The oxygen problem...


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Posted by Bob Johnson (12.19.49.2) on June 26, 2000 at 17:29:50:

In Reply to: My history of CH..sorry if it is a bit long! posted by Cathy Rowe on June 26, 2000 at 13:01:24:

Print the following out and give to your doctor. It's from Dr. Peter Goadsby, The Institute of Neurology, London, @ www.ion.ucl.ac.uk He is well known to us as one of the leading research folks in headache. Perhaps, your doctor would find it helpful to contact Goadsby if he needs some guidance in treating you.
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Cluster headache is a complex neurobiological disorder. Our group is currently actively studying the basic biology of cluster headache. This page will develop with time as our data evolve.

The pain of cluster headache is perhaps the most severe known to humans with female patients describing each attack as being worse than childbirth. The syndrome is well defined clinically and, despite the fact that it has been recognised in the literature for more than two centuries, is poorly understood in terms of its underlying mechanisms. Once thought to be related to migraine, it has been referred to as a vascular headache.

Unlike migraine cluster headache is a condition mainly of males (5M:1F) and manifests with strikingly characteristic features clearly distinguishing it:

1. cluster headache is strictly one-sided and changes side only rarely;
2. cluster headache is almost always accompanied by autonomic features such as tearing, redness of the eye and blocked nose on the same side as the headache;
3. attacks are relatively short compared to migraines lasting beteween 15 minutes and 3 hours and can occur up to many times a day. Characteristically, sufferers can be woken at night by the headache about 1-2 hours after falling asleep;
4. cluster headache is a relapsing-remitting pain syndrome which mainly occurs in bouts with a duration of usually 2-4 months, followed by headache free intervals of up to one year. Most cluster headache patients report some kind of regularity in these pain intervals, often occurring in spring and autumn.

The relapsing-remitting course and the clockwise regularity are characteristic but unexplained signature features of the cluster headache. The striking daily timing of attacks has led to the concept of a brain origin for the attacks. Ten per cent (10%) of sufferers have chronic cluster headache where the attacks occur regularly without significant periods of freedom from pain.

Cluster headache does not seem to run in families although exceptions for this rule are known. Cluster headache can occur at any age. The youngest person reported was aged one year and the oldest 73; the peak age of onset is around the age of 30. Unfortunately it does not seem to be a condition which one 'grows out of'.


Treatment

Treatment of cluster headche can be divided into acute treatment of the attacks and prevention of the attacks. Unlike migraine there are no trigger factors which influence the headaches apart from alcohol and drugs such as nitroglycerine (used as a spray in the treatment of angina). The actual mechanism by which such substances trigger the attacks is as yet unkown.

One of the safest treatements for the acute attacks is oxygen. This needs to be between 7 and 12 litres/min to be effective and may take 15 minutes to work. Sumatriptan injections can provide rapid relief of the the acute attacks, often within 10 minutes. Tablets take some tiem to get into the blood stream and in many sufferes the attack has resolved spontaneously before the medication has started to work. More recently Sumatriptan in a nasal spray formulation has been available and can provide better relief than the tablets. Ergotamine may be helpful particularly when taken before going to sleep to prevent the night time attacks. It should not be taken if sumatriptan is being used at other times.

Verapamil is an effective drug fro preenting attacks from occurring. Lithium has been used successfully but it requires regular monitoring of the blood levels to avoid unnecessary side-effects. Other preventatives include Methysergide and Sodium Valproate. A short course of corticosteriods is often useful, particularly to provide temporary relief from the attacks whilst one of the aforementioned preventative treatments is being introduced.


The future

The most pressing problem in cluster headache remains what is triggering or turning the attacks on. Positron emission tomography (PET) may represent the best currently available technique for visualising in vivo changes in the brain, reflecting the function of the brain rather than its structure. Current research using PET techniques is beginning to show the areas active during an attack and promises to tell us a considerable amount about this crippling disorder.



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