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Is this cluster? (Read 780 times)
Sophy
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Is this cluster?
Jan 8th, 2013 at 5:30am
 
Hello everyone Smiley!
It's my first post on this forum (please, forgive the english mistakes, i'm not a native speaker).

So first of all a little introduction: I'm an 18 years old female, from France, who's been recently diagnosed with cluster headaches. I know doctors are doctors and they are way more qualified than I am at diagnosing diseases, but I'm starting to have my doubts about how accurate the diagnosis actually is.

I have been reading quite a lot about clusters, and I realized that I didn't get all of the symptoms, and even if I did, it was very mild and not as visible as most people would describe it. For example, my eye does get redder during an attack, and starts tearing a bit, and my nose gets a bit runny, but it's very mild. It isn't bright red and my eyelid doesn't drop. I don't sweat a lot either. I almost look normal during an attack.
Does anyone also have this? Cluster pain, without excessive tearing or droppy eyelid?

I do get the excruciating pain though, several times a day (well used to), and I am rather agitated during my attacks.

But my main worry has to do with the fact that I am ALWAYS in pain. The attacks come and go, but the "shadows" always remain. I always feel some kind of pressure on my eye, and on my cheek, and sometimes even on my ear and teeth.

My neurologist prescribed me some Verapamil (Isoptine? Not sure how you call it in the US Wink) and some Imitrex shots for my attacks. The Imitrex shots does abort the attacks and the Isoptine greatly reduced the attacks frequency and strength (is that normal? That I now get some "baby clusters"? They feel like a cluster but waaaaaaaaaaaaay more bearable). But the medication haven't helped with the shadow one bit.

So I am wondering, was I misdiagnosed? Could it be clusters AND something else? Does anyone else show this weird combination of symptoms, that do not exactly fit in the cluster definition?

Well, thanks a lot to anyone who takes the time to read this post (kind of long... Sorry!) and tries to help me Smiley

Bye, have a very good day!

PS: I am seeing my neurologist again in a week, so I guess I'll know for sure then Wink But I was just kinda worried about it all, so I decided I'd check first with experienced people Smiley
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Bob Johnson
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Re: Is this cluster?
Reply #1 - Jan 8th, 2013 at 9:08am
 
We can't diagnose but can offer a few observations.

With a newly developing Cluster picture variations in the various symptoms is quite common. It may take months before a stable picture develops and this can be confusing both for the doctor and patient. Secondlyl, adjustments in your medications, especially the preventive, Verapamil, is very common. Dose changes are the norm.

At this stage, try and be patient, work closely with your doctor. Again, it will take some weeks/months before stability develops.

But read and educate yourself in the meanwhile.


Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
====

Three sites which are worth your attention: medical literature, films, plus the expected information
about CH.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register
------

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register Search under "cluster headache"
-------
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register
  Full of articles, blogs, book: written by one of the best headache docs in the Chicago area.
  Worth exploring. The latest book is in e-book edition, $10; comprehensive and worth buying for
  a careful read.

And explore the extensive reading material on this site.
======
Print the PDF file, below. Give your doc a copy and then use it as a tool to discuss treatment options with him.
===
Finally: patience! This is a complex disorder and changes in treatments is common before the picture becomes stable.


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Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register (96 KB | 16 )

Bob Johnson
 
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We have members of this board who suffer from TMJ
Reply #2 - Jan 8th, 2013 at 9:38am
 
What Bob said! I'm almost 53, my clusters started in my late teens, I wasn't diagnosed until my early 20's. In my teens they were never all that severe, and really didn't start a discernable pattern until my 20's.

Could you be suffering from 2 different headache types? Absolutely. We have people on this site who have CH and other headache types like migrain. That's why it's so important to work closely with a headache specialist neuro. Continue to educate yourself with the materials Bob gave you. If you're not already keeping a headache diary I'd suggest you start it. The more details the better, this is a valuable tool in diagnosing, especially with the potential of multiple headache types.


Hang in there, the early stages can be the toughest while you work through the diagnostic journey. We'll be here to help any way we can.

joe
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Sophy
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Re: Is this cluster?
Reply #3 - Jan 8th, 2013 at 11:02am
 
Thanks a lot to both of you for answering and your precious info Smiley

I read the article, and it sure helped reassuring me Smiley. I had no idea some people didn't even have the dysautonomic symptoms, and still were diagnosed with "cluster headaches": I guess I fall into this category, with very subtle physical symptoms!

Anyway, I guess we'll see with the neuro, and the headache diary sure sounds like a good idea (I have migrains too, but they in no way resemble the cluster headaches Wink ).
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« Last Edit: Jan 8th, 2013 at 11:11am by Sophy »  
 
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