Posted by Doc Greg on September 24, 1998 at 14:42:17:
In Reply to: Newbie friend questions posted by B. Montgom on September 24, 1998 at 02:18:42:
Some excellent questions from a friend...Let me attack a few
1) Serotonin is involved with cluster headaches...as well as migraines...but simply increasing the amount in the brain does not seem to have any benefit. In fact, blood levels of serotonin are often elevated in people during an attack...but decreased levels are found elsewhere (like in platelets). Why, and what this means, we are only beginning to understand. Lithium has a fairly localized effects with serotonin interaction...unlike SSRIs...though a number of effects elsewhere. Imitrex, which is a seroronin agonist, only acts at one of many serotonin receptors (5ht1D), but not at others (Receptors are where a chemical binds...different sites in the body have different receptors...). So far, use of SSRI (the antidepressent medications) has not been shown effective in the treatment of clusters.
2) Histamine is also related...somehow. Injecting histamine in a person with a history of clusters will almost certainly induce a headache. But the use of antihistamines has been shown not very effective. Histamine also binds at multiple receptors...but 2 mainly H1 and H2. H1 blockers are what many people take for allergies...as H1 receptors are located in parts of the body usually associated with allergic reactions. H2 blockers are located in the stomach and produce acid...which is why people can take H2 blockers for acid reflux (pepcid, axid, etc). Taking both H1 and H2 blockers does not seem to help clusters eather.
3) Environmental factors, are, without a doubt, involved. 50+ percent of people with clusters get headaches after drinking alcohol, for example. Finding triggers, and eliminating them, can often be very helpful...but far from the solution. There may be triggers yet to be identified, but I have never met anyone who has been able to eliminate enough triggers to get their headaches to go completely away.
4) Lidocaine nasal drops is an acute, temporary solution for a headache. They have no theraputic effect other than pain relief, and will not break a cluster. Limited efficacy in the acute attack, but some people find it very usefull. If it works for your friend...great. If not, find something else.
Again, good questions. May I suggest to you that you read the excellent review article posted on this web site. It covers just about all of this and much more.
I'm sorry their is another person joining the ranks of people suffering from cluster. Nice that he/she has a good friend looking out for him. Hope some of this helped.