Talk:Cluster headache

Cluster headache attack itself is not life-threatening

This is false as people who suffer from cluster headaches have been known to commit suicide to stop the intense pain. Therefore, a cluster headache attack could be considered life threatening as it could cause a reasonable person to commit suicide that otherwise would have not ended their life if they did not suffer from such a condition. Source: http://umm.edu/health/medical/reports/articles/headaches-cluster Quote: More than half (55%) of respondents reported experiencing suicidal thoughts. — Preceding unsigned comment added by 173.95.181.125 (talk) 08:16, 29 November 2013 (UTC)

Medical sourcing and content guidelines

Please review WP:MEDRS and WP:MEDMOS, including WP:MEDMOS#Sections. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches helps understand how to apply Wikipedia's medical sourcing guidelines, and where/how to find secondary review sources. SandyGeorgia (Talk) 17:54, 2 January 2014 (UTC)

Primary studies

This article is rife with primary studies: see WP:UNDUE, WP:RECENTISM, WP:NOT (news or a support forum), and WP:MEDRS. I've removed this text for discussion. SandyGeorgia (Talk) 19:23, 2 January 2014 (UTC)

In 2012-2013, in an effort to reduce the amount of imaging, number of consults and number of admissions related to headache whilst maintaining pain relief for patients, pain physicians from the Cleveland clinic are working to refine an algorithm for use in Emergency Department (ED) headache presentations. Details of a report on implementation of the algorithm were presented at the 2013 International Headache Congress and showed an 82% reduction in the use of opioids in Headache presentations in ED. “We were astonished at how much we were able to diminish the use of opiates,” - lead investigator Cynthia Bamford, MD. Further validation of the algorithm will show whether it will hold up in various ED settings.

"Suicide" headache

Some of the sourcing in this article is extremely poor. This is a marginal review (appears to be only a partial review combined with a study on a small sample); nonetheless,

• Torelli, P; Manzoni, GC (2002). type=Review "What predicts evolution from episodic to chronic cluster headache?". Current pain and headache reports. 6 (1): 65–70. doi:10.1007/s11916-002-0026-5. PMID 11749880. {{cite journal}}: Check |url= value (help); Cite has empty unknown parameter: |1= (help); Missing pipe in: |url= (help)

mentions "suicide" headache. SandyGeorgia (Talk) 19:52, 2 January 2014 (UTC)

"Suicide disease" is also applied to trigeminal neuralgia... and the sourcing there for this term is poor too. It is known that a tiny fraction of patients with chronic and severe craniofacial pain conditions will commit suicide, but I would not say that they are commonly referred to as suicide headache or disease, at least in medical publications. Lesion (talk) 21:21, 2 January 2014 (UTC)

Thanks Lesion. SandyGeorgia (Talk) 21:52, 2 January 2014 (UTC)

I'm not making a case for "suicide headache," which surely is not used much in medical literature (I've seen it one or two places, but it's not worth looking for), but in response to Lesion's post, I'd point out that in the largest study to date of CH patients, involving surveying 1134 people, 55% of the respondents said they had considered suicide, 2% said they had attempted it, and 50% had engaged in self-injurious behavior during a CH attack. (Rozen, T., MD, and Fishman, R. "Cluster Headache in the United States of America: Demographics, Clinical Characteristics, Triggers, Suicidality, and Personal Burden," published in Headache in 2011). Anyone in the CH community has known multiple people who have killed themselves. I apologize for "debating" a settled point here, and I won't do it again I promise, but I don't think these are the "tiny fractions" that Lesion is suggesting. Chfather (talk) 01:52, 4 January 2014 (UTC)

Debate is healthy, please feel free. Here is another source which mentions it:

“ The severity of the pain has earned it the sobriquet “suicide headache,” although in our experience this is a rare occurrence in this exceptional patient group. ”

-From the Nesbitt 2012 review, already used in the article. So yes we should should mention it imo. Not sure how others feel. Lesion (talk) 01:59, 4 January 2014 (UTC)

Redundant, repetitive and off-topic prose

This article says the same things over and over and over, often based on primary sources, looking like individual researchers wanted to work their links in. I'm reducing some of the redundant prose, but by no means all of it; that should be done better when the article is thoroughly rewritten to reflect more recent secondary reviews-- since the article is so poorly sourced, it's hardly worth it at this stage to clean up all the prose. SandyGeorgia (Talk) 21:52, 2 January 2014 (UTC)

There are 2 cochrane reviews, one is already used, here is the other: [1]. Lesion (talk) 23:07, 2 January 2014 (UTC)

I put that Cochrane review in, but expansion needed. SandyGeorgia (Talk) 03:03, 3 January 2014 (UTC)

• Suggest structure the features of cluster headache according to Socrates (pain assessment), see for example Atypical facial pain for how this looks. Lesion (talk) 23:34, 2 January 2014 (UTC)

