PREMATURE ABORTIVE TREATMENT

We are all drawn here to learn and, to a great extent, to share our experiences with coping with CH. The urge to offer relief to people, most especially to the new souls who in the great stress of experiencing the unknown, pushes us to offer our best ideas/experiences on understanding and coping.

With success comes appreciation and inner satisfaction that we have been of benefit.

The concern I'm raising is that we can mislead by offering a solution to the pain which, because it works, may draw the suffer away from exams which would reveal a more serious medical condition. Cluster-LIKE headaches (definition below) often respond to the abortives which we find effective. The subtle clue that this may not be CH is that the action of the abortive is briefer and recurrence of the attack develops more quickly. (Of course, the new sufferer does not have the experience to make this judgment and is primarily in love with the new found relief.)

Very directly: I'm suggesting that we do not recommend specific abortives unless we know that a formal diagnosis of CH has been made. MASKING A MORE SERIOUS PROBLEM IS A GREATER "SIN" THAN NOT OFFERING IMMEDIATE RELIEF TO HEADACHE.
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Cephalalgia. 2010 Apr;30(4):399-412. Epub 2010 Feb 15.

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. federico.mainardi@ulss12.ve.it

Abstract
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]
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Expansion of this idea--

Section, "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache"

We occasionally offend some of our newer guests when we poke prod and question them about HOW they were diagnosed, while stressing the importance of getting to a qualified headache specialist neuro. A good reminder of the harm faulty diagnosis can cause. :-/

Joe

Joe, while I agree with your comment, I don' believe this is the most significant problem.

Too many first timers report their list of symptoms--have not yet seen a doc--and then we respond with suggestions about our favorite treatments--on the assumption that the issue is Cluster.

Suppression of pain can mask non-Cluster problems (Cluster-LIKE...). The relief from pain carries two risks: the assumption that the correct problem has been identifed; and, the loss of motivation to follow thru with a medical work-up.

This pattern is especially common around heart attack. Disregarding symptoms: out of ignorance; denial (it will pass with time/rests/aspirin; and, for women, a symptom picture which is sufficiently different from that of men to reinforce the avoiding of seeking medical attention.

Recall when a brain scan became stanrdard practice re. Cluster? Initial response was, a waste of time, too few problems revealed to justify the expense, etc.

Unless you're the 1% who has an undetected stroke.

IMO, any person that has not been diagnosed by a professional should seek out a neuro or headache 'specialist' asap if they're having severe 'headaches'. The 'regulars' here should try to point that out and press the issue (Which I've seen many times here before). I don't see Undiagnosed people coming here getting advice and someone not telling them to seek out a doctor asap ... not that I can recall anyway.

Besides, not to many people are going to get there hands on an Imitrex injection without a prescription from a doctor.

But I do think you've brought up a good concern.

I4B

All the newbie's i've seen coming here to get advice have
already seen their Doc, had a cat/scan and been given Med's
which ar'nt working. " I'm sure we've all been there." and in
desperation are seeking help. The nickname, " Suicide headache," did'nt just fall out of the sky.  :(

Hoppy wrote on Jun 6^th, 2013 at 1:01am:

All the newbie's i've seen coming here to get advice have already seen their Doc, had a cat/scan and been given Med's which aren't working. " (

Not all, and that's Bob's frustration which I share. Beyond that concern, though, is my belief that CHs are becoming a garbage can diagnosis for docs who are not headache specialists, and are willing to call any pain they can't pigeon hole a cluster. Usually this is coupled with a garbage treatment plan that is really designed around migraines. Not much I can do about that except to argue "your particular line of assault will probably not work if these are CHs." Merely saying "if" can cause tempers to flare. 'Nuff gripin'. Have a pf day, all ya'll! lance