Yet another report on the need to work with a headache specialist if we are to obtain optimal treatment. A secondary lesson: use of abortives BEFORE a diagnosis is made can mislead the physician by masking important clinical signs.
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Cephalalgia. 2009 Sep 7. 
Cluster-like headache. A comprehensive reappraisal.

Mainardi F, Trucco M, Maggioni F, Palestini C, Dainese F, Zanchin G.

Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venice, Italy.

Among the primary headaches, cluster headache (CH) presents very particular features allowing a relatively easy diagnosis based on criteria listed in Chapter 3 of the International Classification of Headache Disorders (ICHD-II). HOWEVER, AS IN ALL PRIMARY HEADACHES, POSSIBLE UNDERLYING CAUSAL CONDITIONS MUST BE EXCLUDED TO RULE OUT A SECONDARY CLUSTER-LIKE HEADACHE (CLH). The observation of some cases with clinical features mimicking primary CH, but of secondary origin, led us to perform an extended review of CLH reports in the literature. We identified 156 CLH cases published from 1975 to 2008. The more frequent pathologies in association with CLH were the vascular ones (38.5%, n = 57), followed by tumours (25.7%, n = 38) and inflammatory infectious diseases (13.5%, n = 20). Eighty were excluded from further analysis, because of inadequate information. The remaining 76 were divided into two groups: those that satisfied the ICHD-II diagnostic criteria for CH, 'fulfilling' group (F), n = 38; and those with a symptomatology in disagreement with one or more ICHD-II criteria, 'not fulfilling' group (NF), n = 38. Among the aims of this study was the possible identification of clinical features leading to the suspicion of a symptomatic origin. In the differential diagnosis with CH, red flags resulted both for F and NF, older age at onset; for NF, abnormal neurological/general examination (73.6%), duration (34.2%), frequency (15.8%) and localization (10.5%) of the attacks. WE STRESS THE FACT THAT, ON FIRST OBSERVATION, 50% OF CLH PRESENTED AS F CASES, PERFECTLY MIMICKING CH. THEREFORE, THE IMPORTANCE OF ACCURATE, CLINICAL EVALUATION AND OF NEUROIMAGING CANNOT BE OVERESTIMATED.

PMID: 19735480 [PubMed]

Bob Johnson wrote on Oct 5^th, 2009 at 7:42am:

A secondary lesson: use of abortives BEFORE a diagnosis is made can mislead the physician by masking important clinical signs.

I'm not quite sure I follow you on that one Bob.  What abortives are you referring to?  And how is this secondary lession derived from the study quoted?

-Dennis-

WOW! Bob  thats interesting..
   Had to read it 3 times to understand it ....but interesting.
   Kind of scarry given the number of doctors out there, that misdiagnose CH.   Wonder how many people with tumors, inflamatory, etc go to long without help  :o

   thanks for the info.    lorac

My Neuro's have always wanted imaging to rule out the potentially deadly stuff.

It's expensive for insurance companies, but as the potential list of problems was explained to me - kinda glad I did!

Quite aside from looking for tumors, while performing an MRA of the head, the carotid arteries can easily be imaged at the same time. Artial blockage there can mimic CH's and also indicate potential coronary arterial blockage. Wouldn't want to start slamming Triptans under those conditions.

Marc

Marc wrote on Oct 5^th, 2009 at 3:32pm:

My Neuro's have always wanted imaging to rule out the potentially deadly stuff. It's expensive for insurance companies, but as the potential list of problems was explained to me - kinda glad I did! Quite aside from looking for tumors, while performing an MRA of the head, the carotid arteries can easily be imaged at the same time. Artial blockage there can mimic CH's and also indicate potential coronary arterial blockage. Wouldn't want to start slamming Triptans under those conditions. Marc

As a side shoot to the MRI that was done on me it was discovered that I hve a bone chip in my spine near the base of my scull & very close to the spinal cord, in the postition it is there isnt any problems but befor I get any Chyro or Physio manipulation done they have to be aware of the situation.

Cheers
Barry

Dennis, it's an old rule when treating head injuries: don't give morphine, etc. for pain because the med suppresses neurological signs needed to make a good Dx.

Basic idea is to let the doc see the full range/degree,etc. of the problem.

And then watch your Neuro's face when he/she actually sees a high level hit in action. That will become a good part of their education into the world of CH's.

Marc