DEAR DR. DONOHUE: I am writing for information on the management of cluster headaches. My daughter, in her mid-40s, has had them for three to four years. All her lab work is normal, as is a CT brain scan. She has the headaches three to four times a day. Are hormones involved in this kind of headache? Any recommendations you could provide for our daughter’s management would be appreciated. — H.C.
A: I’m not going to be much help to your daughter. She has been to one of the most outstanding headache treatment institutions in the United States, but others might benefit from a discussion of this agonizing headache.
Cluster headaches get the name “cluster” because they come in clusters of up to eight episodes in 24 hours, and in daily clusters that last weeks to months. Then they disappear for as long as years, but they invariably return. A few people have chronic cluster headaches without any remissions.
The headache is one-sided and centers around the eye, which is often red and teary. The nostril on that side frequently becomes stuffy and drippy. The involved side of the face might sweat. The pain is intense, often wakening a person from sleep. Awake, the sufferer paces restlessly until the pain leaves, which can be as short as 15 minutes or as long as three hours.
Breathing 100 percent oxygen for 15 minutes can sometimes end the headache. Sumatriptan, a migraine drug, is available for self-injection. The injection provides rapid action, something needed for this headache. Ergotamine, another migraine medicine, comes in an under-the-tongue form, another avenue for quick action.
Prevention drugs include ergotamine, verapamil, lithium and prednisone. Most patients require both kinds of medicines — one for the headache and another for preventing headaches.
Unlike migraine headaches, cluster headaches don’t seem to have a relationship to menstrual periods, so there is not a strong hormone connection.
On the bright side, cluster headaches tend to decrease and eventually disappear as the years pass.
DEAR DR. DONOHUE: I recently have been getting a sore on the same spot on the right side of the upper lip. I have been married faithfully for seven years. I am petrified that this sore comes from the herpes virus. Please tell me if I am being stupid. Is there any reason for this recurring sore other than my husband having cheated on me? — Anon.
A: You describe a cold sore (fever blister is another name). The herpes-1 virus causes cold sores. They are not a sexually transmitted illness, in most cases. More than 85 percent of the adult population is infected with this virus, and most of them were infected during childhood. The virus stays with a person for life. Not all infected people break out with cold sores, but most can still transmit the virus when no cold sore is present. Cold sores are not a sign of unfaithfulness on either spouse’s part. You got the wrong idea about this. You’re thinking of genital herpes, a herpes-2 infection.
Zovirax cream or ointment, Abreva cream and Denavir cream can hasten cold sore healing. Oral medicines can be taken to do the same and to prevent frequent recurrences. Many readers testify to the effectiveness of L. lysine, available without prescription.
c. North America Syndicate
