been dealing with CH for the last 5yrs untreated, but this year when it started like it always does around mid-November, the timing during the day was completely random instead of 9am on the dot like usual.  But when it did, 45min of pacing around the office wanting to rip my hair out and bang my head on the wall and im fine again.  BTW, does anyone notice that they have to burp alot after an attack?  Maybe its just the excess deep breathing i end up doing.

Anyway, so that session ends in a timely 5 weeks like normal, but now in the last few weeks (2 months later) ive been noticing very mild CH sensations on the opposite side of my head (left side).  This has never happened before, and to this point all of my CH happen on the right side, once a year, for 5 weeks.  I wouldnt rate these left-side CHs any more than an annoyance...not debilitating like the normal ones, and they're gone in 15min.

have others noticed this happen at all?  Its been a week sofar, so im just hoping they dont escalate into the garden variety i-want-to-smash-my-head-in CH :) 

also, as a final question...my fiancee's father has had a brain aneurysm but was taken to the hospital in time and has made a full recovery.  Anyway, she gets completely freaked out when i have my normal CH session...always wanting me to go to the hospital and get an MRI or such since the symptoms are very similar to what her father went through.  Is there any benefit to getting an MRI?  I am fully aware that its not an aneurysm, but didnt know if there would be anything interesting show up or not, and id like to calm her nerves a bit.

Thanks,

Doug

Doug, You probably should have had an MRI done after your initital apt with the neruologist or dr. to rule out anything bad like anuyrism or tumor.  Then on to get your diagnosis of ch once everything else was ruled out.  If so, no need for an MRI now.  But if you didn't get an MRI now that your years into your ch I really dont know what to say if you havent had one.  Let your dr. know that your ha are changing some (left side vs right side and time of year) and ask for an MRI at this time might be ideal.  Talk to your dr about why he never gave you an MRI it may put your mind to ease and hers as well.

I have heard of a very small number of people, like count on one hand, that burp after a ch.  Yes, ch can and does switch sides.  It is not a fact that it is going to happen.  But it can.  I would not be allarmed by it.  However, as I mentioned earlier any change in your ha should be reported to your dr and discused.  But my guess is this is just normal ch and the beast is morphing again to cause you more pain. 

Years ago, the expression was "nervous stomach", to note the disgestive changes which come when we are under stress. No significance.

CH changing side is not uncommon and has no medical significance unless the change is to pain both both sides: this may be associated with movement to chronic cluster.

Re. brain scan: there is a growing  level of recommendation to have a scan even as data show very low risk of finding anything. I think you are in your doc's hands on the question.

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]
============

: Curr Pain Headache Rep. 2008 Apr;12(2):128-31.
Cluster headache: to scan or not to scan.

Favier I, Haan J, Ferrari MD.

Department of Neurology, K5-Q, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands. i.favier@lumc.nl

By definition, cluster headache (CH) is not caused by underlying structural pathology. However, patients with CH or CH-like syndromes and an associated structural lesion have been described. In many cases it is difficult to establish a causal relation between the headache syndrome and the lesion. We reviewed the literature for symptomatic CH or CH-like cases in which causality was very likely, and we found that even typical CH with a typical episodic time pattern and a response to typical CH treatment can be caused by underlying structural pathology such as a pituitary tumor. Based on this small retrospective series of case reports, it is impossible to give advice about neuroimaging.

IF NEUROIMAGING IS CONSIDERED, MRI (NOT CT) IS THE INVESTIGATION OF CHOICE.

PMID: 18474193 [PubMed]