HEADLINES

VOLUME 2, ISSUE 8, AUGUST 1997

A Publication of the East Bay Headache Support Group

(The text of this newsletter has been simplified with all graphics removed to suit all users' browsers and computer speeds.)

AUGUST 14th MEETING NOTES:

ALLERGIES

"Could my headaches be caused by allergies?" If you have asked yourself that question, and have other questions about allergies, come to the Tuesday, August 12th meeting of the East Bay Headache Support Group. Guest speaker, Nathan Schultz, M.D., is a specialist in the treatment of patients with allergies and a member of the Clinical Research Division of the Allergy & Asthma Medical Group of Diablo Valley in Danville.

For information, call (510) 938-5252.

Past Meetings:

September 9th: Dr. Jerome Goldstein — New and experimental headache treatments.

October 14th: Dr. Roger Johnson — Stress and headaches.

November 11th: Dr. Leonard Saputo — Natural approaches to treating headaches.

December 9th: Dr. Peter Visendi —

Note: Notes from each of the above-listed meetings are available on line by going to the site directory and clicking on the date of the meeting.

CLUSTER HEADACHES

Unlike migraine headaches, which affect mainly women, cluster headaches affect primarily males by a ratio of 6:1 over female sufferers. Although the exact incidence and frequency is not known, researchers suggest that less than 1% of the population suffers from these excruciating headaches.

The features of cluster headaches are actually quite distinguishable, but surprisingly can go undetected by health professionals. The pain focuses around the eye area—almost always on the same side and is extremely severe in intensity. Unlike the throbbing of migraine pain, cluster pain is described as stabbing, boring, piercing, or drill-like.

Unlike the quietness and stillness that most migraineurs pursue, this type of pain generally makes the person pace or bang his head desperately because the intensity is so great. Perhaps that is why these headaches have been referred to as "suicide headaches" or "sick headaches."

Cluster headaches quickly begin without warning and usually last about 30 minutes, although the length can vary from 10-75 minutes. Cluster pain tends to subside quickly, tricking some people into suspecting cranial nerve damage, tumors, or aneurysms.

Generally referred to as one-sided attacks of pain usually in and around the eye, temple or forehead area, these extremely painful headaches acquired their name "clusters" because they usually appear in bouts or series. The most common form of these attacks is referred to as episodic cluster headaches. The sufferer experiences an attack every few days, or in some cases, 2-3 attacks daily for several weeks or months.

These attacks are often nocturnal, awakening the person from a sound sleep and frequently arising at early morning. Then with the episodic form, they disappear mysteriously for months or years, only

to return back again. In 10% of these cluster sufferers, no period of remission is experienced, suggesting what is known as chronic cluster headaches.

Other features of a typical cluster head-ache include facial blushing and sweating, a blocked or discharged nostril on the pain side, or a drooped eyelid. Many cluster victims also complain about pain in the lower skull area where the head meets the neck, or pain in the forehead region. All of the pain symptoms tend to be on one side of the head.

Similar to migraine, cluster headache is a vascular headache. The actual cause of the pain is not completely known; however, the severe pain to the eye area is partly due to stimulation of the internal carotid artery. The ophthalmic artery which is a branch of the carotid artery is connected to the anterior and posterior ethmoidal arteries located in the nasal passage. Therefore the stuffy or runny nose that many cluster sufferers experience can be explained.

The age of onset tends to begin around the mid to late twenties. This is significantly different than migraine which tends to affect mainly women, often beginning with their first menstrual cycle.

Although the exact cause of cluster headache is not known, the portion in the brain known as the hypothalamus is suspected. The hypothalamus is responsible for our "biological clock" which controls appetite, hormonal secretions, and other influences. This might suggest why cluster attacks tend to come at the same time each day. The hypothalamus is also connected to the portion of the brain stem known as the mid-brain which is serotonin headquarters. Scientists are currently experimenting with medications that will alter serotonin metabolism within the brain, thus stopping the pain cycle.

Similar to migraine, cluster headaches are influenced and triggered by alcohol. This is especially true during the cluster season of the sufferer.

Oxygen is usually administered by face mask and has proven useful among some sufferers. Most cluster headache victims report a higher success rate when they use direct oxygen as soon as the pain begins. An oxygen tank must be purchased with a doctor’s prescription and consent.

Many preventive medicines such as calcium channel blockers, methysergide, prednisone, and lithium carbonate tend to be the major drug treatments for cluster headaches. Other medications can include beta blockers, major tranquilizers, and nonsteroidal anti-inflammatory agents which have been found useful in some people.

