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Article on possible triggers. (Read 2601 times)
maalstroom
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Article on possible triggers.
Jul 9th, 2008 at 3:08pm
 
Hi all.
friedrich (Cluster from Germany) gave us a link on an article from Germany. I tried to translate it as good as I could - it was a lot of work but I had some hours to spare, and hope someone somewhere might deem it usefull for themselves.
This is about 75%, and will be posting the rest very soon.



Clusterheadache triggers.

During an episode or with chronic patients, one can easily trigger an attack by taking for instance histamin (hence the name histamine-headache) or Nitrolingual. Works identical to alcohol. Triggers however have no influence of starting a cycle.

Triggering factors.

The exact causes of CH are not fully researched. One may suspect, that because of genetic make-up, a CH affected brain responds more sensitive from healthy people. Bodily changes, like hormonal swings in daily or annual rhythm, or changing outer influences may trigger a hit.
Those inner and outer influences, that will provoke a CH, are called triggering factors. They are however not the actual cause.

Which triggers will provoke an attack, is hugely individual and may differ from one person to another. For one, changes in stress level can play a role, for another a change in sleeping patterns, such as the weekend. In many patients, nutrition and stimulants are a factor. It is in any way usefull to find them with a doctor, so they can be avoided.

It helps to keep a headache-diary. as available through headache-specialists such as neurologists and anaestesists. Then jot down the date, hour, duration, painlevel and the exact sort of aching, medication used and suspected triggers.

It is senseless avoiding known foodtriggers, as not all CH-sufferers experience them as such.

Important is to exclude only those specific foods, whom come forth as personal triggers, through the use of the headache-diary. While trying to detect them, one should remember there are oftentimes hours, sometimes even a day, between ingesting and the following hit. Even when patients find out, which ones provoke them,  they sometimes happen to tolerate them when there are no other disturbing factors. Only when consequent troubling factors rock the boat, foodtriggers will release an attack. Also, preventatives like Verapamil, will decrease or even solve trigger sensitivity.

Scientifically researched and documented triggering factors are Glycerintrinitrat (nitroglycerin in the form of cardio medication) and histamin. Reported are also Sildenafil (Viagra) and heat (weather and climate dependant, sauna's, bathrooms etc). Even the preventative Lithium is known to trigger attacks in many patients.

Known triggers:
-Red wine
-Wheat beer (contains histamin)
-Monosodium aka MSG which is a flavour enhancer found in almost any industrially processed food (glutamic acid). In natural form to be found in cheese and tomatoes. Chinese food and other Asian dishes are commonly seasoned with glutamic acid, as are canned soups.
-Potassium nitrate (E249) and Sodium nitrate (E250), mainly found in sausages and other processed meat.
-Fish and seafruit.
-Chocolat.
-Cheese.
-Tomatoes.
-Nuts.
-Citrusses and/or lemon juice.
-Strawberries.
-Feeling hungry, irregular meals.
-Flickering lights, TV, computer, cinema screen, beamer.
-Altitude, flying.
-Napping, changing sleeping patterns.
-Odours such as: petrol, alcohol, terpentine, glue, dissolvants, smell of fish, detergents (for cleaning), perfumes, scentcandles.
-Having a cold/ medication for colds.
-Noise.
-Heat, airdraft, airconditioning.

Nutrition.

As a healthy, well-balanced diet consisting of fresh quality products works positively on the entire organism, it is generally recommended. Some patients reported good results from switching diets.

Statistical survey.

Results from a nationwide survey of German CH supportgroups in a 2003 poll may not be fully representative. 38 out of 76 interviewees (spelling?) changed their diets.
-Avoiding triggers 78,9% (good or mild results: 72%)
-Reduction of fats 31,6% (good or mild results 32%)
-Urinal acid reduction 26,3% (good or mild results 24%) - I am not sure what is meant by this or if I even translated it right. Maalstroom.
-Reduction of cholesterols 34,2% (good or mild results 28%)
-Becoming vegatarian 10,5% (good or mild results 12%)
-Others: no more alcohol (mentioned 3 times), lots of water, glutenfree diet, Rennberg diet, reducing acidosis, no drugs, no sweets/candy.

76People mentioned the following triggers:
-Alcohol 50%
-Flickering lights 33%
-Blinding lights 24%
-Food additives 22%
-Smells 20%
-Certain cheese 18%
-Noises (including music) 16%
-Tomatoes and it's derivatives 13%
-Citrusses 5%

Others (numbers of times mentioned):
-Glutamic acid 12
-Chocolate 4
-Histamin 3
-Solvents/lacquer 3
-Sports, airdrafts, airconditioning, bananas (each mentioned twice)
-Gluten, tyramine, glutamic acid, cinnamon, aniseed, Maggi-spices (not sure if it's also known in the US - Maalstroom), spinach, dairy products, legume (such as peas, alfalfa, peanuts), marmalade, liquorice, peppermint, nuts, disinfectants, etherical oils, gas stations, nicotin, fatigue, stress, sauna's, hot steam, humidity, carrying heavy load/moving, same bodyposition in theatre (each mentioned once).

