Im 40 (male) and my doctor believes i have been experiencing cluster headaches for the first time in my life this past week (about 4 of the past 7 evenings). What is confusing to me is (1) what i need to do to get a formal diagnosis of CH (so i can rule out other possibilities like tumors) and (2) how to find out if viagra is the root cause of my CH headaches (that is my educated guess). Also why i am able to drink alcohol (this seems to be a common CH
trigger)

Hi Mikey. I would ask the dr about having an MRI, and/or other tests to rule out something more sinister.

I would also start keeping a headache diary and ask about seeing a neurologist.
Viagra, being a vasodilator, can trigger clusters.
Alcohol, while the most common trigger (especially for episodics), does not trigger everyone.

pf wishes, nani

"To scan or not to scan in headache
Some patients with primary headaches may need imaging"


"Some life threatening brain disorders present with secondary headache, where the headache is caused by the disease. A brain tumour, for example, is best diagnosed by brain imaging early in the course of the disease, which is essential for optimal management of this and other secondary headache disorders. However, brain tumours, as an example, account for less than 0.1% of the lifetime prevalence of headache.1 This contrasts with the fact that most headaches in the community are either associated with mild systemic infection or due to primary headache,1 where the headache is itself the disorder. Dissecting primary from secondary headache is the problem, since, by definition, primary headache does not need brain imaging because no disease process exists that leads to macroscopic change in general terms.

"How does one dissect primary from secondary headache? This question can have only a clinical response since no controlled trials have been conducted to identify causes of secondary headache. In clinical practice we generally accept that the so called red flags of headache should trigger a search for secondary headache.2 Thus change in the pattern of headache; new onset of headache in people older than 50; onset of seizures or headache associated with systemic illness, including fever; personality change; or with symptoms suggestive of raised intracranial pressure, such as new onset headache in the early morning; or headache that is worsening with coughing, sneezing, or straining should each be viewed with concern. Acute onset of the worst headache of the patient's life should trigger immediate referral for consideration as a sentinel headache of an intracranial aneurysm. An abnormal neurological finding is a clear indication to investigate, unless the finding is longstanding.2 Fortunately most worsening of headache is probably longstanding primary headache going into a more troublesome period, which mercifully is not a marker of a life threatening problem."

Source: BMJ 28 Aug 2004[Not complete article here.]
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"Imaging Strategies"
"For the vast majority of patients presenting with a headache, no imaging studies are necessary. It is estimated that only 1 in 250,000 headaches are secondary to a life-threatening condition compared with the 1 in 11 Americans who suffer from migraines.[3] The US Headache Consortium has recently offered guidelines for imaging.[4] Patients with an abnormal neurologic examination should be considered for imaging along with those presenting with an atypical headache. Magnetic resonance imaging (MRI) and computed tomography (CT) are the usual accepted methods of imaging.

If you suspect Viagra is causal, the only response is to stop using it and see what happens. There are no clinical tests to establish causation.

IF the CH is established to be caused by the med, then you don't have CH. A number of medical conditions can produce "cluster-LIKE" symptoms but the condition is not the brain induced abnormality which we recognize as "primary CH". (True CH is believed to be caused by some disorder of the hypothalamus: exact mechanism not yet understood.)

Hope you are working with a doc who has experience in complex headache disorders. Making the correct Dx is often the major barrier to obtaining effective treatment.

i tried that stuff it gave me headaches, before my ch , then i did alot of testosterone which put me into , ch