FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

GIANT CELL ARTERITIS NOT YOUR NORMAL "PAIN IN THE HEAD"

Question: I developed a very bad headache a couple of weeks ago. It was so bad that I went to the emergency room. The doctor there told me I had something wrong with the artery in my scalp. He started me on medication that night and insisted that I see my regular doctor the next day. My doctor then sent me to a surgeon to have a biopsy of a scalp artery. The biopsy showed giant cell arteritis, what ever that is. I'm doing much better now, thanks to my doctors. But, I still don't understand what caused the giant cell arteritis, and why it caused the terrible headache.

Answer: Headache is a very common complaint. Headache pain can come from many structures within the head and neck, including inflammation of the arteries in that region the problem you had. The headache you experienced is quite classic for this type of pain. In fact, giant cell arteritis is used as a "classic example" of pain due to artery inflammation when this type of pain is described to medical students. The pain is so intense in giant cell arteritis because the inflamed artery stimulates the endings of a large number of nerves that surround the artery. This results in signals being sent to the brain that it interprets as severe pain.

Fortunately, most headaches are not caused by giant cell arteritis or similar serious conditions. The most common type of headache is a "tension headache" that almost everyone has from time to time. Migraine headache is also quite common. Fortunately, there are good treatments for both of these common headaches. Treatment for the headache of giant cell arteritis is directed at eliminating the underlying inflammation that causes the pain. The most commonly prescribed medication for this is prednisone, a very strong anti-inflammatory drug.

I wish I could answer your question about the cause of giant cell arteritis, but medical science has been unable to give us specific answers, so far. It is currently classified as an auto-immune disease. This means that it is caused by your defense system turning against a normal part of your own body. In this case, the arteries are attacked. We haven't been able to determine what triggers this self-destructive behavior in giant cell arteritis.

In this condition, the arteries in the head particularly the one supplying the area of the temple are most commonly affected. This preference for the temporal artery resulted in the old name for this condition temporal arteritis. As you know, the new name is giant cell arteritis. This term more accurately reflects the signs of damage to the arteries that we can see under the microscope and doesn't imply that only the temporal artery can be involved. The reason your doctor had the surgeon perform a biopsy of the artery is to make sure that you actually have giant cell arteritis. An accurate diagnosis is quite important in this condition because the prednisone treatment lasts for several months. This is considerably longer than it takes to clear up the obvious symptoms of headache. Also, prednisone can have some potentially serious side effects, such as osteoporosis, when it is taken for this length of time. So, your doctors are looking out for you. They want to be sure you are taking the correct medication for your condition and that you take it no longer than necessary.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.