DEAR DR. DONOHUE: I’m 28 and have been driving a truck for four years. I am happily married with two children and am in good health. In the past two months, I have had several headaches that are so painful they wake me from sleep, and I have to get out of bed. They last about an hour. I take aspirin for them, but I don’t know if it works or if the headache just goes away on its own. What is this? – B.L.

ANSWER: Your headaches have many of the characteristics of cluster headaches. They are the most painful of all headaches. They usually first appear between the ages of 20 and 40. They’re on one side of the head, often centered around the eye. The eye on the side of the headache frequently tears, and the nostril on that side can drip mucus. The headaches can come at night, and they are so bad that they drive a person out of bed. He (male cluster headache sufferers far outnumber females with cluster headaches) paces around the house in a frenzy until the pain leaves. That can take anywhere from minutes to hours.

Cluster headaches come in “clusters.” There might be several in a day or night, and they can recur for days or weeks at a time. Then they go away. But they always come back, just when you had begun to forget them.

There are many treatments. Breathing pure oxygen for 15 minutes can end a cluster headache. Migraine medicines in self-administered injections can also abort the headache. Oral medicines are of little use; they take too long to be absorbed.

If a person is in the midst of a cluster when one attack follows another, there are preventive medicines to take. Verapamil, lithium, ergotamine and prednisone are examples.

See your family doctor, who can get you on a treatment and preventive program.

The headache booklet discusses all kinds of headaches and their treatments. Readers can obtain a copy by writing: Dr. Donohue – No. 901, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am writing to you about your comments on polymyalgia. I think you should include a statement saying people should always consider other things when polymyalgia lasts for years and years. My mother-in-law was told she had it for years. When she died, we discovered that cancer had spread throughout her body. She had all the symptoms you described, but she obviously had something more serious. Thanks for listening. – A.C.

ANSWER: Polymyalgia is something that strikes people over 50. Its symptoms are stiffness and pain in the shoulders, lower back, hips and thighs. Symptoms are usually worse in the morning after a night’s sleep. Its cause remains a puzzle. Low doses of the cortisone medicine prednisone usually suppress symptoms quickly, but medicine might have to be taken for a couple of years.

People with polymyalgia have no greater risk of coming down with cancer than do those without it.

Some cancers produce symptoms similar to polymyalgia, but their symptoms don’t respond to prednisone.

Two different processes can be going on at the same time, and perhaps that happened to your mother-in-law. All the same, your point is well taken. Doctors, including me, often fall into a trap of ascribing all of a person’s symptoms to one illness when there might be two at work.

Write back with the kind of cancer your mother-in-law had. I can give you its usual time course.

DEAR DR. DONOHUE: You say it’s safe for a man to have two alcoholic drinks a day, a drink being 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor. How much is safe for a man taking Lipitor? – L.S.

ANSWER: The same amount. Alcohol doesn’t interfere with Lipitor, and Lipitor doesn’t interfere with alcohol.

Lipitor is a statin drug, the popular cholesterol-control drug family.

DEAR DR. DONOHUE: I have been put on a very strict caffeine-avoidance diet to see if it would help me control the pain of cystic breasts. I have been on it for a week, and I think it’s working. However, I have eliminated only coffee and tea. What are other caffeine sources? – K.D.

ANSWER: If you steer clear of coffee, tea, chocolate, many soft drinks and some medicines – both over-the-counter and prescription – you won’t take in much caffeine.

A cup of coffee has 100-120 mg; a cup of tea, about 40; 12 ounces of Coke and Pepsi, around 35; 12 ounces of Mountain Dew, 55; 1 ounce of baking chocolate, 25; 1 ounce of semi-sweet, dark chocolate, 20. Caffeine is often combined with pain medicines to enhance the potency of the pain reliever. You’ll have to read the list of ingredients to see if it’s combined with the active drug.

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. Readers may also order health newsletters from www.rbmamall.com.

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