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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Carotidynia, brain damage and meds
        
(Message started by: violet on Jan 23^rd, 2004, 12:36pm)

Title: Carotidynia, brain damage and meds
Post by violet on Jan 23^rd, 2004, 12:36pm

I have spasms in my left carotid. I have also had 2 small strokes to my left occipital lobe. I was "fortunate" enough to have an allergic reaction to the dye in the MRA/MRI I was having and I had a vaso spasm right there on the table while I was getting the MRI. My Neuros thought that this was very interesting, and I had to have a CAT Angio and a bunch of other MRI's to check it out afterward. (I refused the catheter angio, as they are HIDEOUSLY PAINFUL!)
According to my Neuro's, I just have spasms there, and I have to learn to live with it. They give me Verapamil and dyperidimole (spell?) to keep the arteries more stable, and I use O2 and nitro tablets (yes...I know...ouch) to prevent anymore constricting, TIA's and strokes. The Verapamil has really helped the clusters, but this thing in my neck really freaks me out and I wish I knew more about it. I also have 2 herniated discs in my neck, and even though the Neuros promise me that they aren't affecting the artery, I don't believe them. I have a floor traction unit I use for physical therapy when my neck gets really screwed up, and when I use it, I get a cluster.
Any feedback?
Thanks,
Vi

Title: Re: Carotidynia, brain damage and meds
Post by thomas on Jan 23^rd, 2004, 12:43pm

on 01/23/04 at 12:36:20, violet wrote:

Any feedback?

Yeah, owwwwwwwww. I'm am so sorry that you are going through so much right now........ I can't help you with and medical advice, but know that I am thinking about your suffering....... :(

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 23^rd, 2004, 1:42pm

Have you been checked for paroxysmal hemicrania ?? The symptoms are similar to cluster headache, it is associated with carotidynia, and it is treatable with indomethacin. The fact that you have a neck injury, and that the traction machine triggers a headache suggests cervicogenic headache that resembles a cluster, not a true cluster.

Quote:

Rev Neurol. 1999 Dec 1-15; 29(11): 1054-5.

[Carotidynia as a form of presentation of paraxysmal hemicrania]

INTRODUCTION: Paroxysmal hemicrania is a well-defined clinical condition about which many articles have been published. Attempts have been made to explain the response of this illness to indomethacin, suggesting its possible cervical origin. In some patients it is set off by stimulation of certain trigger zones situated in this region. The exceptional radiation of the pain seen in our patient clearly supports this theory. CLINICAL CASE: A 34 year old man with a past history of a similar but briefer episode 5 years previously presented to us. He complained of repeated episodes of stabbing pain with no obvious cause. The pain started at the base of the neck and radiated along the right carotid vessels to the cheek, base of the nose and ipsilateral eye. This was accompanied by injection of the conjunctivae, tears, nasal congestion and nasal discharge. Each episode lasted 15 to 30 minutes and was repeated 20 to 25 times a day without any particular relation to the time of day. The neurological examination, MR and angio-MR were normal. Before being seen by us he had been treated with prednisone and verpamil without effect. Indomethacin at a dose of 100 mg/day controlled the problem completely. CONCLUSIONS: We report a case of paroxysmal hemicrania with a spontaneous description of pain starting at the base of the neck and radiating along the carotid vessels. We consider this clinical description to be of interest since it supports the theories of a cervicogenic origin of this type of headache.

Note that the person described above was on verapamil and prednisone (ie, probably misdiagnosed as cluster headaches), but that didn't help.

Quote:

J Neurol. 2003 Nov; 250(11): 1273-8. Headaches with (ipsilateral) autonomic symptoms.

Primary short-lasting headaches broadly divide themselves into those associated with autonomic symptoms, so called trigemino-autonomic cephalgias (TACs), and those with little autonomic syndromes. The trigeminoautonomic cephalgias include cluster headache and paroxysmal hemicranias, in which head pain and cranial autonomic symptoms are prominent. The most striking feature of cluster headache is the circadian and circannual periodicity of the attacks. Inheritance may play a role in some families. The attacks are of extreme intensity, of short duration, occur unilaterally, and are accompanied by symptoms of autonomic dysfunction. Medical treatment includes both acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period. Some types of trigemino-autonomic headaches, such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indomethacin, leading to a consideration of indomethacin-sensitive headaches.