• I'm typically not a fan of listified prose, and another problem I have with the table at Atypical_facial_pain#Signs_and_symptoms is that the citations are disassociated from the text, and there's a whole long list of citations above the table where it's not apparent what is citing what. I guess here, whatever works and whatever others want, but I don't think something like at AFP would ever get through FAC (just saying), where prose is preferred to lists and tables, and citations should be attached to the text they verify. Best, SandyGeorgia (Talk) 00:01, 3 January 2014 (UTC)

• Yes the table needs inline citation. That is a problem that needs fixing. It is not really MEDMOS to use socrates, in fact I recall there is something in there about not using mnemonics at all, but I think it is a nice structure to apply to the signs and symptoms section for conditions characterized mainly by pain. Lesion (talk) 00:13, 3 January 2014 (UTC)

Back to psilo/LSD

I would really like to improve the discussion that is there now, but I want to do it right. Maybe you can advise me. My concerns relate to these two elements: 1. Vasoconstrictors such as ergot compounds are sometimes used immediately at onset of attack. Cafergot, a vasoconstrictor combination of caffeine and ergot, has been demonstrated in some cases to abort cluster headaches within 40 minutes of ingestion. BOL (2-bromo lysergic acid diethylamide), a non-psychedelic form of the ergot-derived psychedelic LSD, has shown promise in the treatment of cluster headaches.[unreliable medical source?][48] 2. Some isolated case reports suggest that ingesting LSD, psilocybin or cannabis can reduce cluster headache pain and interrupt cluster headache cycles.[49]

Re #1, there really is no relationship between cafergot and BOL-148, except that they both contain ergots (as do some other CH meds mentioned elsewhere in the article). So, I would make a new topic. Re BOL-148, I can edit to provide a link to a peer-reviewed journal, Cephalagia, which published the results of a small trial of BOL-148 for people with CH. But I think that's a "primary source." Would it allow for removing the "unreliable medical source" note that there's now (deservedly so)? BOL-148 is different from cafergot, among other things because it seems to be not just an abortive (and not just an generally ineffectual abortive, as cafergot is) but also a possible preventive. For people with CH, the difference between maybe aborting an attack in 40 minutes and preventing attacks altogether is enormous.

And the fact that BOL-148 works is evidence that the next part -- about LSD, etc. -- is not some whackjobs taking drugs to escape their pain. BOL-148 works because it has LSD in it. So, Re #2. I don't know what "some isolated care reports" means. As far as I know, there is exactly one report of cannabis helping someone, whereas research conducted by medical professionals has shown hundreds of cases in which CH patients receive relief from psilocybin, LSA, and LSA. Yes, these are anecdotal self-reports collected by those medical professionals, and not clinical trials, but since the substances are scheduled, there's no more than that that can be done. I could cite several such reports (and I note that LSA, which is not mentioned in the current text, is the subject of some of them), but again I fear that this will be removed as "primary sources."

There are probably thousands of CH sufferers using LSA, LSD, and psilocybin to treat CH, with no lasting side effects (LSA, for that matter, is effective even without short-term psychedelic "side effects"). I understand someone's reluctance to give this treatment what I think of as its proper attention here -- it's not medically proven; it might sound weird or scary to some people; and the substances are scheduled. At the same time, it is saving lives every day.

If you're going to delete any edits I make, I guess I just won't bother doing so. But if there's a way to provide this information that is consistent with Wikipedia's policies, I would be happy to take a shot at it.~~chfather~~ — Preceding unsigned comment added by Chfather (talk • contribs) 00:34, 3 January 2014 (UTC)

There are 2 main issues when writing about medical treatments. First is to use a good source, (see: WP:MEDRS). Essentially, a fairly recent (i.e. last 5-10 years) review paper from a peer review journal (ideally a systematic review), OR a mainstream medical textbook. Mistake many people make is to use animal studies or human studies. Second main issue to make sure that the Wikipedia article reflects how a medical condition is treated in the real world. For example, if 95% of doctors use drug A to treat cluster headache in reality, we should not talk excessively about drugs B-Z. Hope that helps. Kind regards, Lesion (talk) 00:41, 3 January 2014 (UTC)

Hi, Chfather; Lesion's explanation is a (cool) way of explaining Wikipedia's due weight policy.

Another factor in writing for Wikipedia is that Wikipedia text must be verifiable to and rely on secondary sources; we can't engage in original research by analyzing or reporting on primary research studies that haven't been reviewed by secondary sources (that is, independent from the researchers who did the studies)-- our medical sourcing guidelines prefer secondary reviews to primary studies. Primary studies are individual case reports, trials, studies whether controlled or not, animal studies, surveys, and other studies that-- even if published in peer-reviewed journals-- haven't been the subject of a secondary review from independent authors examining their conclusions.

In addition to that, there are a lot of things that Wikipedia is not-- we aren't news, we aren't recent, we aren't for support-- a whole lot of things. We should only be reporting and giving due weight to what other secondary sources have already stated, in encyclopedic tone. An encyclopedia doesn't strive to be current in the same way the daily news does; it strives for long-term accuracy.

To that end, I have gone through and flagged numerous primary sources and laypress reports that don't meet our sourcing requirements, shouldn't have been in the article, and need to be replaced with secondary reviews. I've also removed some text that simply shouldn't be here at all without secondary sources (treatment issues, etc), and flagged the secondary reviews now (correctly) in the article by adding the word "Review" to their citations.

