Dr. Keith Roach: Cluster headaches come in waves
Dear Dr. Roach: I was diagnosed with cluster headache at age 20. Now, at age 65, I have endured these excruciating headaches for some 45 years. In my particular situation, I can have once- or twice-daily headaches for anywhere from two to four months. My symptoms include a throbbing in my left temple, with the pain then traveling to my left eye. My left eye tears, my left nostril stuffs up and my mouth becomes dry. On occasion, I also experience nausea. There are some days during these times when I might not have any. The cluster of headaches then disappears for anywhere from three to eight years, only to return. I have found verapamil to be somewhat helpful.
I read that these headaches tend to occur less frequently and with less severity as one gets older. That does not seem to be the case for me.
Dear K.B.: Yours is an excellent description of cluster headaches, which commonly affects young men (at least, they are young when they first get the condition). Tearing of one eye is classic, as is the description of several headaches over weeks to months followed by prolonged freedom from the very painful headaches.
People who experience so classic a presentation as yours usually have no trouble getting the correct diagnosis; however, this headache syndrome often is misdiagnosed, especially before the clustering becomes clear.
There are two types of headache treatment: The first stops a headache once it occurs (abortive) and the second keeps it from coming on in the first place (preventive). Cluster headaches often respond quickly and completely to oxygen, but the response is incomplete for some. Most other headaches do not respond to oxygen, so oxygen treatment sometimes is used to help make the diagnosis. Some medicines used for migraine, such as sumatriptan, can be used to stop a cluster headache. Octreotide can be given as an injection to abort a headache.
As soon as a cluster starts, beginning a preventive medicine is important. Verapamil, usually used as a blood pressure medicine, is probably the best-studied and may be the most effective. Steroids, lithium and methysergide are drugs with significant toxicities, and are less commonly used.
Dear Dr. Roach: I am a retired test pilot. I was diagnosed with rheumatic fever at age 16. I was treated with penicillin, and recovered with no heart involvement. Somewhere along the way I donated blood and was asked when I had had Epstein-Barr virus. I replied “never,” and was informed that I was wrong! Once you have EBV, it will show up in blood tests for life. The symptoms are said to be similar to rheumatic fever, and I wonder whether it is possible that what was thought to be rheumatic fever was actually EBV.
Dear F.D.: Most people get EBV, the virus that causes most cases of infectious mononucleosis, either as a child or teen, and many people never know they had it. You are right that the antibodies in the blood stay positive forever.
I don’t think your doctors would have confused rheumatic fever with EBV infection. Although there are some similarities, the patterns of fever, joint pain and rash in the two are very different, and decades ago we had specific blood tests for rheumatic fever.
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