Title: Re: Carotidynia, brain damage and meds
Post by violet on Jan 23^rd, 2004, 2:10pm

I don't always have my clusters when I am having neck pain. I have been diagnosed with clusters by a neuro at the Mayo clinic.
Vi

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 23^rd, 2004, 2:58pm

Quote:

I don't always have my clusters when I am having neck pain. I have been diagnosed with clusters by a neuro at the Mayo clinic.

Ok, but you also said:

Quote:

I also have 2 herniated discs in my neck, and even though the Neuros promise me that they aren't affecting the artery, I don't believe them. I have a floor traction unit I use for physical therapy when my neck gets really screwed up, and when I use it, I get a cluster.

That sounds like you believe you get cervicogenic headaches ("originating in the neck"). More than one doctor has mislabeled PH or CPH as CH. Some doctors consider PH to be a form of cluster headache, others consider it to be a separate but related disease. The important thing in getting an accurate diagnosis is that the treatments are very different - and very effective for PH/CPH.

Do you know how they ruled out a diagnosis of paroxysmal hemicrania? Did they do the INDOTEST?? (see below) Did they rule the posibility that you have both CH and PH?? Maybe a pinched nerve triggers a cluster for you, but chances are good that it could be the related PH. Maybe your neuro was very thorough and ruled out PH for good reason (I won't second guess em when I have so little info), but your questions raise a big yellow flag that say "paroxysmal hemicrania???????"

Is your pattern episodic with strong calendar influence, episodic with weak calendar influence, chronic, or intermittent and unpredictable?

Quote:

Cephalalgia. 2003 Apr; 23(3): 193-6. Parenteral indomethacin (the INDOTEST) in cluster headache.

The interval between indomethacin administration and clinical response may be extremely relevant in the assessment of chronic paroxysmal hemicrania (CPH) and other unilateral headache disorders like cluster headache (CH), with which CPH can be confounded. Indomethacin is inactive in CH; however, in some anecdotal reports in recent years, doubt has been cast on the ineffectiveness of indomethacin in CH. In this study, we have re-assessed the effect of indomethacin treatment in a group of 18 patients with episodic CH (three females and 15 males). From the day 8 of the active period, indomethacin 100 mg i.m. was administered every 12 h, for 2 consecutive days, in an open fashion. The mean daily attack frequency before the test (1.6 +/- 0.6) was not statistically different from that on day 1 (2.1 +/- 0.9) and day 2 (1.9 +/- 0.8) after indomethacin administration. The mean interval between indomethacin injection and the following attack (day 1 and day 2) was 4.6 + 1.1 h. We did not observe any refractory period in any patient after indomethacin. Since the 'expected' attack occurred when there theoretically could have been a protective effect after indomethacin administration, it can be reasonably assumed that there is no such protective effect. The use of a test dose of 100 mg i.m. indomethacin (INDOTEST) appears to provide a clear-cut answer in this situation. It may be a useful tool for a proper clinical assessment of unilateral headache with relatively short-lasting attacks when problems of classification arise. A correct diagnosis of CPH or CH is important, since a CPH diagnosis may imply a lifelong treatment with a potentially noxious drug.

Title: vasospasm and magnesium
Post by floridian on Jan 23^rd, 2004, 3:26pm

Vi,

you also might want to consider magnesium for the vasospasm. There is some evidence that it helps with that condition. It has also been shown to help with clusters (about 40% of patients responded to it in one study).

