was told I had sinusitus for 20+ years and given medicines ad nauseum for it before a CT scan of my sinuses showed no inflammation at all.

Just a thought.

Kate

Title: Re: New to CH - have many questions
Post by sistersue on Aug 26^th, 2007, 4:56pm

Kate, you gave a good answer. He already has had CT sinus scans and an MRI of his head. He's going to an ENT specialist tomorrow to find out once and for all if it's sinus or CH shadows. My main question for everyone here is: Has anyone had sinus pain next to the nose as the only symptom of a "shadow?" He sprays lidocaine and it gets rid of the pain and no CH "hit" for about 3 weeks now. Thanks for answers. Also, the answer about the trigeminal nerve causing CH is very interesting. I always thought it was true and it's good to hear someone actually say it.

Title: Re: New to CH - have many questions
Post by chewy on Aug 26^th, 2007, 4:57pm

Sounds like a sinus infection seperate from CH that would probably worsen during a cycle.

Title: Re: New to CH - have many questions
Post by cash5542 on Aug 26^th, 2007, 8:50pm

My daughter (she's 22) has had sinus issues as long as I could remember. Last year the CH began and the hits were always on the same area where her sinus hurt. Her MRI showed a totally blocked sinus with major issues. The hits kept coming while we waited for surgery. She had it done in Dec. and I was hoping that would stop the CH but it didn't. What did happen was less pain with the hits. The trigeminal nerve was so close to the infected sinus that it did cause issues. She said before surgery she felt like she was having shadows all of the time. In hind sight, it was the sinus. I'm glad you are following through with an ENT.

Charlotte

Correction: It was a CtT Scan, not MRI

Title: Re: New to CH - have many questions
Post by MJ on Aug 27^th, 2007, 12:37am

sistersue.

Hi

Myself and I believe most others dont experience sinus pain on a continual basis. I would be hesitant to call that a shadow.
The vast majority of CH sufferers do experience sinus issues just prior and during an attack. This tends to go away when the attack is over.

There is a thing called intra nasal contact point headache that can sometimes be the trigger of real clusters. An ENT should be able to spot this.

I would however ask for proof if he does spot some point contact as many clusterheads have been treated needlessly for this.

Just something to look at: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=8924166&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

[3-year follow-up after endonasal microscopic paranasal sinus surgery in migraine and cluster headache][Article in German]

Welge-Lüssen A, Hauser R, Probst R.
HNO-Universitätsklinik, Basel, Schweiz.

BACKGROUND: Migraine and cluster headache can both be triggered by sensitive intranasal areas. METHODS: Endoscopic nasal surgery was performed in 20 patients with chronic migraine without aura or cluster headaches that were refractory to other forms of treatment for a mean period of 18 years (range of 1-45 years). The selected patients showed clinical and radiographic evidence of contact between the middle turbinate and the nasal septum. All patients experienced immediate relief of pain following topical application of cocaine to the presumable triggering area. Five patients with cluster headache and 15 patients with migraine were treated. RESULTS: All patients with cluster headache were free of symptoms after surgical intervention and for a mean follow-up period of three years. Six of the 15 patients with migraine were completely free of symptoms after a mean follow-up period of three years; five had improved more than 50% in the duration and frequency of their attacks. Treatment was unsuccessful in four patients. CONCLUSION: This trial established a likely relationship between nasal trigger areas and cluster headache through the trigeminovascular system and a possible relationship to some type of migraine without aura.

PMID: 8924166 [PubMed - indexed for MEDLINE]

Title: Re: New to CH - have many questions
Post by sistersue on Aug 27^th, 2007, 2:23am

All I can say is "thank you" for the answers, especially the last one.