On the topic of psilo/LSD, there is mention of it in one secondary review (PMID 21352222), and that is in the article now; unless that review has more to say on the topic, or unless other secondary reviews surface, it won't be productive for you to write from laypress or primary sources on the topic of psilo/LSD.

This article was (is) actually in pretty bad shape, making use of very old sources, including a lot of repetitive text and editorializing; I've only made a first pass at cleanup, and some other editors will probably go through soon and try to beef it up. It will benefit everyone for the article to be as good as it can be, as it's not close now!

If you want to know more about how to research for writing medical content on Wikipedia, Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches explains how to locate secondary reviews in PubMed. Regards, SandyGeorgia (Talk) 03:50, 3 January 2014 (UTC)

I don't know how to reply to your kind replies, so I hope this isn't a mess. I just wanted to thank you for your help, and say that I do think that the current edits have made the entry much better (regardless of how I feel about the diminished place of psychedelics as treatments). I might try an edit at some point, if I think I can do that within the rules and still add value, and I will now apologize in advance if it turns out to be something you have to take down. Chfather (talk) 06:07, 3 January 2014 (UTC)

What was in the article before was uncited; if you can propose text here on talk, based on the secondary review PMID 21352222, we can discuss whether that source has been given due weight. SandyGeorgia (Talk) 07:33, 3 January 2014 (UTC)

Well, let me see if I can do it correctly. The second sentence of the uncited text says >>A self-reported interview of 53 cluster headache sufferers taking LSD or Psilocybin was conducted by doctors R. Andrew Sewell, John H. Halpern and Harrison G. Pope, Jr.[citation needed]<< The citation to Sewell et al is Sewell RA, Halpern JH, Pope HG. Response of cluster headache to psilocybin and LSD. Neurology. 2006;66:1920–1922. These studies are also referred to in what I think is a secondary source -- Christina Sun-Edelstein, MD, Alexander Mauskop, MD “Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments.” Headache. 2011;51(3):469-483 -- where the authors write (among other things): “Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks while 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination. In addition, 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension, meaning that the next expected cluster period was delayed or prevented. These results are interesting . . . because no other medication has been reported to terminate a cluster period. Furthermore, the drugs were effective at subhallucinogenic doses and effective treatment required very few doses of either drug.” I believe the data here would support (and potentially expand) the second citationless entry (but I don't know how to get back to that original material now to look at it!). Would these citations be acceptable? Would returning some version (probably shortened) of the earlier uncited text to this article be acceptable if similar cites could be found? Maybe I'm asking too much -- maybe I just need to know if the cites would be okay, and then, if they would be, offer my proposed new text. Again, THANK YOU. (For what it's worth, I am a financial contributor to Wikipedia, but I know I am taxing your time, if not also your patience.) Chfather (talk) 16:10, 3 January 2014 (UTC)

Depersonalize

We should remove all names of experts and researchers, and their quotes. Suggest only keep name of the person who discovered it (1974, Ekbom according to one source). Lesion (talk) 04:24, 3 January 2014 (UTC)

Yes (unless we are directly quoting someone, in which case we need attribution). SandyGeorgia (Talk) 06:22, 3 January 2014 (UTC)

CH?

Is cluster headache not alternately referred to as CH? Because switching many of the uses of the phrase cluster headache to CH in the article would probably shave 5KB !! SandyGeorgia (Talk) 07:03, 3 January 2014 (UTC)

Emotive words

I noted that this article also uses "sufferer" in a few places. The MEDMOS discourages this, instead we should use more neutral wording like "persons with cluster headache". Lesion (talk) 01:39, 4 January 2014 (UTC)

Lesion, I was out all day, so got no Wiki work done, but I did have a chance to read through the article from my cell phone, and the prose is atrocious throughout. I will engage again tomorrow or Sunday, read both Cochrane reviews, and before anything else, work on some of the worst parts of the prose. Unless someone tells me not to, I will switch a lot of the repetitive "cluster headaches" to "CH". Still have to find time to deal with all the primary sources. Does anyone have a copy of the full text of the journal article referenced above by Chfather? SandyGeorgia (Talk) 02:00, 4 January 2014 (UTC)

>>The full text is here: http://www.medscape.com/viewarticle/738530 Chfather (talk) 01:00, 6 January 2014 (UTC)

Done for now-- ready for another pass from Lesion or Jmh649 or Anthonyhcole. SandyGeorgia (Talk) 16:02, 4 January 2014 (UTC)

I would like to do a general editing pass--not to mess with content but small edits in quite a few places that I think will add clarity. I guess I could just do that (?) . . . but is there a way to somehow do it offline so that you-all don't think I'm trying to willfully impose myself on the published page? For whatever it's worth, I'm a writer/editor by profession.

Updated prevention and treatment sections

I think that was the most dangerous stuff. We have inline tags so have removed the banners from the lead. Feel free to replace them if you feel strongly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:06, 4 January 2014 (UTC)