Title: Re: Carotidynia, brain damage and meds
Post by violet on Jan 23^rd, 2004, 6:07pm

My Neuros are saying that the neck difficulties are completly seperate from the clusters, and the carotidynia. I have seen umpteen neuurosurgeons, and several migraine specialists, and stroke experts ( as I have had 2 strokes from vaso constriction, and not blood clots), and they tell me that I have clusters, carotidynia, and the 2 herniated discs, but that they are all seperate. I've been really happy with my evaluation and treatment from the Mayo clinic, and I don't really doubt my doctors there, but I think that it is wierd that when I go into my neck traction unit, I have one sided numbness, dizzyness, and hideous jaw and face pain. Maybe that is seperate from the clusters and carotidynia. I don't know. They say it is, but you know how so many syptoms can seem alike.
It can be really confusing. My clusters are episodic with a strong calendar influence.
Vi

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 23^rd, 2004, 7:15pm

The strong calendar influence does points to clusters. It may well be that the two types of pain are not related, or that a pinched nerve can trigger a cluster. The beast (and his many cousins) are wiley, but they are not invincible. Hoping that you find pain free days and nights.

Title: Re: Carotidynia, brain damage and meds
Post by violet on Jan 24^th, 2004, 12:28pm

Thank you Floridian for your consideration and great information.
Vi

Title: Re: Carotidynia, brain damage and meds
Post by henzey on Jan 24^th, 2004, 6:01pm

I sure do feel for you having these spasms!! Sounds just awful. I appreciate you sharing this because sometimes I get major spasms in various parts of tmy body when I am really anxious....and it appears that there is a strong connection between anxiety disorder and clusters (especially for us females). Hang in there and let's hope that we are close to getting some insight into how how this fits together....

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 25^th, 2004, 10:52am

Vi,

here's an article that links carotid disease with clusters. In this case, it was a type of cancer around the carotid artery, but I don't see why other types of carotid irritation might not cause the same. Not suggesting that you have cancer - just pointing out there can be a link between the carotid and clusters.

Quote:

J Neurol. 1989 Oct; 236(7): 430-1. Pericarotid cluster headache.

Cluster headache is generally not associated with recognised disease, and the pathogenesis remains unclear. The onset of typical cluster headaches is reported in a patient with nasopharyngeal carcinoma. The tumor encircled the internal carotid artery but did not extend intracranially. It thus appears possible that cluster headaches may be triggered by processes involving the carotid artery.

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 25^th, 2004, 11:22am

Another article showing a link between the carotid and clusters.

Quote:

Cephalalgia. 1992 Oct; 12(5): 280-3.
Vasoreactivity of the intracranial internal carotid artery.

The vasoreactivity of the intracranial segment of the internal carotid artery to transmitters, present in the perivascular sympathetic, parasympathetic and sensory nerves, as well as to other vasoactive agents of relevance for headache, was tested in man and monkey. The total arterial segment from both species is equipped with contractile receptors for noradrenaline, serotonin, prostaglandin F2 alpha, ergotamine and sumatriptan. Further, the total arterial segment dilated upon exposure to calcitonin gene-related peptide in both species. Other vascoactive transmitters, acetylcholine, substance P and neurokinin A, caused only weak dilatation, restricted to the proximal extracavernous segment in the monkey. The findings are discussed in relation to the pathogenesis and treatment of cluster headache.

Title: Re: Carotidynia, brain damage and meds
Post by violet on Jan 25^th, 2004, 12:33pm

Floridian,
That's really interesting, and I will mention it to my neuro. Thank you again Floridian, for your time and energy! It is was really nice of you to go to the trouble to find that information for me. It's greatly appreciated.
Vi

Title: Re: Carotidynia, brain damage and meds
Post by brad267 on Jan 25^th, 2004, 2:26pm

Floridian,

Where do you find this info? And more importantly, how come you understand it??? LOL

It's all greek to me,
Brad

Title: Re: Carotidynia, brain damage and meds
Post by floridian on Jan 25^th, 2004, 5:01pm

My main source of info is Pubmed: http://www.ncbi.nlm.nih.gov/PubMed/

I have an education and some work experience in biology (microbiology and plant physiology). I have also been doing a lot of digging on clusters in the past few years - got tired of the beast and started to take it personally.