In the last few months eagerness to help has begun to stimulate treatment suggestions before a clear diagnosis has been made. Especially for new folks, this can lead them down the wrong pathway.
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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.


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]

I wrestle with this issue to. On one hand, you're afraid of giving someone a tool to relieve pain, which will make them stop their search for a thorough workup, possibly masking a more serious issue.

On the other hand, people who show up here have already elected to handle their own research and treatment, and will continue to suffer the pain of whatever is hurting them.

Factor in that the majority of GP's and even most neuros are woefully uneducated in headches, and going to them is about as efective as surfing the net, you end up with so many people who are hurting so much.

So what percentage of people that we give suggestions to are actually going to mask a more serious condition? Given the fact they have chosen NOT to seek medical care on their own, are we really hurting them?  Compare this with the other 98-99% who will finally have relief from the most horrific pain the mind can imagine?

I will continue to preface all of my suggestions with the directive that a qualified headche specialist neuro is your best bet at getting an accurate diagnosis and an effective treatment regimen. Then I will tell them how to stop hurting.

Joe