In his regular column, Dr James Le Fanu answers your questions. This week, a reader suffers from horrendous headaches
Q. For the last couple of years I have suffered horrendous headaches always following the same predictable pattern. I wake at three in the morning with a throbbing pain over my left eye accompanied by profuse watering and blockage of the nostril on the same side. This rapidly increases to an agonising pitch forcing me out of bed to pace up and down clutching my head. Then quite suddenly, after an hour or so, it stops, leaving me completely exhausted. My doctor is sympathetic but the several powerful painkillers he has prescribed provide no relief.
A. There were, at the last count, more than 150 different types of headaches posing a significant medical challenge, not least as blood tests and scans tend to be normal and thus uninformative. Rather their accurate diagnosis relies almost exclusively on paying close attention to the sufferer’s description of the salient characteristics.
The two most common, migraines (throbbing and unilateral) and tension headaches (persistent and vice like) are familiar enough. But beyond that, detailed questioning as to the nature, quality and location of the pain, its frequency and duration is necessary to distinguish cephalgia fugax (sharp and transient) from hemicrania continua (one sided, continuous), chronic daily from medication-induced and so on.
This reader’s description is absolutely characteristic of “cluster headaches” – so called because they are grouped into clusters up to several times daily, persisting for weeks or months on end interspersed by equally prolonged periods of being symptom-free. The further typical features are their intensity, rated as the worst of any type of headache, likened to a hot poker or screwdriver penetrating the eye.
