Matthew Mandel, MD, has enjoyed an illustrious career in Medicine as an anesthesiologist, and now in retirement has been recognized for his volunteer efforts.
But what you won’t learn from watching the video is that Dr. Mandel suffered from debilitating headaches for 45 years. I wouldn’t have known anything about Dr. Mandel, or his headaches, were it not for the news feature that popped up near my toolbar this morning. The feature addressed the diagnosis that he finally received for his mysterious headaches, hemicrania continua. Don’t feel badly if you’ve never heard of this. After all, Dr. Mandel is someone who has been around patients in pain all his life, and despite having access to the best specialists in the world had never been effectively diagnosed or treated.
The condition is considered relatively rare, and is not readily recognized because it overlaps many other conditions. Here is a nice article on the condition in the journal Brain. If you prefer something more lay oriented, here is a description of it from WebMD. Look at all the eye involvement, and here is the key: the pain is always unilateral. It is most often confused with cluster headaches. There is pain referenced to the eye, intra-orbitally, over the brow, or temporally. There can even be pain radiating to the occiput. There can be edema of the lid, ptosis, miosis, or mydriasis, and congestion in the globe. Check out a previous blog we did on the eye as a specialized joint adapted for sight, and you’ll note how congestion in the orbit due to a variety of conditions can lead to pain and discomfort. It isn’t surprising that an NSAID (non-steroidal anti-inflammatory drug) would help here. What differentiates hemicrania continua is that, as the name implies, there is a radiating pain that often extends through the eye and entire side of the head.
What is surprising is that it seems one specific NSAID, Indomethacin is key in eliminating the pain – which is what did the trick in Dr. Mandel’s case. Because Indomethacin can have annoying side-effects, he was switched successfully to Melatonin. The take home message here is that while headaches and visual discomfort are associated with a variety of causes, relief may sometimes be attained through targeted pharmacologic means once the differential diagnosis has been made.