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Medical Edge Newspaper Column from Mayo Clinic
THE MYSTERY OF CLUSTER HEADACHES
DEAR MAYO CLINIC: Is it my imagination, or does going for a hard
run actually do something to clear up my killer headaches? Before the
run, the pain is almost unbearable — it even brings tears to my eyes.
In fact, I think I discovered the running cure when I tried to “run away”
from the pain. My wife says the “exercise cure” is the opposite of any
headache remedy she’s ever heard of. I agree, but I know what works. Have
you ever heard of this? — Iowa City, Iowa.
ANSWER: Yes, I have heard of the beneficial effects of hard exercise
for some patients who have cluster headaches. Cluster headache is a primary
disorder — a distinction that means the headache is itself the problem,
not a symptom of an underlying condition. To rule out any other health
problems, it would be wise to see a physician who has expertise in headaches.
In the event you receive a diagnosis of cluster headache from your physician,
here is some background to help you understand it better:
Cluster headaches are very uncommon, and no one knows what causes them.
Genetics appears to play a small role. Patients who have cluster headaches
sometimes become so agitated that they may rock or pace. I’ve rarely had
patients report that they can stop the headache by going for a fast run
when the headache is coming on.
The pain of cluster-type headaches is severe — it has been described as
“a hot poker in the eye.” This pain tends to peak rapidly, usually within
minutes after onset. It’s often located in and behind one eye, and it
may involve the temple. Other symptoms include eye redness and tearing,
and nasal congestion on the affected side. A cluster headache commonly
lasts for 30 minutes, but some can hang on for up to two or three hours.
Cluster-type headaches get their name because they tend to occur daily
for weeks or months, then disappear until the next “cluster” appears.
Jerry W. Swanson, M.D., editor-in-chief, Mayo Clinic on Headache
Additional Resources:
Treatment
of Cluster Headaches
Appointment
Information
More
Information on Cluster Headaches
DEAR MAYO CLINIC: I recently arrived back from Japan, where my
in-laws insisted (as they do every year) that our nine-year-old daughter
is overweight. Our pediatrician, who thoroughly examines her each year
for sports and school physicals, disagrees. She says our daughter reflects
my heavier Germanic build and has an athletic physique. My in-laws are
adamant. This year they added a new worry to the list: that their granddaughter
is at risk of developing cirrhosis of the liver. Is this possible? — San
Francisco
ANSWER: Yes, it’s possible — though quite unlikely — that an obese
child’s liver becomes so damaged that the child develops cirrhosis. In
cirrhosis, liver tissue is progressively destroyed. Scar tissue may replace
the damaged cells — but the loss of healthy cells leaves fewer cells to
perform vital liver functions. Eventually, the liver becomes so impaired
it cannot do its work. The patient may need a liver transplant.
That’s an extreme scenario. Now, let me talk in general terms about this
worrisome trend of obesity-related pediatric liver disease — not about
your daughter, since it sounds as if you have had an appropriate medical
specialist evaluate her.
Worldwide, there is a rise in a liver disorder known as non-alcoholic
fatty liver disease — NAFLD — in both children and adults. As with many
disorders, NAFLD can be severe or mild. An early sign of NAFLD — accumulation
of fat in the liver — can be found in almost two-thirds of obese people.
This accumulation is usually benign. But about 10 percent of people can
develop other liver abnormalities that impair function in a condition
known as non-alcoholic steatohepatitis, or NASH. The current thinking
is that people with NASH are at most risk for progressing to cirrhosis.
As a pediatrician, I feel we are dealing with an epidemic. There is no
effective medical therapy for obesity-associated liver disease except
for losing weight permanently through lifestyle modifications in diet
and exercise. And while most cases of NAFLD do not progress to cirrhosis
or require a liver transplant, the prospect of obesity-related liver disease
compromising a child’s well being is very real.
Ariel Feldstein, M.D., Pediatric Gastroenterology, Mayo Clinic, Rochester,
Minn.
Additional Resources:
Nonalcoholic
Fatty Liver Disease
Appointment Information
More
Information on Nonalcoholic Fatty Liver Disease
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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