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Cluster Headaches

by Bernie
(Miami, FL USA)

I am forty years old. I started working the midnight shift as a cop around five months ago. I rarely get headaches, if ever.

Around the time of my twenties I used to suffer from cluster headaches. I used to be very unhealthy back then and I smoked, drank a lot, and generally did a lot of other stupid things. Therefore, I attributed my clusters as a hazard of my stupid lifestyle.

But lately I get these headaches, sometimes they will wake me up, and it starts right over my right eye and begins to throb. Sort of like a cluster "lite." I have gotten one a day for the past couple of weeks. It then creeps to my eye and ear, even down to my jaw and molars. That's when it just feels very cluster-y. I can't even have one drink lately without having all this pain. It started, I believe, about a week and a half ago when I drank like three or four servings of Whiskey. Never again!

But now it's happening when I am not drinking. I thought it might be due to caffeine withdrawal, so I always get some coffee. Today I got one, there was some cold coffee laying around, I drank it with sweet creamer, and it went away without Tylenol. I laid down with a cold pack on my neck/head and felt much better.

I am not sure if this headache is being caused by sugar craving or low blood sugar, caffeine withdrawal, high BP or what. My BP is always in the healthy range. I run around four to five miles a day six to seven days a week and my heart is generally healthy.

I have cholestoaisis, and take lipitor. Semi-daily. It keeps my total cholesterol below 180. Help! It's becoming a regular thing and I can't stand it. I always feel like it's lurking around the corner, like a boogeyman.

Bernie

Answer:

Hi Bernie,

You have pretty much described the classic symptoms for cluster headache. About 80% of patients are male, with a unilateral stabbing headache around and behind the eye. Usually the face gets a little red as does the eye, and the nose and eye are a bit runny.



Another big difference between cluster headache and migraine is that cluster patients want to move around to relieve pain. Migraineurs want to lay down and be still in a dark room.

You mentioned the classic trigger for a cluster once you are in a "phase"..alcohol.

Cluster headaches can come back at any time in your life once you had them, usually in the spring and fall. Other clues are that you are getting one a day at about the same time. We still don't know what causes them, but they may be tied to the circadian rythyms of the brain.

Call the doctor and try to get in to be seen soon. To break the cycle you should be on steroid for a couple of weeks, and perhaps verapamil 240mg twice a day for a couple of months until the fall is over. You can have a triptan such as Imitrex for treatment of the headache and injectable is best, but only if you have no cardiovascular disease.

I tell my patients after the few months of treatment to stop the verapamil and keep it on the shelf in case the headaches come back. If they do, then they start the verapamil again and call me to be seen in the office.

Good luck!

Mary Kay Betz MS RPA-C

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Ice Pick Headaches

by nicholas
(metairie, LO, USA)

hello
i've been having episodes of icepick headaches for the past few days,
recently i have noticed a strange sensation of awareness of my brain right above both of my ears. sometimes it feels tightening, sometimes it just feels like pressure.
in the past week i had been VERY VERY nervous.
i am constantly trying to figure out if my head aches or if its just normal, but i cant find any information anywhere.
no fever
no vomiting
no seizures
no nausea
no weakening or tingling sensation, like numbness on arms just a couple of times back when i was very nervous and anxious
i don't wake up with headaches and neither do they wake me up
very mild headaches really.
my neck and back feel tense and it almost feels like my muscles are contracted in between my neck and shoulders.

really i am just so worried its something serious and i don't have any medical insurance to get a CT or MRI

Nicholas

Answer

Hi Nicholas,

Thank you for providing all your symptoms..makes this much easier!

The clue here is the neck. With spasms in the neck, you have a type of headache called cervicogenic headache. Usually patients complain of neck pain and pain at the back of the head, but it can wrap around the head to form a tension type headache.

The trapezius muscle at the back of the neck is attached to the base of the skull. When it spasms, it pulls on some other muscles on the scalp, so pains on the scalp are sharp and short. It may be a form of ice pick headache but I would let your read more about this type of headache.

Usually stretching exercises help along with an anti-inflammatory as needed.

I suspect that you have never really had any severe headaches before and because of this it has provoked anxiety. Exercise helps! It reduces anxiety and gets those muscles in better shape. De-conditioning is the most common cause of spasms.

Good luck!

Mary Kay Betz MS RPA-C

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Severe left side headache

by Marjorie
(Menomonie, Wi. USA)

I get a real severe pain on the left side of head, always the same spot and lasting for only 20-30 seconds. It occurs sometimes 5-10 times per day. Had a CT Scan done and it did not show anything.

Would you have any idea what these could be? This has been going on for more than 5 years. Please give me an answer if you can. Thank You

Marjorie

Answer:

Hi Marjorie,

There are two possibilities here: either an ice pick headache or chronic paroxsysmal hemicrania. The second type of headache is quite rare and is considered a subset of cluster headache. Like cluster headache it is associated with redness in the eye on the side of the headache, and nasal stuffiness. It is 100% of the time on the same side.

If your primary care doc has not been able to treat this effectively, then you need to see a neurologist.

Good luck!

Mary Kay Betz MS RPA-C

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One-sided headache

by Nena B
(Plant City, FL)

I have a one-sided headache with a lot of pressure. It's on the right side, from the side of the base of my skull, up behind my ear, up through my temple, across my right eye and then radiate out somewhat like fingers. One symptom I cannot find info about, which I have, is that I can physically feel a 3-4 inch long area along the side of my head, above my ear, that is protruding and this is where the pain/pressure is most severe. It runs basically from over my ear to above my eyebrow.

I have had neck surgery / fusion a few years ago, but seems like I've had these type headaches way back before that. Is the protrusion a muscle, or possibly a blood vessel? Other people can physically feel this area if they rub my head in that area, and it is very sensitive.
I do smoke a pack per day, I'm a 44 year old female, I've had a hysterectomy, fractured spine and neck fusion. I've tried everything, with one Dr. stating it was muscle spasms, but even with muscle relaxers, it takes days for relief.

I'm just concerned it could be something worse. If it's a muscle that I'm feeling, then I can live with that. :0)

Thank you,
Nena B

Answer:

Hi Nena,

The fact that you improved with muscle relaxers indicates that it is indeed a spasm. Muscles in spasm usually become a bit harder to the touch and feel larger as the muscle pulls together. The pain can be excruciating at times (think "Charley horse").

Usually when on the scalp it is coming from pathology in the neck and is a form of cervicogenic headache.

What most people don't realize is that they need to be on anti-spasmotics for several weeks, perhaps 2-3 months to get total relief. Ask the doctor about this again and also ask if he/she knows a physical therapist who can do cranial-sacral therapy. This is a form of PT directed towards headaches and has had success with our patients.

Good luck,
Mary Kay Betz MS RPA-C

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Does the scenerio above sound like you? If not, or if you think you need more information please read about different types of headaches to find out which type of headache you are experiencing.

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