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Posted by Bob Johnson ( on October 26, 1999 at 14:42:53:

In Reply to: Names for CH posted by Bob P on October 26, 1999 at 10:46:12:

Names of medical conditions often incorporate terms which reflect the hypothesis about the cause or origins of the condition. In the list you provided you can see the evolution in knowledge about the nature and assumed causes of CH. It starts with "Bing-Horton's Syndrome": often the early name reflects the person who first describes the set of conditions which later becomes recognized as a new disease. Later names reflect the understanding of what part of the body is involved, or specific organs/nerves, or chemicals, or processes, and so on. In effect, this string of synonyms for CH is a sort of shorthand history of the medical understanding of the disease; the name changes as uuderstanding evolves.

Your question about MAO inhibitors is insightful and interesting. There are several drugs of this type: Marplan, Nardil, Parnate, Eldepryl, and a new one the name evading me. They are not equally effective with CH and migraine but some can be very helpful. MAOs are not used for headache very often, I assume, because the side effects are often significant and they gained bad press during the early years of their use so that many docs are wary of them. (In truth, I only consider using them when a good psychiatrist is in charge of the case. They take skill.)

The comment about serotonin: clearly, this is a major player in brain functioning. Most of the antidepressants commonly used affect serotonin. I reviewed six articles on the treatment of CH and migraine and found the large majority of medications which are recognized as effective are used for both conditions (excluding those used exclusively for pain or nausea). I have always understood this shared effectiveness as suggesting important commonalities in the processes of CH and migraine.

Recall a few months ago the rush of interest in Peter Goadsby's research (which DJ has now linked). In the original journal articles, he very explicitly says that CH and migraine share common processes but affect different parts of the brain. I suspect the evolution of research will show that these two conditions are more alike than different--with the sharing of medications which we now see being an important marker of that commonality.

If you follow the research, you will readily see how almost all medications emerging out of research on migraine quickly become tried, and often adopted, for the treatment of CH. So, while it's true, that most research on headache is done around migraine, we also end up with the benefits. (The last time I looked, there were 52 clinical trials going on in headache research, all on migraine!) It's this line of thought that allows me to follow developments in migraine, knowing that much of this information will eventually help me directly. No one is stealing anything from me by talking about migraine and some of their knowledge will help me.

The most discouraging part of your message was the "disclaimer": that you felt the need to CYA suggests the tone which has been set on CH.COM. In the last few days, someone commented on their recognition of self-censorship, how they were avoiding posting some ideas/questions lest they be flamed. This contentious spirit does not reflect differences on knowledge, fact, or medical information. But the end result is that ideas and issues become avoided out of fear--and we all lose in the process.

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