For my own part, I finally have a diagnosis for my suspected cluster headaches. Basically: they’re cluster headaches.
My nights had started getting desperate: I could continue to take Migraleve and be entirely headache-free, but who wants a codeine monkey on their back when there’s as yet no explanation for the pain? And so I took as many days off as I could, compiled a “headache diary” (time, circumstances, medication, experience of the pain and onset), and then booked an appointment with a doctor who was not my own. Having one of the few decent doctors in the local surgery means I never actually get to see her when I need to.
After cycling to the surgery and arriving far too early, I freshened up in the toilets, only to find they had called my name already. As I gathered up my pannier and bike helmet and started down the corridor, the locum came to meet me. He floated along like an untethered weather balloon, ponderous, fat and moving surprisingly quietly and weightlessly for such an enormous man. Solemnly he acknowledged I was who he had called for, and beckoned me to follow him into the room.
I gave this queer Pyecraft chap an account of all my symptoms, trying hard not to suggest a diagnosis, but nonetheless giving him as much information as I had been able to gather. He digested this for a while, inflating slightly; then, in a voice like the distant whirr of an outboard motor, he told me quietly but precisely that what I had was “a kind of cluster neuralgia”; entirely harmless, he assured me. He mentioned much that I knew already, about trigeminal nerves and the like, and then gave me a prescription for (of all things) amitriptyline.
So, there you go. Cluster neuralgia, only in my head. There’s a shorter way of putting that, I’m sure. That night, I didn’t take a Migraleve, to ensure I was still within the cluster before committing myself to starting the amitriptyline; it’s typically used as an antidepressant, although K. was prescribed it for her RSI – there’s some sort of folk belief in it being good for more mundane nervous disorders than depression – and it completely knocked her out.
I suffered no headache, that night, or the next, or since. Just as I’d got a doctor’s appointment, my cluster was over; for another half year, or a year, or longer still. Luckily, amitriptyline’s use-by date is a long time in the future, so now I feel thoroughly equipped.