Interviewer: What’s cluster headaches, are they like really intense headaches for a short period of time? So intense that it’s what, completely debilitating, or what happens?
Sarim Mir: What happens is that people will have these attacks. They describe it like there’s an ice pick in their eyes. They feel like they have to bang their heads, and people do sometimes, bang their head against the wall until it goes away. They are terrible. For them you have to give them something that works really fast.
Patients with Frequently Recurring Cluster Headaches are Put on a Daily Prescription
Interviewer: When you are able to get relief for them, what happens? Do they completely go away? Or is it something you can manage but still have?
Sarim Mir: With cluster headaches, when they go away, they could be completely gone for 6 months or a year. On some people, they will go away for two. On some, they will have them frequently. They will have a short period of a few months and they come back. What you have to do with those patients, is that you have to put them on a daily prescription that can prevent the headache.
Getting Confused or Fainting May be Considered as Symptoms of Seizures
Interviewer: You mentioned also, people having seizures?
Sarim Mir: Seizures are a big part of our practice. There are some patients that come to us because they are having spells. For example, they will get briefly confused or will faint. Sometimes they feel like they can’t talk or a strange feeling comes on them. Those episodes are a possible seizure. These could also be panic attacks or anxiety attacks.
As I told you, sometimes people feel they can’t talk briefly or they feel confused. There’s also a chance they could be TIAs. TIAs are Transient Ischemic Attacks. So it could be one of those terrible things. We can differentiate between them. We can diagnose if the person is having seizures.
Interviewer: What is TIA again?
Sarim Mir: TIA is what we call a Transient Ischemic Attack. In the common language, they are also called mini strokes.
Common Methods of Treatment Utilized in Dealing With Seizure Patients
Interviewer: When you treat people for seizures, these people have had seizures all their lives or is it like a sudden occurrence for them?
Sarim Mir: We deal with different populations. There are some patients who have had that since childhood. For those patients there isn’t any issue about diagnosing them.
Then there are patients who are sent to us, for example, they passed out. We don’t know if it was just a simple passing out spell or they passed out because of a seizure. The biggest thing we can do is that we can make a diagnosis. People come to us confused and we give them clarity. We can establish the episode they had and the cause. I can give you an example.
Non Epileptic Seizures are Also Known as Pseudo-Seizures
We have had several patients who in the past were diagnosed to have seizures. They would get upset—they would begin to have a seizure. They would begin to have convulsions; they would fall on the ground and they will begin to shake. They had been put on epileptic medications. Even on 2 or 3 drugs they would continue to have seizures. We have seen several patients who actually don’t have epilepsy. They have what we call non-epileptic seizures. The other term for that is pseudo-seizures.
Extreme Stress or Anxiety May Precede the Onset of Pseudo-Seizures
What’s happening to them is that they are under extreme stress; they are under extreme anxiety. It’s almost as if they are against a wall and will have a seizure. But that seizure isn’t because they have epilepsy. It is like a call for help. The patients aren’t doing that on purpose. It is like a maladaptive response to stress. We can distinguish this.
On top of that some people have epilepsy and in addition to being an epileptic, they will also have pseudo-seizures. So there are some patients who can have both.