Routine consultation with a family doctor, pharmacist and neurologist can assist the cluster headache sufferer in coming up with the best prevention plan. Like any other major health problem, cooperation and perseverance from both the sufferer and medical professional can bring significant positive results to what was once a devastating illness.

You can identify cluster headaches by the following signs and symptoms:

* The headache is always located on one side of the head, in and around the eye, temple, or forehead.

* Quality of pain: Burning, boring, piercing, or drill-like.

* Severe or excruciating degree of pain.

* Headache typically lasts 20 minutes to 2 hours.

* Frequency varies from 1 to 6 times per day, for weeks or months; often awakens sufferer from sleep.

* Associated symptoms include redness and tearing of the eye, blocked nostril, or drainage on the side of the headache.

* Alcohol tends to be a big trigger.

* Clusters or bouts tend to disappear after a few months, only to mysteriously reappear.

By G. Brent Lucas, B.A., Executive

Director, Help for Headaches, Windsor, Ontario, Canada. Excerpted from

Making Headway, June 1997.

Questions and Answers

Q: Is Soma Addictive?

A: Carisoprodol (Soma) is a muscle relaxant that modifies the perception of pain and can be helpful therapy for tension-type headache. Doses of 350 mg may be given three times a day. Higher doses may cause unwanted side effects and may be associated with abuse potential. Both sedative effects and tolerance can occur. Caution should be used when taking other drugs with Soma. Central nervous system depression can occur when alcohol or other depressants are concurrently prescribed. Soma Compound, a combination of carisoprodol and aspirin, should not be prescribed with other anti-inflammatory drugs such as nonsteroidal anti-inflammatory medications (NSAIDS), or with anti-depressant medications. Cynthia Sheppard Solomon, R.Ph., F.A.S.C.P.

Q: Can low blood sugar precipitate a migraine headache?

A: In some patients, hunger or food cravings are part of the prodrome of migraine. Treating the attacks with medication during this prodrome is often effective. Relative low blood sugars are sometimes implicated in precipitating migraine. These blood sugar shifts are often not demonstrated with glucose tolerance tests. Eating regularly with small healthy snacks (e.g., fruit) between meals is helpful to some sufferers. R. Michael Gallagher, D.O.

Q. Do others share in the frustration of being a "guinea pig" when it comes to finding an effective migraine prophylactic? How do I find the right therapy for me?

A: The treatment of complex headache problems often requires several clinical trials of medication until an effective and well-tolerated treatment plan is found. It is not uncommon for patients to feel like "guinea pigs" when they try several different medications for their headaches.

We are fortunate that we have a large number of effective medications for headache; however, no one therapy is right for everyone. Therefore, we need to continue with "trial and error" of trying various medications until the best choice is found. Glen Solomon, M.D. Excerpted from the Spring 1997 issue of NHF Headlines, publication of the National Headache Foundation.

Handling Job Interviews

With good jobs becoming harder and harder to land, the skill of interviewing becomes much more important. There are numerous books giving advice on how to dress and present yourself, but how do you handle the topic of health problems? Do you mention your chronic headaches at the first interview? Do you bring the issue up after several interviews? Or do you wait until you have been hired and have that first migraine?

As a partner with a national executive search firm, I have seen individuals handle health issues in every way imaginable, with mixed results.

Here are some questions to ask yourself before applying for or accepting a job. How severe or frequent are my headaches? How will they impact my productivity? Will I have to miss work—how often? How will the company and my co-workers be affected by my absences? What is the competition for this position?

As a monthly migraine sufferer, I would not reveal my health problem to a potential client. My illness only knocks me out for ten hours a month, and in my line of work I operate fairly independently. If I have to reschedule a client meeting or interview, it is not a serious inconvenience. Now, if I were the staffing manager for a corporation where others were highly dependent on me, my headaches might create problems.

My advice is not to reveal your health problems on the first interview. The first interview is much like a first date. Typically you are gaining information about the position, the employer is finding out your experience, and you are both assessing chemistry. If there is mutual interest between you and the company, you should discuss your headache condition before an offer is extended.

By Jane Howze. Excerpted from the Winter 1996-1997 issue of Headache, a quarterly publication of the American Council for Headache Education.

Notes...

At last month’s meeting, Bob Horwitz, Pharm.D., talked about compounding medications. Medications can be given to the patient in many different dosage forms, which are outlined in the notes taken of his presentation. At each meeting notes from past meetings are available, covering the following topics: Biofeedback therapy, genetics, caregiving, dietary triggers, chiropractic treatment, pharmaceutical remedies, hormonal triggers, reducing stress in the workplace, dealing with holiday stress (and all stressors), acupuncture, children’s headaches, temporomandibular joint disease (TMJ), and somatic headache relief. Suggested donation is $2 for each set of notes.