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    Suggest treatment for cluster headache and blisters on the lips

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Posted on Mon, 1 Aug 2016 in Brain and Spine
Question: My husband has been having terrible pains in the left side of his nose and around his eye. ENT nor his Dr can find anything from CT scan or Xray. It hits really quick and last about 15-30 mins then goes away just as fast. Now he has developed tiny blood blisters on his lips-9 so far. Could this be some sort of neuro problem that involves the nerves? He isn't able to sleep and can barely eat scared he will start it up again. No pattern to the beginning or ending. What can we do?
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Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

From the way you speak and the fact he’s had a CT I assume this has been going on for some weeks/months. That would exclude a nerve infection like Zoster which manifests skin signs early, those blood blisters may not be related.

It is good that he has had a CT although I would say a MRI would have been preferable to detect subtle compression of the trigeminal nerve or other causes. If possible it should be scheduled.

In the meanwhile I would say that those attacks could be a case of cluster headache. It is a primary headache, meaning with no identifiable cause. Comes in the form of attacks involving the eye area, lasting 15-180 minutes and commonly associated with at least one of the following tearing and injection of the conjunctivae, nasal congestion, eyelid edema, forehead and facial sweating, drooping of the eyelid, a sense of restlessness. So if that is the case it is the most likely diagnosis. Management of acute attacks is giving oxygen or medication of the triptan group.

Another primary headache to be considered is chronic paroxysmal hemicranias which is similar in manifestation to cluster, but is more rare, usually shorter and more common in females. If in doubt though and treatment for cluster doesn’t work a trial of Indomethacin may be done as it is the only effective medication with great efficacy, so used as a diagnostic test as well.

Trigeminal neuralgia has to be considered as well but its attacks usually last for seconds not as long as you describe.

I remain at your disposal for other questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3655 Questions

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