“Pain so severe you just want to die” –and yet affecting approximately as many people in the UK as the widely known condition multiple sclerosis (MS) (1),  any mention of cluster headaches will likely draw blank looks from most of the general population. Given this, it’s hardly surprising that many sufferers feel alone in their battle with the condition. (1)

What are cluster headaches?

Cluster headaches (CH) differ vastly from a regular (tension) headache. Attacks (individual headaches) come on very suddenly. During an attack, sufferers experience a sharp, burning pain of excruciating intensity on one side of the head. (2) In fact, women who have both given birth and have CH have branded the latter as worse. (3) The pain is typically centred around the eye, but may affect other parts of the head or neck. The side affected may change between attacks, or less commonly, in the same attack. (4) Other symptoms occurring alongside the headache can include a red, watering eye, a congested or runny nostril, facial sweating, a droopy eyelid and a constricted pupil. (2)

Unlike migraine sufferers who usually want to lie down and rest during an attack, those with CH may pace around, rock their head or even resort to banging their head against a wall due to the severity of the pain. (2)

Attacks normally take place in bouts, or ‘clusters’, which persist on average for a period of four to twelve weeks. Within a cluster, attacks normally happen every day at the same time of day, and may occur multiple times a day, beyond eight in some cases. (2)

The period in between clusters is known as remission, which may last years before attacks return. However, many sufferers find they experience clusters around the same time every year.

In some particularly unfortunate instances, sufferers experience attacks on a chronic (ongoing) basis. This means they have experienced attacks every day for a year or more with no remission period, or a very short one. (3)

The excruciating pain of CH, along with the relentless nature, has led to the condition being dubbed “suicide headache”. (5)

What is the cause?

As of yet, there is no known definitive cause of CH, however, it is believed that malfunctioning of the hypothalamus, a part of the brain responsible for many vital bodily functions and processes, is the most likely basis. Additionally, CH is sometimes found to run in families, indicating a genetic link. (6)

How is it treated?

There are treatments available both to stop an attack from progressing and to prevent attacks from happening in the first place.

The following are abortive medications, used to treat individual attacks:

• Sumatriptan, when used at the beginning of an attack, can bring the headache to a halt. It comes in either injection form, which can be self-administered once or twice a day, or as nasal spray if preferred.

• Zolmitriptan is a similar medicine to sumatriptan and is available in a nasal spray form.

• Pure oxygen can be breathed through a mask to provide relief from an attack.

• Lignocaine is an anaesthetic administered in nasal drop or spray form. It is usually not sufficient to stop an attack completely, but can be helpful when used alongside other medicines.

• A gammacore device is a handheld appliance that can be held to the neck to generate a pulse which stimulates the vagal nerve, which is believed to play a role in CH. This can stop an attack in its tracks. (2, 7)

The following medications are preventative:

• Verapamil is the most common medicine used to prevent attacks. It may cause heart problems, so it is important to have regular electrocardiogram (ECG) tests during treatment.

• Local anaesthetic injections to the back of the head, corticosteroids or lithium are alternatives if verapamil is ineffective or unsuitable. (2)

It is thought that certain triggers can bring on attacks in some people. The smell of pungent chemicals, such as perfume or petrol, has been known to be a trigger. Also, avoidance of alcohol and smoking cessation is recommended. (2)

If these symptoms sound all too familiar and you think you may have cluster headaches, make an appointment with your GP as soon as you can. They will rule out other causes and assess your condition. Once you have a formal diagnosis, you should then be referred to a specialist who will discuss a treatment plan with you and help you to regain control over your life! (2)

For further support and information, visit ouchuk.org.

References

1. OUCH UK. Organisation for the Understanding of Cluster Headache [cited 3 September 2017]. Available from: https://ouchuk.org/

2. National Health Service. Cluster headaches [cited 3 September 2017]. Available from: http://www.nhs.uk/conditions/cluster-headaches/Pages/Introduction.aspx

3. OUCH UK. What is Cluster Headache? [cited 3 September 2017]. Available from: https://ouchuk.org/what-is-cluster-headache

4. OUCH UK. Cluster Attack [cited 3 September 2017]. Available from: https://ouchuk.org/cluster-attack

5. Medscape (2015). Hope for 'Suicide Headache'. [online] Available from: http://www.medscape.com/viewarticle/844217 [Accessed 3 Sep. 2017].

