This topic continues to lead to a growing number of reports/recommendations. Of the 8 or so abstracts I have, we now have a 100% agreement that imaging should be done for all new cases.
============================

Curr Opin Neurol. 2009 Jun;22(3):247-53.
Neuroimaging in trigeminal autonomic cephalgias: when, how, and of what?

Wilbrink LA, Ferrari MD, Kruit MC, Haan J.

Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.

PURPOSE OF REVIEW: Trigeminal autonomic cephalgias (TACs) are characterized by frequent, short-lasting headache attacks with ipsilateral facial autonomic features. They include CLUSTER HEADACHE, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. The pathogenesis of TACs is largely unknown, but many case reports in the literature suggest that TACs are secondary to structural lesions. Thus, the question arises whether TAC patients should undergo neuroimaging. Here, we review the recent literature on secondary TACs and attempt to formulate guidelines for neuroimaging. RECENT FINDINGS: Recently, we published two reviews of, in total, 33 case reports of patients with a secondary TAC or TAC-like syndrome. Since then, 23 additional cases have been published. Here, we provide a summary of these 56 case reports. TACs were found to be associated with a wide range of both intracranial and extracranial neurovascular and structural lesions. We could not identify a 'typical' clinical warning profile for secondary TACs as these patients could present with clinical features that are entirely characteristic of a TAC, including alternating attack and attack-free periods, and excellent response to TAC-specific treatments. SUMMARY: EVEN CLINICALLY TYPICAL TACS CAN BE CAUSED BY STRUCTURAL LESIONS. THERE ARE NO 'TYPICAL' WARNING SIGNS OR SYMPTOMS. NEUROIMAGING SHOULD BE CONSIDERED IN ALL PATIENTS WITH TAC OR TAC-LIKE SYNDROMES, NOTABLY IN THOSE WITH ATYPICAL PRESENTATION. DEPENDING ON THE DEGREE OF SUSPICION, ADDITIONAL IMAGING SHOULD BE CONSIDERED ASSESSING INTRACRANIAL AND CERVICAL VASCULATURE, AND THE SELLAR AND PARANASAL REGION.

Publication Types:
Research Support, Non-U.S. Gov't
Review

PMID: 19434790 [PubMed]

I have yet to meet good a neuro who didn't want to see both MRI and MRA imaging before telling me I have Cluster Headaches.

All three of my Neuros insisted that they needed good imaging in order to rule out other potential problems. My latest Neuro in Austin wants to see them done at 10 year intervals as long as I remain chronic - even though I come out 100% clean every time.

Marc wrote on Jul 14^th, 2009 at 11:46am:

even though I come out 100% clean every time.

Marc - Lack of grey matter does not constitute "coming out clean."

Brew wrote on Jul 14^th, 2009 at 1:18pm:

Marc wrote on Jul 14th, 2009 at 11:46am: even though I come out 100% clean every time. Marc - Lack of grey matter does not constitute "coming out clean."

hmm...  does "Negative Brain"?   ;D  ;D
Hey, when the results of those tests show there's nothin in there to have problems with - well - it's gotta be squeaky clean right??  Now it's just whatever's stabbing through my head I gotta worry about.  :-?

Brew wrote on Jul 14^th, 2009 at 1:18pm:

Marc wrote on Jul 14th, 2009 at 11:46am: even though I come out 100% clean every time. Marc - Lack of grey matter does not constitute "coming out clean."

Actually I think it does qualify as squeaky clean!

In fact, the way our Government is going, I think that there is a lot brain washing going on.................

Nicely done, my friend. [smiley=thumbsup.gif]

Marc wrote on Jul 14^th, 2009 at 2:45pm:

Brew wrote on Jul 14th, 2009 at 1:18pm: Marc wrote on Jul 14th, 2009 at 11:46am: even though I come out 100% clean every time. Marc - Lack of grey matter does not constitute "coming out clean." Actually I think it does qualify as squeaky clean! In fact, the way our Government is going, I think that there is a lot brain washing going on.................

The neuro and HA Specialist sent me in for MRIs so the Gov't could Brainwash ME???   :o hmmm   a bit suspect... I think no differently.  Actually I think as little as possible these days... it hurts to think  :-[

[quote]Actually I think it does qualify as squeaky clean!
In fact, the way our Government is going, I think that there is a lot brain washing going on.................[quote]

The very reason one should never leave home without the protection of your Tin Foil hat.
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGESTART PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Cheers
Barry

There are some really great "TFH" pictures around from the original days here at ch.com (Paco's comes to mind) but I will say that:

The RIGHT way to deal with a new Clusterhead potential diagnosis is to get the imaging done - the whole point of Bob's original post.

Even if you have all of the classic symptoms, get it confirmed by ruling out the stuff that can kill you.

Marc

I had imaging done in the late 80's or early 90's.

I'm claustrophobic and I don't think they will ever get me in one awake!  :'(

Do open ones work...they would even bother me! :'(

Can they do them when you are put out?

I think they can give you enough valium so that you don't remember or care that you're claustrophobic.

Brew wrote on Jul 16^th, 2009 at 7:38am:

I think they can give you enough valium so that you don't remember or care that you're claustrophobic.

That's exactly what they did for my Brother-in-law.  He did fine once he stopped caring where he was [smiley=me&mb.gif]

-Dennis-