Cluster headache case

[Guest guest]

Hi everyone,

 

I've got a case I need some help with.

34 yo man; factory foreman

Chief complaint: left sided headache just behind Stomach 8. It is fixed in location burning and aching in quality. When it is most intense it spreads down to the left eye. It started during August 4 years ago and lasted until March of the next year. It came again the next August and now follows the August to March pattern during which time he has the headache every day although sometimes the intensity varies. Nothing seems to make the pain better or worse although occasionally pain meds(percodan, darvoset) will help. He rarely takes meds because mostly they don't do anything. He doesn't recall anything unusual going on when the headache began except that he had a wisdom tooth removed from the right side which damaged a nerve to his tongue which is now numb on the right side. He can't recall whether the tooth extraction came before or after the headache. He has no previous history of headaches.

 

Biomedical Dx: cluster headache. Sinus involvement, allergies, tumors, etc have all been ruled out through CT, MRI, allergy tests.

 

Systems Review

Digestion: occasional reflux for which he occasionally takes a Prilosec; drinks 1 cup fo coffee a day

Sleep: 6 hours a night, pain can wake him up

Respiratory: has a history of sinus infections and bronchitis

Musculoskeletal: occasional low back pain and stiffness

General: doesn't get much exercise, no abnormal body temperature or sensations

 

Pulse: Left side deep and constrained, very weak chi postion.

Right side mid to deep level and slippery especially in the guan position. Stronger than the left side.

 

Tongue: Pointed presentation. Deviated to the right because of tooth extraction. Central crack to the tip

Swollen overall.

Pale red overall. Dusky tip.

Slightly thick white coat, thicker in back.

Thin dark purple sublingual veins.

 

General impression: A stocky man with a red face and pale circles around his eyes. Big voice. Frustrated temperment.

 

Pattern Dx:Blood stasis, dampness and heat obstructing the GB channel of the head. Liver yang rising. Stomach heat.

Kidney vacuity.

I'm not completely happy with this diagnosis. I am confused by the time element of the headache. Why does it come in August and go in March? Could there be an externally contracted pathogen involved that goes latent for 6 months of the year? Or is does it's coming and going have more to do with the fluctuation of yin and yang tendencies during the year-the headache coming in the more yin times of the year and going when yang begins to become more prominent? Or both? Also, is there any possibility that the left sided headache could have anything to do with the right sided wisdom tooth extraction?

 

I have treated this patient 3 times with acupuncture.

After the first treatment he was pain free for 3 out of 7 days and the pain never reached over 5/10 in intensity, whereas before it was would regularly reach 8 and above. The last 2 treatments didn't make a difference in the pain but he maintained 3 painless days during each week.

 

Herbs: I prescibe herbs in granulated extracts so .the numbers after the medicinal shows its proportion. He's taking 12 grams of extract or about 60 grams of raw herbs a day. 5 days of taking the herbs have made no difference.

 

shi jue ming, 6

tian ma, 6

huang lian, 2

huang qin, 6

chai hu, 5

he shou wu, 6

tu fu ling, 12 Dr. Tsai, a teacher of mine in San Diego, uses this as an all purpose headache herb. I added it here because of my suspicions of the pathogenic origin of this condition

chuan xiong, 6

yi mu cao, 5

di long, 6

chi shao, 5

ye jiao teng, 5

niu xi, 5

ban xia, 5

xi xin, 3

gan cao, 3

 

Anybody have any ideas?

Thanks so much for any help you can give.

Kristin

[Guest guest]

Have him try lidocain nose drops

alon

[Guest guest]

Kristin, I had a case with some similarity once where a man had intense headaches for the month of August every year. He came to see me in September so we didn't know for 11 months whether we would get the desired result. Fortunately we did. I have a few thoughts: 1) It may be more successful to treat this condition when symptoms are not present, in the headache's off season. And treating his constitution, as you seem to be doing, rather than focusing on the headache has been the best approach for me. Perhaps Alon's suggestion could be used symptomatically as a last resort. But using lidocane nasal drops will mask the pathology making it difficult to assess the value of your treatments. 2) It may be helpful to rule out the aggravation from the dental work as a cause. Dental problems commonly cause treatment-resistant conditions of all kinds. I have had the best results using St6, St44, and Lu3 for dental aggravations. If this helps then you may need to delve further into the channel pathology that the tooth extraction could have caused. If the dental aggravation is a problem, and you treat it with acupuncture, you can often see a result, at least a temporary improvement, with one treatment. If you change a lot of other aspects of the treatment at the same time you may not know what to attribute improvements to, so it may take up a treatment to see if the dental points help or not. It is common with dental aggravation to see an initial but temporary improvement that subsequently does not respond to the treatment. I could also say the same about this type of condition that is related to an allergy, which I still wouldn't rule out, despite the assessments that have already been done. And...if the dental extraction was a trigger, it is likely that there was a pre-existing condition that was only aggravated by the extraction. 3) I would consider Qing Wei San as a way to temporarily treat the channel pathology, which you can obtain in the type of granules that you use. It is useful for heat in the stomach channel and would support treatment of the theory that the extraction triggered an underlying pathology affecting the channel. The high content of sheng ma may help reduce stomach heat affecting the gums. You can always adjust the formula as you see fit, perhaps adding some bai zhi?

 

Stephen

 

kwisgirda [kwisgirda]Thursday, November 30, 2000 2:22 PM Subject: Cluster headache case

Hi everyone,

 

I've got a case I need some help with.