6. OUCH UK. Causes [cited 3 September 2017]. Available from: https://ouchuk.org/causes

7. OUCH UK. Abortive Medication [cited 3 September 2017]. Available from: https://ouchuk.org/abortive-medication

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 04/09/17

Erectile dysfunction, or impotence as it’s sometimes called, is a very common condition that distresses men of all ages. It’s the inability to achieve or maintain an erection that is sufficient for satisfactory sexual activity.

Listen to our Superintendent Pharmacist, Margaret Hudson, discuss ED in a recent radio interview

In the UK erectile dysfunction, or ED, is thought to affect more than 50% of men over 40 years of age.¹

Most men are unaware that ED could be a symptom of a more serious underlying medical condition, and so if you suffer from ED you should get a health check from your GP. The most common of these conditions are high blood pressure, high cholesterol and diabetes.

ED can have a range of causes but the main culprits are physical problems, psychological factors and the side-effects of certain medications.

Physical problems include narrowing of the blood vessels going to the penis; commonly associated with high blood pressure (hypertension), high cholesterol or diabetes. Hormonal problems such as an over or under active thyroid gland and surgery or injury to the penis, pelvis or surrounding area can also cause it.

Some examples of causative neurological conditions are Parkinson’s disease and multiple sclerosis while the psychological causes of ED include stress, anxiety, depression and relationship problems.

Lifestyle can also cause ED and so if you’re overweight, smoke, drink excessively or take recreational drugs, you are more likely to suffer from these symptoms.

In younger men, it may be caused by anxiety, nervousness about having sex, inexperience in using a condom or even fear of causing an unwanted pregnancy.

The most common health conditions causing ED are cardiovascular disease and diabetes but the medications for high blood pressure, prostate problems, high cholesterol, depression and anxiety can also cause ED and therefore compound the situation. For example, you might have high blood pressure which causes ED, then you take a medication for your blood pressure which also causes ED making your symptoms even worse! ²

In fact, there is a long list of medications that may cause ED, including:

• Diuretics - “Water tablets”
• Beta-blockers - used to treat high blood pressure
• H2-antagonists - used to treat stomach ulcers
• Antihistamines - used to treat allergic health conditions, such as hay fever
• Antipsychotics - used to treat some mental health conditions, such as schizophrenia
• Anticonvulsants - used to treat epilepsy
• Corticosteroids - medication that contains steroids, which are a type of hormone

Speak to your GP if you are concerned that a prescribed medicine is causing erectile dysfunction as alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by a qualified healthcare professional who is responsible for your care.

Most men blame themselves for having ED as they think it’s a reflection of their masculinity and don’t realise that it’s caused by a health problem that they may or may not be aware of.

It is believed that if more men were aware of this fact then they would be much more willing to go to their GP for a health check. Not only would the individual find out if they have an important health condition but they would also be more confident about seeking a solution to their ED.

Most men don’t talk about ED when they meet up with their friends for a drink or for any other social activity. It’s a topic that they would rather avoid at all costs!

In fact, most men even find it difficult to speak to their partner about it and it’s thought that ED causes the breakdown of about 20% of all relationships. ³ It seriously impacts on all aspects of a man’s quality of life and his self esteem. It can also affect how a man interacts with his friends and co-workers as it may cause him to lose confidence, reduce his morale and enjoyment of life generally. Furthermore, since ED is not openly discussed, a man may feel isolated and alone as he struggles with these symptoms.

Some men find counselling helpful as a means of exploring psychological causes for ED. Some sexual health clinics (also known as GUM clinics) offer this service or your GP may be able to direct you to someone who can help. ⁴

If someone was too embarrassed to go to their GP about ED, there are other options. The first line treatment for ED is a group of drugs called phosphodiesterase -5 inhibitors (PDE-5 inhibitors) that dilate the blood vessels leading to the penis and, with sexual stimulation, give a much firmer and longer lasting erection.

In the UK there are four PDE-5 inhibitors available for treating erectile dysfunction.

They are:

• Sildenafil – sold under the brand name Viagra or generic name sildenafil
• Tadalafil – sold under the brand name Cialis
• Vardenafil – sold under the brand name Levitra
• Avanafil – sold under the brand name Spedra

There are differences between the various products available. They differ in the time it takes for them to act and how long they act for. This is due to the different pharmacokinetics* of the active ingredient. The pharmacokinetics, which include the half-life** of a medication, dictates how long it stays in the blood.

* Pharmacokinetics – How the drug moves through the body

**Half-life – The time taken for the levels of medicine in your blood to fall by half. This directly relates to how long the medicine acts for.

