Posted by John R (24.4.254.3) on January 16, 2000 at 10:36:58:
In Reply to: Hey Ted - let's put it another way.................. posted by Jack Boyd on January 16, 2000 at 09:24:37:
1.1) "Pharmeceutically controlled chronic with episodic-type break-throughs." This is where you would get the headaches every day except that the medication--like verapamil, lithium, Sansert, prednisone--is is keeping them at bay. Still get shadows and the odd headache so know your still "chronic" of some sort. Eventually the current medicine stops working so you have an "episode" that lasts from days to months of trying to get another drug(s) to control them again for a while.
1.2) "Intractable chronic," where nothing works at all. I can't imagine not having a break at all. I thought I was an unfortunate one as a "chronic", but I was really a "pharmeceutically contolled chronic with episodic breakthroughs." Then I came here and read of some of you who go for years & decades with headaches day after day.
Any of categories 1) through 3) or whatever, but with a subcategory of "XA" and "XB" and "XC."
For expamle, there could be three clusterheads out there who have never had a day with no headaches, but one of them can almost always abort one with either oxygen or Imetrix if he/she catches it soon enough. He/she would be a "1.1A." Or "intractable chronic with fully abortive headaches." (Is there a word "abortable?")
The second is able to stop about half of the headaches with some sort of abortive treatment if started at beginning of headache. This sufferer would be a "1.1B." Or "intractable chronic with moderately abortive headaches."
The third poor kid has to suffer through each one and has found oxygen, Imetrix, cold air, rapid exercise at onset, etc to all be ineffective in stopping any headaches. This would be "1.1C." Or "intractable chronic with fully non-abortive headaches."
Types 2) and 3) could also be broken down those ways. Someone could clean up my spelling and logic a bit to put together a better classification system, but you see what I'm getting at.
There could be other sub-categories, also. Like suicidal or non-suicidal. BTW, I saw at some site for doctors treating clusterheads, that there was a section in the article that was titled something like "Legal Issues to Consider" which meant "watch out for a malpractice suit." One of the things in that category was to be sure to find out if the cluster headaches were making the patient suicidal. Presumably, family members of clusterheads who killed themselves could sue a doctor for not referring the poor sucker to someone for treatment of depression.
None of my doctors has asked if I was depressed. Anyone else's? Of course, I've never been seriously suicidaly once an actual headache was over, even if I knew there were several more to go through that night. I think I would have if my first year or two of chronic headaches had been 9's instead of 7's. (Actually, I think my very first headaches were even less than 7's. And I was already diagnosed and seeking treatment for the right ailment a couple of years later when they got up into 7's and above.) The ones that fully blossom now go to the 9 range right away. But I think I'm finally episodic now. Yippee!!! Last headache 12/30/99. Last Sansert 1/10/00. Now only taking feverfew and doing the capsaicin in the nostril thing.