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Posted by Todd ( on April 27, 2001 at 23:28:04:

Been a long time since I studied logic, but as I remember it there are three ways to view relationships between two or more things - causal, coincidental and mutually coexistent.

A causal relationship is one in which one thing (the cause) sets in motion something else (the effect). For most clusterheads, consumption of alcohol during a cycle will cause an attack. It appears from research done by Dr. Goadsby that nitroglycerin will also cause an attack. These things, IMHO, can be called triggers for those effected by them.

A coincidental relationship is one in which something is related to something else purely by chance. You wear blue socks one day during a cycle and you get hit. These may appear to be triggers but in reality are totally independent of each other. One basic rule of science is repeatability. A few years back a group of scientists claimed to have found the answer to cold fusion. No one else has ever repeated it, hence it is not accepted. If you continue wearing blue socks out of cycle and don't get hit, we can consider them most likely coincidental.

Mutually coexistent relationships are when the relationship between two things is neither causal nor coincidental. In other words, one does not cause the other nor do they exist by chance. For example, most all of us have beating hearts, but they are in no way related (other than mutual coexistence) to CH. Generally, mutually coexistent relationships are where two or more things exist as part of something else.

The most important part of understanding this is to recognize that percentages have nothing to do with which type of relationship two things might have. In the 'early days' of literature about CH, it was observed that a large percentage of clusterheads were large men with ruddy complexions and hazel eyes. As more studies were done, this data was found to be inaccurate. Regardless of the percentages, ruddy skin and hazel eyes never had a causal relationship to CH.

The sleep apnea issue is an excellent example of all of this. One very small study showed that 80% of clusterheads studied have sleep apnea to some degree. It is very likely that a study of 35 clusterheads would now reveal that 80% of us have brown eyes, since brown eyes are the most common among caucasians and caucasians appear to account for the vast majority of clusterheads.

Both of these are mutually coexistent or coincidental, as are bumps on the head, auto accidents, viral infections, Peruvian butterfly farts and every other theory put forth to date. Yes, I said every theory. Even Dr. Goadsby's excessive gray matter discovery is still a theory since no actual connection between this gray matter and CH has been found to date.

Think about this - even Glaxo doesn't know how Imitrex works. It is believed to be a seratonin agonist, but nobody really knows what it does or how.

In our search for causes and answers it behooves all of us to be as precise in identifying "triggers" as we possibly can. If you eat a fig and get hit very quickly and can repeat that over and over, it just might be a trigger for you. On the other hand, it might also be a psychosomatic response, but that's another post.


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