DEAR DR. DONOHUE: I am a 32-year-old male who has enjoyed perfect health until now. Lately I have been getting severe headaches during the night. They wake me up, and I have to get out of bed, the pain is so bad. I take Tylenol, and they are gone in about half an hour. I am afraid to go to bed because of them. What gives? – W.W.

You give the classic description of cluster headaches. They are headaches of indescribable pain that often come on at night, wake a person from deep sleep and drive that person to jump out of bed and pace through the house frantically. They usually don’t last long.

They got the “cluster” name because they come in clusters – two or three in one 24-hour period, for consecutive days, weeks or months. Then they disappear, only to reappear at a future date.

The pain of a cluster headache is on one side of the head and usually centered around and behind the eye. Tears sometimes drip from that eye. The nostril on that side of the face often drips in sympathy with the eye.

It’s hard to say if the Tylenol relieves your pain. Generally, the brevity of the headache is such that it is gone before any medicine has a chance to act.

Breathing pure oxygen from an oxygen tank can sometimes put a quick end to the headache. The oxygen tank is a bona fide medical expense for people with cluster headaches.

Sumatriptan is a migraine-headache medicine. It is also useful for cluster headaches. It comes as a nasal spray or as a self-injection. Those two routes speed the drug’s absorption so it can act quickly on a cluster headache.

If these headaches come frequently, there are medicines that can be taken to prevent them.

The headache pamphlet details the many types of headaches people have. Readers can obtain a copy by writing to: Dr. Donohue – No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: For a week, I had a golf-ball-sized swelling behind my left elbow. My doctor said it was an effusion. I had never heard that word. He put me on some medicine and told me to return if the swelling did not go away in another week. Then he would drain it. Please give some details on this effusion. – J.R.

Effusions are collections of fluid. They occur in many places. One common place is the space between the double-ply covering of the lungs – a pleural effusion.

Your effusion is a collection of fluid in the bursa behind the elbow. A bursa is a flat disc that serves as a ball bearing, reducing friction between tendons and bones. If your doctor told you that you had bursitis, you would have recognized that. You do have bursitis. Yours is special because the bursa has become swollen with fluid.

The usual cause of a bursal effusion is overuse.

Moist heat and anti-inflammatory drugs can usually cause an inflamed, swollen bursa to resolve without any interference.

In the few instances when that does not happen, draining the bursa with a needle and syringe and sometimes instilling it with cortisone will end the swelling.

DEAR DR. DONOHUE: Please answer a question for me. Who are more likely to get thyroid cancer, men or women? How deadly is thyroid cancer? Is it ever cured? How does one get it? – D.J.

Women who have not reached menopause are more likely to get thyroid cancer than are men of the same age. After menopause, the incidence is the same for men and women.

The causes for most thyroid cancers are not known. Sometimes they occur because of past radiation. Treating acne with radiation was once a common practice. It has not been abandoned.

The most common kind of thyroid cancer is curable 90 percent of the time. Only a small number of thyroid cancer patients die from it.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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