June 29, 2006

Q: I have cluster headaches. They appear approximately every two years and last two to four weeks with three or four episodes a day. Is there a cure? What is the best treatment? It’s the worst pain ever.

A: Cluster headaches are one of humankind’s most painful experiences. They come on suddenly and last for a relatively short time –– 15 minutes to two hours –– but each minute of the headache seems like a year. The headache is a one-sided affair, and often the nostril on that side of the head drips and the eye on that side tears.

People find the pain so unbearable that they cannot sit still, a feature that distinguishes cluster headaches from migraine headaches, which make their victims seek a dark, quiet place to lie down. Often cluster headaches waken people from sleep.

The headaches come in “clusters” of one to four a day for weeks to months at a time. Then they disappear as inexplicably as they appeared.

Some find that the best way to end a cluster headache is to breathe pure oxygen for about 15 minutes. Since oral medicines take time to work and since cluster headaches are somewhat brief, oral medicines are not the greatest in terminating a headache. Sumatriptan, a migraine medicine, comes in a self-injectable dispenser, and it can bring an end to the headache. It also comes in a nasal spray, which works quickly.

To shorten the periods of recurrent clusters, prednisone, valproate, baclofen, Tegretol or lithium may be prescribed.

If the periods come frequently, verapamil and lithium are used on a more constant basis as prevention.

Q: Several years ago you wrote that older men experience breast enlargement. I am now getting breast enlargement and would like to know how to reduce it. It is disturbing me.

A: Enlargement of the male breast is gynecomastia (GUY-nuh-coe-MASS-tee-uh), and it happens in two periods of life –– adolescence and older age. It’s due to an imbalance of male and female hormones that occurs during those two stages of life. In puberty, the hormone imbalance brings on a temporary enlargement of the breast that happens, in some degree, to all boys. It disappears as the years pass, and the normal ratio of male-to-female hormones is re-established.

In later life, with a diminution in the production of male hormone, the ratio is disrupted, and breast tissue grows. In addition, at this point in life, it is common for men to deposit more fat, and some of the breast enlargement is fat, not just breast tissue.

If the condition is truly disturbing you, then the most direct and satisfactory answer is surgical removal of the redundant tissue. Not many men choose that route.

There are some pathological processes that promote gynecomastia. Liver disease, an overactive thyroid gland and tumours of the adrenal gland and testes are examples. Rapid breast growth, particularly in a lean man, would prompt a doctor to look for those conditions, rare as they are.

Q: I am told that doctors place grapefruit off-limits for people who take cholesterol medicine. If enough time elapses between eating grapefruit and taking the medicine, wouldn’t it be permitted to continue having grapefruit?

A: Grapefruit inhibits the action of an enzyme involved in the metabolism of some medicines. Inactivating the enzyme raises the blood level of those medicines, and that could cause problems. The effect lasts 24 hours, so taking the medicine even 12 or more hours after taking grapefruit doesn’t circumvent the effect. This doesn’t happen to all medicines or to all cholesterol medicines –– just some. n

Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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