Nearly three times the amount of episodiacs, as opposed to chronics, stated to be unaware or not responding to triggers (chronics 12,9% - episodiacs 36,2%).

Out of 76 patients:
-50% episodic
-14,5% chronic from the start
-26,3% episodic turned chronic
-11,8% chronic turned episodic

USA guidelines in treating CH:
1. Avoid naps, or changing sleeprhythm
2. No alcohol, especially during cycle
3. No exposure to chemical agents
4. Avoid extreme rage or emotions
5. No physical exhaustion
6. No changing in altitude


More to come soon!
  Wink
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...AND AS A FINISHING TOUCH, GOD CREATED THE DUTCH.
 
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monty
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Re: Article on possible triggers.
Reply #1 - Jul 9th, 2008 at 9:47pm
 
Thanks for taking time to translate that. 

One thought that occurred to me when reading that is that many people have said that organic solvents (gas, diesel, cleaning fluids) act as a trigger, but it seem a bit low there.
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The outer boundary of what we currently believe is feasible is far short of what we actually must do.
 
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cluster
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Re: Article on possible triggers.
Reply #2 - Jul 10th, 2008 at 3:43am
 
Hi Maalstroom,

Great!

Libby already copied your translation here:

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and made some small changes.

pf wishes,
Friedrich
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sandie99
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Re: Article on possible triggers.
Reply #3 - Jul 10th, 2008 at 12:30pm
 
That was interesting read. Thank you so much. Smiley

I just read from Finnish website a list of triggers (it was gathered by a neurologist), most of which were the same, but interestingly, ANGER was one of the things on the list.

Sanna
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mike64
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Re: Article on possible triggers.
Reply #4 - Jul 14th, 2008 at 3:33pm
 
I am mike from germany, new here but not to CH, I read that article and must say you did a real good job translating it. If you would like any help feel free to contact me.

mikehaus@aol.com

regards,

mike
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cluster
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Re: Article on possible triggers.
Reply #5 - Jul 16th, 2008 at 9:06am
 
Hello maalstrom,

we changed the introduction of the article including the English version as follows:

Quote:
During a cluster headache episode and in chronic cluster headache patients, cluster headache attacks can often but not always be triggered by histamine or by nitroglycerin.[1] Drinking alcohol triggers attacks in about half of the patients, red wine in 70%.[2] Triggers seldom have an influence on the start of a new cluster headache episode. Some heart medications for example can induce cluster headache episodes.[3]

References
1. Sances G, Tassorelli C, Pucci E, Ghiotto N, Sandrini G, Nappi G.: Reliability of the nitroglycerin provocative test in the diagnosis of neurovascular headaches. Cephalalgia. 2004 Feb; 24(2): 110-9. PMID 14728706.
2. Schürks M, Kurth T, de Jesus J, Jonjic M, Rosskopf D, Diener HC.: Cluster headache: clinical presentation, lifestyle features, and medical treatment. Headache. 2006 Sep; 46(8): 1246-54. PMID 16942468.
3. Ekbom K, Sjöstrand C, Svensson DA, Waldenlind E.: Periods of cluster headache induced by nitrate therapy and spontaneous remission of angina pectoris during active clusters. Cephalalgia. 2004 Feb;24(2): 92-8. PMID 14728704.

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Sandie,

ANGER is in the article, see section US Guideline.

Funny: We translated this from English ANGER to German "Wutausbrüche" and maalstroom translated it back to English using the word RAGE. We changed this section to the original version from

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pf wishes,
Friedrich

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Re: Article on possible triggers.
Reply #6 - Jul 16th, 2008 at 11:47am
 
Many thanks, Maalstrom - that's a lot of work and we all appreciate it.
David
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maalstroom
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''Dance to my tune''....
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Re: Article on possible triggers.
Reply #7 - Jul 17th, 2008 at 7:22am
 
Thanx everyone for the reactions! It was all I hoped for that people would find it useful in one way or the other. I also love the fact that others are contributing to an even better translation (I have a very good understanding of German, but as I am not a native speaker improvements are welcome! Thanx!).

Unfortunately, I promised the final 25% of the article within days, but I have been very VERY busy this week so I did not find the time, alas. Please forgive me for breaking my promise haha. I will however finish it. Hopefully somewhere next week.

Pf vibes to all from Pascal (my real name, you guys are family so you should know it haha).

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...AND AS A FINISHING TOUCH, GOD CREATED THE DUTCH.
 
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Re: Article on possible triggers.
Reply #8 - Jul 19th, 2008 at 11:28pm
 
Other than humidity, I'm surprised that other weather factors such as long periods of lingering storms and changes in atmospheric pressure not being mentioned as triggers.
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