Annette
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Cluster headaches causing anxiety disorderCluster Headaches: Do They Cause Anxiety Disorder?
University of Iowa Health Science Relations and
Ricardo Jorge, PhD
Assistant Professor of Psychiatry
Peer Review Status: Internally Peer Reviewed
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The intense pain of cluster headaches may not be the only worry for those patients suffering from them.
Patients with cluster headaches--severe headaches occurring in clusters of several months and then receding--have a higher rate of anxiety disorders during the time between clusters of headaches and show memory deficits during headache clusters, according to a recent University of Iowa Health Care study.
Ricardo Jorge, MD, associate research scientist in the UI Department of Psychiatry and lead author of the study, said the impetus for the study was a previously identified link between migraines and depression and anxiety. Cluster headaches, similar to migraines in many ways, were thought to have a similar link, increasing the likelihood of patients getting mood and anxiety disorders.
"If cluster headaches occur frequently with anxiety, the headaches may cause the anxiety or the other way around," Jorge said. "It is important to know the relationship between them so that doctors may treat patients better."
Cluster headaches' intense pain lasts 15 minutes to an hour. This pain usually occurs over periods that last a few months. After this time with multiple and severe attacks, the headaches disappear for a long length of time and then begin again without warning.
The causes of cluster headaches are unknown, but some evidence suggests changes in blood flow in the brain and dysfunction in certain brain areas. The incidence of cluster headaches is low, and cluster headaches affect more men than women, at a ratio of as many as seven to one. These figures may be somewhat misleading; doctors are increasingly diagnosing cluster headaches in women, Jorge noted.
The association of cluster headaches and anxiety disorders may also be related to brain dysfunction, especially certain areas known to be involved in the development of mood and anxiety disorders, according to the researchers.
There is no universal treatment for cluster headaches, Jorge said, although many treatments may be divided into managing the headache attack or decreasing the number of attacks during a cluster. Oxygen is often used to alleviate the pain as it happens, while other medications, including lithium, are used to reduce the length of an episode.
While there may be a link between cluster headaches and anxiety disorders, more work should be done before attempting to decide how best to treat patients with both or who are likely to contract both, Jorge noted.
"We need a bigger sample and then we will try to replicate our findings. Then maybe we can see if any specific type of treatment or approach is needed for those patients with cluster headaches and anxiety disorders. We also need to further research the significance of the memory disturbance involved with these headaches," Jorge said.
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Tami
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Great post Annette,
Thanx 4 sharing
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Sherri
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Most deflinately. I have had anxiety disorder nearly all of my life.
CH triggers it. Especially when Im getting hit consecutively....I tremble, have panic attacks when I feel a hit coming on. I usally have an anxiety attack wth a hit.
It's like having five minutes to KNOW you're going to the electric chair, or about to experience medieval torture.
About four months ago, I went through something different with CH. I thought I was becoming episodic.
For twently seven days, without fail, I would get hit at the same time...anywhere from five thirty p.m. to six thirty p.m....then the hit's would go on all nite.
CH is undpredictable for me, always has been. Hits come around the clock without any pattern...but THAT....was terrifying. KNOWING.
I kept trying to talk myself out of it...telling myself "Nah...the last fifteen days were a coincidence...it's NOT going to happen...last nite was the last time, etc."...it didn't stop for twenty seven days straight. I was exhausted....
Around four p.m. I would begin to get anxious...I could feel my neck tightening, and all the tell tale signs that a CH was going to happen.
Anxiety....terror....is a part of CH. A part that's overlooked many times. CH is terrifying. The pain is just something that cannot be explained, and it's really, really scary to have to go through it. 
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Annette
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Sherri, Phil and Ike
I have heard that for chronic CH, there is no pattern to the hits, is this correct ?
With Daniel, it was like clock work, every day for 8 months, almost without fail, the hits would come 9 am, 3 pm, 7 pm and 4 am. It was like Sherri said, terrifying because you know its coming and there wasnt anything you could do.
Even when the meds were helping, they would still come, just less severe and sometimes not more than a shadow. But the beast let you know its around one way or another.
Melatonin made a big difference to the night hits though, after 2 weeks and 15 mg the night hits stopped coming. Some night Daniel would still wake up with a headache but it would only be a 4 or 5, which he could get rid of with oxygen.
