Q: For the past 10 years I have suffered from cluster headaches. They occur about once a year for about a month, producing one to two headaches a day. The pain feels like an extraordinary pressure behind the eye. I take aspirin, but it rarely works fast enough to help. Have there been any advances in treatment?
A: Yours is a good description of cluster headaches -- an uncommon grouping or clustering of headaches that occurs once or twice a year and runs its course over one to three months.
During a series, victims suffer one or more attacks a day, each lasting from a few minutes to several hours. Related to migraines, cluster headaches typically cause intense pain in or around one eye, often associated with eye redness, tearing, nasal congestion, sweating or flushing of the face, and drooping of the eyelid on the affected side of the head. This condition usually begins between age 20 and 40, and most victims are men.
Certain factors may provoke an attack, including alcohol, smoking, exercise, medications that dilate blood vessels, stress, hay fever, weather changes, skipping meals and over-sleeping. Avoiding any inciting factors may limit the frequency of attacks.
There are two treatment strategies: therapy of the acute attack, and preventive therapy.
For the acute attack, pain relievers or medications known as ergotamines may help, although, as you point out, they may not work fast enough to do much good. Breathing pure oxygen is beneficial for many people, but it may not be readily available.
For preventive therapy, doctors have used a wide variety of medications, but there is no consensus on which drugs work best.
Methysergide (Sansert), lithium and steroid medications, such as prednisone, have been effective in preventing cluster headaches, but all have potentially dangerous side effects and should be used under close medical supervision.
Propranolol (Inderal), phenytoin (Dilantin) and antidepressant medications sometimes help, and they are generally somewhat safer.
Cyproheptadine (Periactin) and indomethacin (Indocin) are safer still but generally much less effective.
Q: I have had two herpes skin infections on my buttocks over the past 10 years, confirmed by my physician. Neither my husband nor child has any signs of it. How can I know what kind of herpes I have? Could this be genital herpes?
A: The herpes simplex virus causing your skin infection comes in two forms -- type I, the kind that usually causes fever blisters on the lips, and type II, which usually causes genital herpes infections.
I don't think it's helpful to know the type of herpes, because both can cause either form of infection. The skin infection is contageous, but not highly so, and almost only when the blisters or open sores are present.
Because of the location of your infection, there is a chance that herpes is also present in the genital area. So during the five- to seven-day period of active infection, your husband should avoid contact with the affected area and refrain from intercourse. To be certain, I'd also recommend seeing your doctor to check for genital infection the next time your skin infection is active.
Q: I'm 17 years old and seem to catch more viral illnesses (cold, sore throats, flu, stomach virus) than anyone else I know. In the past 14 months I've been sick eight times. Do you have any suggestions on how I can make my body more resistant to viruses. What do you think of flu shots?
A: Eight viral infections in 14 months may sound like a lot, but it's not out of the ordinary for someone your age. Preschool-age children get an average of 10 to 12 colds a year. Older children average six to eight, and adults two to four.
There's some evidence that stress or poor nutrition can weaken resistance to infections, but aside from reducing one's level of stress and being well nourished, there's not much else that can be done to strengthen natural defenses against viruses. In any event, it doesn't sound like you have some serious underlying cause of frequent infections.
I don't recommend flu shots for someone your age. They wouldn't prevent routine colds, simple sore throats or stomach viruses, anyway.
Until better therapy exists, it's best to treat the symptoms of these infections and allow them to run their course. Follow-Up
Readers have asked for more information about the effects of certain drugs on the developing fetus. There are several genetic counseling centers in the area that specialize in advising women about the risks of drug exposure during pregancy as well as about other genetic disorders. I suggest working through your doctor to make use of their services if needed. The centers are:
* Children's Hospital, Department of Clinical Genetics. 745-2187.
* Columbia Hospital, Reproductive Toxicology Center. 293-5137.
* Georgetown University Hospital, Division of Genetics. 625-7852.
* Georgetown Washington University Hospital, Wilson Genetics Unit. 676-4096.
* Howard University Hospital, Hereditary Clinic. 636-7224.