34 yo man; factory foreman

Chief complaint: left sided headache just behind Stomach 8. It is fixed in location burning and aching in quality. When it is most intense it spreads down to the left eye. It started during August 4 years ago and lasted until March of the next year. It came again the next August and now follows the August to March pattern during which time he has the headache every day although sometimes the intensity varies. Nothing seems to make the pain better or worse although occasionally pain meds(percodan, darvoset) will help. He rarely takes meds because mostly they don't do anything. He doesn't recall anything unusual going on when the headache began except that he had a wisdom tooth removed from the right side which damaged a nerve to his tongue which is now numb on the right side. He can't recall whether the tooth extraction came before or after the headache. He has no previous history of headaches.

 

Biomedical Dx: cluster headache. Sinus involvement, allergies, tumors, etc have all been ruled out through CT, MRI, allergy tests.

 

Systems Review

Digestion: occasional reflux for which he occasionally takes a Prilosec; drinks 1 cup fo coffee a day

Sleep: 6 hours a night, pain can wake him up

Respiratory: has a history of sinus infections and bronchitis

Musculoskeletal: occasional low back pain and stiffness

General: doesn't get much exercise, no abnormal body temperature or sensations

 

Pulse: Left side deep and constrained, very weak chi postion.

Right side mid to deep level and slippery especially in the guan position. Stronger than the left side.

 

Tongue: Pointed presentation. Deviated to the right because of tooth extraction. Central crack to the tip

Swollen overall.

Pale red overall. Dusky tip.

Slightly thick white coat, thicker in back.

Thin dark purple sublingual veins.

 

General impression: A stocky man with a red face and pale circles around his eyes. Big voice. Frustrated temperment.

 

Pattern Dx:Blood stasis, dampness and heat obstructing the GB channel of the head. Liver yang rising. Stomach heat.

Kidney vacuity.

I'm not completely happy with this diagnosis. I am confused by the time element of the headache. Why does it come in August and go in March? Could there be an externally contracted pathogen involved that goes latent for 6 months of the year? Or is does it's coming and going have more to do with the fluctuation of yin and yang tendencies during the year-the headache coming in the more yin times of the year and going when yang begins to become more prominent? Or both? Also, is there any possibility that the left sided headache could have anything to do with the right sided wisdom tooth extraction?

 

I have treated this patient 3 times with acupuncture.

After the first treatment he was pain free for 3 out of 7 days and the pain never reached over 5/10 in intensity, whereas before it was would regularly reach 8 and above. The last 2 treatments didn't make a difference in the pain but he maintained 3 painless days during each week.

 

Herbs: I prescibe herbs in granulated extracts so .the numbers after the medicinal shows its proportion. He's taking 12 grams of extract or about 60 grams of raw herbs a day. 5 days of taking the herbs have made no difference.

 

shi jue ming, 6

tian ma, 6

huang lian, 2

huang qin, 6

chai hu, 5

he shou wu, 6

tu fu ling, 12 Dr. Tsai, a teacher of mine in San Diego, uses this as an all purpose headache herb. I added it here because of my suspicions of the pathogenic origin of this condition

chuan xiong, 6

yi mu cao, 5

di long, 6

chi shao, 5

ye jiao teng, 5

niu xi, 5

ban xia, 5

xi xin, 3

gan cao, 3

 

Anybody have any ideas?

Thanks so much for any help you can give.

Kristin Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

.. Perhaps Alon's suggestion could be used symptomatically as a last resort. But using lidocane nasal drops will mask the pathology making it difficult to assess the value of your treatments. 2) It may be helpful to rule out the aggravation from the dental work as a cause.

>>>>Actually when this works it can brake the pain cycle and at time cure the condition by affecting the sympathetic.

Alon

[Guest guest]

Hi everyone,

 

I've got a case I need some help with.

34 yo man; factory foreman

Chief complaint: left sided headache just behind Stomach 8. It is fixed in location burning and aching in quality. When it is most intense it spreads down to the left eye. It started during August 4 years ago and lasted until March of the next year. It came again the next August and now follows the August to March pattern during which time he has the headache every day although sometimes the intensity varies. Nothing seems to make the pain better or worse although occasionally pain meds(percodan, darvoset) will help. He rarely takes meds because mostly they don't do anything. He doesn't recall anything unusual going on when the headache began except that he had a wisdom tooth removed from the right side which damaged a nerve to his tongue which is now numb on the right side. He can't recall whether the tooth extraction came before or after the headache. He has no previous history of headaches.

>>>To follow up any news with this patient.

Alon

[Guest guest]

Thanks for the interest. For another 2 weeks, he maintained the results from the first acupuncture treatment which made his headache a 4 out of 7 day phenomenon rather than a 7 out of 7 and overall less intense. Then he decided that he would rather buy his kids Christmas presents than continue treatment, even though I tried to find economic ways to manage his case. He hasn't returned my follow up phone calls.

 

Kristin

 

-

alonmarcus

Saturday, December 30, 2000 3:16 PM

Re: Cluster headache case

 

 

Hi everyone,

 

I've got a case I need some help with.

34 yo man; factory foreman

Chief complaint: left sided headache just behind Stomach 8. It is fixed in location burning and aching in quality. When it is most intense it spreads down to the left eye. It started during August 4 years ago and lasted until March of the next year. It came again the next August and now follows the August to March pattern during which time he has the headache every day although sometimes the intensity varies. Nothing seems to make the pain better or worse although occasionally pain meds(percodan, darvoset) will help. He rarely takes meds because mostly they don't do anything. He doesn't recall anything unusual going on when the headache began except that he had a wisdom tooth removed from the right side which damaged a nerve to his tongue which is now numb on the right side. He can't recall whether the tooth extraction came before or after the headache. He has no previous history of headaches.

>>>To follow up any news with this patient.

AlonChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.