Sildenafil (Viagra) has a half-life of 4 hours and vardenafil (Levitra) has a half-life of 4-6 hours while tadalafil (Cialis) has a half-life of 17.5 hours and is active for up to 36 hours.

This means that vardenafil (Levitra) should act longer than sildenafil (Viagra) but the clinical significance is not known although some studies have shown that vardenafil (Levitra) is more suitable for diabetics. Tadalafil (Cialis) has the longest half-life and duration of action and so allows you to take the medication and not relate the sexual activity to its immediate use. It’s been called the “week-end pill” because of its long duration of action and in lower doses can be taken continuously each day, for those who are more sexually active and struggle to plan ahead.

The most recently introduced Avanafil (Spedra) has the quickest onset of action and only takes about 15 minutes but its effects last about the same time as vardenafil and sildenafil.  

ED drugs: How soon they start working and how long they last

It’s very important that men realise that they don’t have to suffer in silence as ED is a very common condition that’s easily treated, in most cases, with oral medication that can dramatically improve their performance and general well-being. 

References

1 NHS. Choices. Department of Health. Erectile dysfunction (impotence); 2016 Jun 21 [cited 2016 Sep 21]. Available from: http://www.nhs.uk/Conditions/Erectile-dysfunction/Pages/Introduction.aspx

2 Miller S. Medline Plus. Drugs that may cause impotence: MedlinePlus medical encyclopedia; 2015 Jan 21 [cited 2016 Sep 21].
Available from: https://medlineplus.gov/ency/article/004024.htm

3 Health Centre. Access to health & medical information on Internet; 2016 [cited 2016 Sep 21]. Available from: http://www.healthcentre.org.uk

4 Charitable Company. Sexual Advice Association. Sexual Advice Association. Factsheets [cited 2016 Sep 21].
Available from: http://sexualadviceassociation.co.uk/factsheets/

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/09/16

There has been a lot in the news recently about the increasing incidence of Type II Diabetes. So, what’s it all about?

Diabetes is a lifelong condition which is caused by a person’s body either producing less of, or becoming resistant to, the hormone insulin. This causes the blood sugar level to become dangerously high, leading to various ailments of the eyes, heart, kidneys, nerves and blood vessels to name a few.

The high levels of sugar in your blood make you tired all the time, thirstier than usual and also causes you to go to the toilet more frequently, especially at night.

The symptoms of this type of diabetes are usually quite mild and so aren’t typically obvious, meaning some may be living life with diabetes for years before it is actually diagnosed.

Type II diabetes has now reached epidemic levels in many places and this is thought to be mainly due to changes in lifestyle but is also partly due to improved diagnosis and treatment of the disease.

It's far more common than type I diabetes and it is estimated that more than 1 in 16 people in the UK has diabetes (diagnosed or undiagnosed), with this figure rising rapidly, and 90% of these cases being type II. (1)

There are some things which make a person more likely to develop type II diabetes, such as;

• Your age
  Most cases are seen in those over the age of 40, but there are now an increasing number of teenagers being diagnosed with the disease.
• Your ethnicity
  Being of Asian or African decent puts you at higher risk.
• Your genes
  If you have a close member of your family diagnosed (mother, father, brother or sister) than again you are at a higher risk. There is also an increased incidence in males.
• Your weight
  Being overweight or obese makes your change of having diabetes much more likely.
  Click here to calculate your Body Mass Index (BMI) to see if your weight puts you at risk. (2)

The majority of these things, we unfortunately cannot change. However, we are able to reduce our weight. It’s been said by the NHS that reducing your body weight by even just 5% could reduce your risk of getting diabetes by more than 50%. (3) This can be achieved by making a few simple lifestyle changes.

We have all heard it before and now you’re going to hear it again. The best way to avoid type II diabetes is to;

• Eat better! Eating a　healthy, balanced diet, not forgetting the fruit and veg.
• Bin the cigarettes! (if you smoke)
• Drink alcohol in moderation! You don’t need to ditch it all together.
• Get on the move! Take plenty of regular exercise, ideally 30 minutes a day.

If you are diagnosed with diabetes, it’s not the end of the world. There are many treatment options available to keep your blood sugar under control and, when managed well, should have no side effects or complications.

Having said that, prevention is most definitely better than cure!

