Hi folks.  Have had these a few times before, maybe 3 cycles in the last 10 years but OMG did they hit hard about 6 weeks ago.  They have totally broken me.  My GP has perscribed the Axert, which only worked for a couple attacks then nothing.  Tried the Verapamil (120mg) but the side effects were very bad.  Have done alot of reading on this site the last couple of weeks but I didn't see anything about upper molar pain and extreme sensitivity to pressure, hot & cold.  Can anyone tell me if this is all part of CH?  This website has been very helpfull.  I find you have to go into your GP's office with alot of amunition before they realize that you will do anything it takes to find which treatment is right for you.  Thank- you CH.COM!!!!!
Randy.....Chatham, Ontario, Canada.

Yup! That nerve runs along your jaw, many people have had teeth pulled trying to alleviate the pain.

Talk to your doctor about a 2 pronged approach:

1: A good prevent medication. A med you takes daily to reduce the number and pain level of your attacks. Verapamil, lithium and topomax are great starts to discuss with the doc. Many more to read about on the meds tab but that's a good start.

2: A good abortive, the attack has started, now what? The first line abortive should be oxygen. Read the "oxygen info" link on the left, print out the details and get a prescription for oxygen. I can abort an attack in 6-8 minutes using oxygen. That's pain free in under 10 minutes. I've had CH for 31 years and oxygen is my first line abortive.

Imitrex injectables and Imitrex nasal spray are both enjoying a good success rate on the board. The injectables worked well for me but the oxygen works just as fast without the med hangover.

For now, buy a couple of energy drinks. Monster, Rock Star, any containing the combo of caffeine and taurine. When you feel an attack coming on, chug one of those down as fast as you can. Many have had success aborting or at least reducing the intensity of their attacks using these.

Bob's given you the latest and greatest in info, you're right, it's your job to educate yourself and help your doc plan your treatment. Do push HARD for the oxygen, enjoying an incredible success rate around here.

Joe

Report of a study (from MEDSCAPE.COM):"Patients With Anxiety Disorders More Sensitive to Bodily Changes"

Sept 16 - Patients who have anxiety disorders appear to be more sensitive to bodily changes, which in turn suggests that the perception of panic attacks is reflective of central rather than peripheral responses, according to the results of a study published in the September issue of the Archives of General Psychiatry.

"Physiologic responses of patients with anxiety disorders to everyday events are poorly understood," Dr. Rudolf Hoehn-Saric and colleagues from the Johns Hopkins Medical Institutions, Baltimore, write. They compared self-reports and physiologic recordings in 26 patients with panic disorder, 40 patients with generalized anxiety disorder, and 24 nonanxious controls during daily activities.

The subjects underwent four 6-hour recording sessions during daily activities while wearing an ambulatory monitoring device. The team collected physiologic and subjective data that were recorded every 30 minutes and during subject-signaled periods of increased anxiety, tension, or panic attacks. Primary outcome measures included recordings of heart inter-beat intervals, skin conductance levels, respirations, motion, and ratings of subjective somatic symptoms and tension or anxiety.

Compared with controls, patients with anxiety disorders rated higher on psychic and somatic anxiety symptoms. Patients with anxiety disorders also rated themselves higher on disability scales and on sensitivity to body sensations. Both patients with panic disorder and those with generalized anxiety disorder experienced diminished autonomic flexibility and less precise perception of bodily states.

Patients with panic disorder had a heightened sensitivity to body sensations compared with generalized anxiety disorder patients. Autonomic arousal levels were slightly higher in patients with panic disorder, and this manifested itself in faster heart rates throughout the day.

"These findings suggest that, after having experienced anxiety attacks that are associated with strong bodily changes, patients become sensitized to such changes and may experience physiological symptoms of panic attacks..." [In effect, their bodies are acting as if there was a threatening condition even when this was not the case.]

The investigators note that the diminished autonomic flexibility found in both panic disorder and generalized anxiety disorder patients may result from dysfunctional information processing during heightened anxiety that does not discriminate between anxiety-related and neutral stimuli.

"It is important to measure physiological responses and not rely on verbal reports," Dr. Hoehn-Saric added. "A demonstration that physiological responses during anxiety attacks are milder than perceived can be reassuring to patients," he said. "However, the long-term effect of diminished physiological flexibility is unknown."

Arch Gen Psychiatry 2004;61:913-921.
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Imagine a person who is afraid of, for example, dogs and can experience an anxiety attack by thinking about meeting a dog or even seeing a picture of a dog. (Or, replace "dog" with your own feared thing/experience.) The anxiety is NOT being caused by a real life experience, in this situation (the thought or picture). The mental and body reactions which we call "anxiety" are a kind of habit response which are very real in their effects, however. Anxiety produces mind and body reactions which are measurable and have a real impact on how we function (and even on long term health of the body). 

The anxiety becomes an automatic response, beyond direct control of will. With this development, the person has experiences (anxiety) which are confusing or misleading--they cannot separate the real life threat from their body's automatic ("I'm in danger!") reactions. When dealing with cluster, for example, the effect of this anxiety reaction (and this is true for depression also) is that the person has increased sensitivity and reduced tolerance for pain; their sense of suffering is elevated and the capacity for effective self-treatment is reduced.

Medication can dampen the experience of anxiety but it does not unlink the reaction from the underlying thoughts or misinterpretation about the situation. ("I'm in danger"; "this will never end"; "I can' bear the pain", etc.) Cognitive therapies have been very effective (especially when combined with short term meds use) in teaching folks how to break this link.
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