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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Image or not? Recurring issue.
        
(Message started by: Bob_Johnson on Feb 28^th, 2008, 8:30am)

Title: Image or not? Recurring issue.
Post by Bob_Johnson on Feb 28^th, 2008, 8:30am

The value/wisdom of having a head scan is a recurring question we all face. The material I have suggests that the chances of finding some pathology in our brain is quite small, making the expense more an issue of defensive medicine rather than clinical need.

Knowing the exceptions is the skill of medicine! There are times when imaging is a first order response and makes it the more important to have a good headache doc "on staff". This abstract points to one of the exceptional times: a CH which does not respond to the usual treatments says: a second opinion is needful and more detailed diagnostic work (always keeping in mind--there is no 100% in medicine.)
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Headache. 2008 Mar;48(3):467-70. Epub 2008 Jan 11.
Cluster headache and internal carotid artery dissection: two cases and review of the literature.

Rigamonti A, Iurlaro S, Reganati P, Zilioli A, Agostoni E.

Department of Neurology, Ospedale A. Manzoni, Lecco, Italy.

We describe 2 patients with cluster headache attacks associated with a dissection [tear] of the ipsilateral internal carotid artery at the extra-intracranial passage. These cases highlight the need for extensive neuroradiological investigation in cluster headache patients when atypical features are present. We also performed a PubMed search to review the current literature data about this association.

PMID: 18194296 [PubMed]

Title: Re: Image or not? Recurring issue.
Post by danielpeterson on Feb 28^th, 2008, 3:15pm

The chances of finding some structural abnormality in our heads is quite small... THAT is why I have said that psychosomatic is not a dirty word. It simpy means that the psyche/mind is connected to the soma/body. Doctors OFTEN can't find a physical reason for a pain.
THAT is why I AM trying to think outside the box. I still get my ole cluster headaches but they aren't as severe as when the doctors were trying to give me "stuff" for a condition they were not clear about.

Title: Re: Image or not? Recurring issue.
Post by MJ on Feb 29^th, 2008, 12:19am

Its maybe not a bad idea for those that are new at this (including the docs) to have an imaging done if some uncertainty exists.

For those docs who order these up every year they should have their skills, ethics and pocketbooks imaged.

There are exceptions as you show but they would seem a bit more obvious.