To further your understanding, take a look at this great list of myths and frequently asked questions on type II diabetes here. (4)

1. Choices N.: Department of Health. Type 2 diabetes; 2016 Jul 28 [cited 2016 Apr 20]. Available from: http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx
2. Diet throughout life; 2014 Nov 10 [cited 2016 Apr 20].
   Available from: https://www.bupa.co.uk/health-information/tools-calculators/bmi-calculator
3. Choices N.: Department of Health. Type 2 diabetes - causes; 2016 Jul 12 [cited 2016 April 20].
   Available from: http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Causes.aspx
4. Myths, questions frequently asked. Myths and frequently asked questions - diabetes UK [cited 2016 Apr 20].
   Available from: https://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/Myths-and-FAQs/

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/08/16

HAIR TODAY; GONE TOMORROW.
The distressing condition of men’s hair loss and the latest remedies

There are different types of hair loss or alopecia but androgenic alopecia, commonly known as male-pattern baldness accounts for more than 95% of hair loss in men. It’s a genetic hair loss condition and usually begins with a receding hairline followed by thinning of the hair on the crown and temples to form a horseshoe shape.

For more information about hair loss treatments for men, click here.

Alopecia may not be life threatening but it can be very distressing to those affected. People who haven’t experienced it may be inclined to see it as a purely cosmetic issue but for many sufferers it destroys their confidence which can lead to depression and create terrible stress.

About half of all men will be affected by male pattern baldness at some point in their lives.

Another type of alopecia that has become more prevalent recently is traction alopecia. It is caused by excessive pulling or tension on hair shafts as a result of certain types of hairstyle. It used to be seen more often in women, particularly those of East Indian and Afro-Caribbean origin, due to braiding their hair. However, there is a popular hairstyle for men that is trending at the moment , the “man-bun” or “top-knot”,  sported by celebrities such as Leonardo DiCaprio, Jared Leto and Harry Styles. Here the hair is tightly scraped back and if you wear it like that all day, every day then it puts long term stress on the hair, pulling the follicle and damaging the root, pulling it out. It's just like plucking an eyebrow hair where if you keep plucking it, it won't grow back. 

Another at-risk group is men who suffer baldness on the top of the head and so they pull the remainder back into a ponytail. This again causes tension on the root leading to even more hair loss.

Furthermore, Sikh men who tie their hair up tightly under their turban may cause traction alopecia.

However, the good news is that traction alopecia is relatively rare, even for men who regularly sport man buns. Therefore, I suggest that those who want to have a bun hairstyle, should style their hair into a looser bun. Also, it’s best to use a soft, snag-free elastic which is kinder to your hair, like a scrunchie.

The latest research into hair loss treatments involves hair cell cloning. The technique takes small amounts of a person's remaining hair cells, multiplying them, and injecting them into bald areas. Cloning is intended to treat both male- and female-pattern baldness. However, the science behind the technique is new and more trials are needed before it can be fully assessed.

Another potential treatment for male pattern baldness is a pioneering technique involving wound healing. The process involves creating a very minor “wound” on the scalp that subsequently allows the formation of new hair follicles.

However, at the moment, the two main treatments available for male-pattern baldness are minoxidil and finasteride.

Minoxidil is available over the counter from pharmacies without a prescription. It takes the form of a foam or solution that can be rubbed into the scalp on a daily basis. It comes in two strengths containing 5% or 2% of minoxidil. Women are recommended only to use the 2% solution and the evidence is mixed as to whether men benefit from using the higher strength. However, side-effects are more likely with the higher strength which involves scalp itchiness or dryness. Also, the treatment seems to be more effective for female pattern baldness. It takes a few months for signs of regrowth to appear  and the situation will revert back to the start if treatment is stopped.

Finasteride is a daily tablet treatment for only men with male pattern baldness. It prevents testosterone  from being converted to dihydrotestosterone(DHT). DHT is responsible for shrinking the hair follicles and therefore they return to their normal size, allowing natural re-growth. About  90% of men see either increased hair growth or prevention of further hair loss. It usually takes between 3-6 months before any effect is seen and hair loss will start again within a year if treatment is stopped. This treatment is recommended by many hair transplant surgeons as the most effective way to encourage hair regrowth.

For more information on Finasteride hair loss treatment for men click here. 

At Webmed Pharmacy we can supply finasteride treatment, after completing a short medical questionnaire that our doctor will review and it will be discreetly delivered the next day, in a 1 hour time slot , by dpd .

Webmed Pharmacy specialises in treatments where patients may feel embarrassed or awkward talking to their GP; or simply find it difficult to get an appointment; or aren't able to take time off from work.

If you would like to see what other treatments Webmed can provide, please click here.

Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 14/10/15