Oxygen therapy may help people with cluster headaches

Q: I get crushing headaches every fall, which I've always assumed are part of having allergies. But a specialist at our local medical center diagnosed me with cluster headaches. She says oxygen is a good therapy. What about meds? This is all new to me, and any information will be helpful.

A: Cluster headaches are a severe form of headache in which pain is concentrated on one side of the head. Your use of the word “crushing” is not an exaggeration, as these types of headaches are notoriously painful. The attacks, which typically last from one to three hours, occur in groups, or clusters. They can arise repeatedly throughout a single day, or they may recur every few days.

Cluster headaches can also occur in regular cycles, as has happened in your case, arising at certain times of year. The cycles can last for several weeks or several months. This can lead to these types of headaches being mistakenly linked to other health conditions, such as allergies.

The cause of cluster headaches is not yet clear. They are fairly rare, affecting just 0.1% of the population, which makes them difficult to study. Due to their cyclic nature, the region in the brain that oversees the body's biological clock, known as the hypothalamus, is believed to play a role. Cluster headaches occur more often in men than in women, and studies suggest a genetic component may be involved.

Nasal congestion, watery eyes and inflammation of the blood vessels that serve the eye area often accompany these headaches. Diagnosis involves a detailed review of the person's symptoms and medical history. Additional tests, including brain scans, are often used in order to exclude other potential causes.

Treatment focuses on easing pain during a headache, and on preventing future attacks. The oxygen therapy your doctor recommended is the most common approach to treating this type of headache pain. The oxygen, at 100% concentration, is delivered via a face mask at the first signs of pain.

It is estimated that 75% to 80% of patients report complete relief from pain after 15 to 20 minutes of oxygen treatment. Oxygen therapy has no side effects and is readily available in emergency rooms and many urgent care clinics. An oxygen canister can also be kept at home. While effective for cluster headaches, oxygen therapy does not offer similar relief for migraines.

When oxygen is not available, a class of drugs known as triptans are often prescribed. For swift absorption, these are administered as a nasal spray or injection. Unfortunately, over-the-counter pain medications are not effective. Neither are medications that contain narcotics. In fact, medications that contain narcotics may generate additional attacks.

Prevention involves identifying and avoiding potential headache triggers, particularly during a known cycle. These can include alcohol, bright light, cigarette smoke, powerful scents and changes in altitude. Galcanezumab, a migraine drug, and the blood pressure medication verapamil may help prevent cluster headaches. Steroids, such as prednisone, may help extend periods of remission. Now that you have an accurate diagnosis, your doctor will advise you on the best treatment regimen.

Q: I had a kidney transplant two years ago, and I have developed thyroid nodules. Are they dangerous? I would like to ask about radio ablation to remove them. Is it an established procedure, or is it in the investigative stage? What does it entail?

A: For those who are not familiar, the thyroid is a small gland located at the lower front of the neck, just above the collarbone. It consists of a left and right lobe, which are connected by a small band of tissue known as the isthmus. Taken together, these form a shape somewhat like a butterfly or a bow tie.

For such a small structure, the thyroid has a lot to do. It plays a key role in regulating the body's metabolic rate, growth and development. Heart, muscle and digestive function, as well as brain development and bone maintenance, all depend on the hormones the thyroid produces.

Among the diseases and disorders that can occur in the thyroid is a condition known as thyroid nodules. These are small, solid or fluid-filled growths that develop within the lobes of the thyroid gland. As people age, thyroid nodules become more common. It is estimated that half of adults 45 and older have them. Thyroid issues, including the presence of nodules, are also common among people living with, or recovering from, kidney disease.

When thyroid nodules are small, they do not cause symptoms. Larger ones may lead to discomfort when swallowing or a physical sensation of tightness while lying down, when wearing a tight collar or while breathing hard. In some cases, the presence of nodules can lead to an overproduction of thyroid hormone. This is a condition known as hyperthyroidism.

When nodules are detected, they are evaluated with the use of imaging scans such as ultrasound and with blood tests that reveal thyroid function. When malignancy is suspected, a biopsy using a thin needle to draw out a bit of tissue from the nodule for analysis will be performed.

Benign thyroid nodules that remain unchanged do not affect thyroid function, and they do not cause physical symptoms and often don't require treatment. When circumstances call for their removal, radio-frequency ablation, or RFA, is an option.

RFA is a well-established procedure in which radio waves are used to create heat, which reduces or eliminates the nodules. During this procedure, a surgeon uses ultrasound to guide the tip of a small needle electrode into the nodule. Heat generated by radio waves then destroys the target tissue. RFA yields good results and is less invasive than other approaches, such as surgery or radioactive iodine therapy.

Patients who are pregnant and individuals who have a cardiac pacemaker are not candidates for this procedure. The location of the nodules also plays a role. Should the target tissues be close to a critical structure, such as a major blood vessel, the esophagus or the nerves that animate the vocal cords, an alternative approach will be recommended.

To learn if you are a candidate for RFA, see your endocrinologist for an evaluation.

Q: I am a 51-year-old woman, and I eat a very good diet and exercise six days a week. When I went into menopause, I got hot flashes. Drinking a cup or two of unsweetened soy milk each day helps a lot. Is that safe? I don't have gout, but I've read that soy products can increase uric acid.

A: When a full year has elapsed since a woman's last menstrual cycle, she is considered to be in menopause. The hormonal changes that occur at this time of life can give rise to a wide range of symptoms. Perhaps the best known, which affects up to 80% of women, are hot flashes. These are sudden and sometimes extreme sensations of warmth in the upper torso, often concentrated in the face, neck and chest.

Hot flashes range from brief and mild to prolonged and intense. They can occur at any time of day or night. A hot flash can cause the skin to become visibly flushed and may leave the individual dripping in sweat. These episodes are not only uncomfortable and sometimes embarrassing, but they can also interfere with quality of life.

Taking steps to stabilize levels of estrogen and progesterone can help ease some menopausal symptoms, including hot flashes. One method is hormone replacement therapy, or HRT. This is a medical treatment that provides either estrogen alone, or a combination of estrogen and progesterone.

Some women, like yourself, opt for alternative approaches. This includes adding foods that are high in isoflavones to the diet. Isoflavones are chemical compounds with estrogenlike properties. Soy and soy-based products are among the foods richest in isoflavones. When our patients choose this route, we advise them to consume whole food products rather than supplements. These include tofu, edamame, miso and soy milk. Flaxseed and flaxseed oil, which have similar properties, have also been shown to have a beneficial effect on the frequency and intensity of hot flashes.

This brings us to your concerns about gout. This is a painful form of arthritis marked by inflammation in the joints. Gout is caused by high blood levels of uric acid, a waste product formed as the body breaks down purines, which are chemical compounds found in varying concentrations in a range of foods.

Soy and its products contain moderate levels of purines, which may be the source of some warnings against eating soy when one has gout. However, a number of studies have concluded that soy consumption does not have a significant effect on serum uric acid. This body of research includes an analysis that looked at 17 such studies and did not find a connection between soy products and gout.

If you are concerned about your consumption of soy milk, talking to your health care provider may ease your mind. A simple blood test to measure blood levels of uric acid can let you know if your diet has placed you at risk. The initial test will also give a baseline result against which future tests can be measured.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.