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A Headache Without the Ache

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Aug. 7, 2000 -- Cluster headaches affect about 1 million people in the U.S. and usually leave misery and frustration in their wake. However, the scenario may not play out this way all the time.

Now, a case report of one man, which appears in the Aug. 8 issue of the journal Neurology, indicates that cluster headaches can occur without the severe pain.

Cluster headaches occur mostly in men, last about an hour, can recur two or three times a day for weeks or months, and are accompanied by an unusual set of symptoms, including stuffy nose, droopy eyelid, and tearing and redness of just one eye. They have no long-term consequences but can be difficult to diagnose and treat.

The report may help doctors understand more about this strange and poorly understood problem, in that it suggests that the unique symptoms of cluster headaches -- aside from the pain -- are primary symptoms of the disorder rather than a response to severe pain, experts say.

"They're one of the most terrifying and severe headaches that occur," says Seymour Diamond, MD, director of the Diamond Headache Clinic in Chicago. "We probably see more clusters than any other clinic in the world, maybe 300 or 400 a year. I've never seen one without pain before."

This unusual case began when a patient came to a Norwegian clinic complaining that his pupil would periodically contract and his eyelid would droop for one or two hours several times a day. "He was worried that something serious was the cause of these problems," Rolf Salvesen, MD, PhD, tells WebMD. Salvesen, the author of the report, is a professor of neurology at the University of Tromsø, in Bodø, Norway.

But tests were normal, and a neurological examination showed nothing suspicious. After six weeks, the symptoms went away.

Then, six years later, the same patient returned to the clinic with all the symptoms of cluster headaches, including the severe pain. A brain scan at that point showed no abnormalities, and again, the symptoms faded after six weeks, Salvesen reports.

"Most people believe that the symptoms occur because of a reflex to pain, but this case demonstrates that cannot be true," Salvesen says. "The take-home message should be that ... a cluster headache is two quite different sets of symptoms that might each have their own cause."

Other experts agree. "It's interesting. I think it implies that the other symptoms might be primary symptoms of cluster headaches," says Morris Levin, MD, professor of neurology at Dartmouth Medical School in Hanover, N.H. But he cautions that the case could also be a unique one: "Let's be on the lookout for more cases like it."

 

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