How can one plan life if one doesnt know when the hits were gonna come ?
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phil h
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Annette , Most of my hits (95%) fall into 2 windows . 1AM to 6AM and then 1PM to 6PM . I tend to range from doing real well 3-4 hits and day ; up to 8-10 hits when I'm not doing well . They pretty much evenly split into the 2 windows . The hits that are intense and fall outside those 2 windows really wipe me out . (A) I get used to timing my laughable work schedule around the 2 windows............ then (B) The beast is letting me know how's incharge and that he can change the rules whenever he wants to . That was a great article . They used to tx. me for anxiety. Anxiety would keep me awake between hits in the morning , even if the hits weren't to bad . They gave me trazadon with the plan to sedate and get 3-4 hours of sleep , before the hits come . That works fine on everything k6 and lower . Once I'm hit by k7's up to k10's in the AM I never get back to sleep . Just getting 4-5 hours sleep a night , after several years of 2-3 1/2 hours is an improvement . Increased rest gives me more strength to survive and try and get moving . I wonder if I shouldn't address the anxiety issues that I still do experience with the Neuro . My internist and gonsulting shrink keep telling me they'ed like to see me medicate the anxiety . Everytime I have discussed this with Neuro he kind of blows it off , saying I'm doing just fine .....LOL..... Maybe I'll bring it up again . The other 2 MD's are for it . I've been kind of holding them off the Neuro... I guess maybe I should listen to the 2 MD's that have known me for 20 years and are in favor of medicating the anxiety .... Whwat do you think Annette ? I know I've become more of my own advocate by necessity ; but it seems like I'm running my own tx. if I put everything to a vote . This is the besy Neuro I've had yet . phil h
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Annette
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I can only speak from my experience with Daniel but I would say yes to treating the anxiety associated with CH.
For a long time, CH was considered just a physical ailment, a headache ( what a joke ! ) and therefore shouldnt be associating with emotional issues. However, from our own experiences as well as from what many others have told me, there is definitely an aspect of anxiety when it comes to severe CH. Anxiety can make CH worse, by increasing the number of hits as well and the pain level.
CH is now understood as more of a neurovascular event involving many neurotransmitters and hormones, which can be affected by anxiety. Medications that treat anxiety stablelise these chemicals and therefore helping CH. It also helps the person cope better.
I dont see anything wrong with you being the advocate for your own treatment. You know your body best so you would be the best person to suggest what you would like to try.
I suggest you print these articles and show them to your neuro next time you see him and see what he says .
Good luck with it Phil and painfree wishes, as well as a big HUG !
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phil h
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THANK YOU ANNETTE...... I will do as you advised .... You know sometimes it gets confusing . Alot of the MD's I see in practice have been telling me this and offering to help out . I get spinning from too much input at times . Copied articles and e=mailed and faxed to Neuro ...... Thank you again .......... phil h  YOU'RE THE BEST ! ! !
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Annette
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Well, I need to look after my daddy, dont I ? 
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phil h
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Sherri
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I don't mean to interrupt... 
Annette, my CH's have been scattered since day one. Day, nite...3, 2, 7, 9, 5, 1...it means nothing.
Phil is an ananomoly. :smt104
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Annette
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Sherri, did you go chronic straight away ? Or did you start out as episodic ?
How did your CH start ?
I asked Ike and he said since going chronic his hits are all over the place too, no pattern of any kind !
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Sherri
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I went chronic from the first hit...and they are just ALL OVER THE PLACE and always were.
They came straight out of the blue. It happened one nite. I was out, having a great time....and got hit. They haven't stopped since.
In the beginning I went to every top specialist on the East Coast....even a professor of anesthesiology.....I was deemed "hopeless".
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phil h
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Now you are not hopeless Sherri . I prefer the term " reluctant to respond to tx. " Hopeless , no powerless is better............ I believe in miracles and you do too . Let's hang out and not quit before the miracle happens . Could be right around the corner .... Could happen ...... Maybe a miracle drug may come out to fix us ... or ........ we could become episodics..... or ...... the beast may just give up on us ... and go away .... We've heard those stories .......
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Sherri
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I didn't say I believed them...because I don't. Miracles happen all of the time...and we're going to be the ones to share ours.
I never, never, never give up hope that they will stop just as fast as they started.... 
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