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When a headache becomes a worry…

42 year old Shanthalal was a Program Planning Officer working in the Ministry of Healthcare & Nutrition. He was very popular among his workmates as he had a friendly nature which endeared him to his colleagues and subordinates. He was also a father of two little girls, and for them their father was their world.

On October 4th Saturday Shantalal came to work as usual and during the day he complained to his colleagues that he was having a slight headache. It was more of an irritation than anything else because it limited his activities. His duties included maintaining the e- mail and internet network of the Ministry, and updating the whole information system of the Ministry. He took two panadol tablets and then felt better but a trace of the headache still lingered on till he went home in the evening. When he complained of this to his wife, she massaged his head with oil and he felt so much better that he even stayed up to watch a rugger match, his favorite game, on T.V.

At midnight he switched off the television after the match and went to bed. As soon as he went to bed he suddenly felt a sharp pain in his head which made him shout out in pain. His wife realizing that something was wrong immediately telephoned his brother who lived close by. When he arrived, Shantalal was writhing in pain with a severe headache which seemed to become worse by the minute. By the time they reached hospital Shantalal was unconscious and two days later he was dead! From a headache which was due to a sudden burst of a blood vessel.

So when does one have to worry about a headache that all of us suffer from at some point of time? Almost everyone gets a headache once in a while, and some unlucky people have them almost every day. Usually most people pay little attention to them. They just take a couple of analgesics such as panadol, and in a few hours the headache is gone!
But sometimes headaches become so painful or so frequent, that it becomes a cause for concern to the person who has it, He/she begins to wonder if it could it be a symptom of a brain tumor or the warning sign of an oncoming stroke, as in the case of what happened to Shantalal.

Good news
The good news is that the vast majority of headaches are completely harmless. However, every once in a while a headache is a warning of some serious condition.
There’s an old joke in which a worried patient asks, “Doc, what have I got?”
“Have you had it before?” the doctor asks.
“Yes.” the patient replies.
“Well.” the doctor announces, “you’ve got it again.”
The important lesson in this joke is that sometimes the most important fact about the symptom is whether it’s happened before. This is especially true with headaches.

Chronic pain
A person might think that the longer they’ve been suffering from headaches, the more likely they are to be dangerous. In fact, the opposite is true—the longer they’ve been suffering from headaches, the less likely it is that they indicate a sinister condition. The medical profession calls these chronic headaches. The two most common types of chronic headaches are tension type and migraines.

Tension
Tension-type headaches usually feel like a tight band around the head, or just an aching pain all over the head. The name tension suggests that these headaches are brought on by emotional tension, or that they are caused by some sort of tension in the muscles of the neck and head. In fact, it’s not clear how significant a role either type of tension plays in these headaches. It’s certainly true that some people do get this sort of headache toward the end of a stressful day. Sitting or working in awkward positions can also bring them on.

Migraines
Migraine headaches are slightly different. The pain of migraine is usually a pounding rather than tight feeling. Instead of being all over the head, migraine pain is usually much worse on one side, and often seems to be centered around or behind one eye. For this reason, many people with migraine mistakenly attribute their headaches to eye strain or sinus trouble. Many people feel nauseated during a migraine, and because light and sound become painful, they want to lie down in a dark, quiet room until the headache passes. Some people see shimmering zig-zags of light and color move across their field of vision several minutes before their headache starts, something referred to as an aura.

Even though migraine is very common, it is still not properly understood why some people are cursed with it, or exactly what goes on inside the head to cause the headache. Some people will have one or two migraine headaches in a lifetime, while others have them almost daily. Migraine headaches can be excruciating, and frequent migraines can completely disrupt a person’s daily life. The complete treatment of migraine is not very straightforward, but there are ways both to prevent migraine headaches, and to relieve the headaches

When to worry
Since chronic headaches occur almost daily, when is it time to worry? As a general rule, doctors are most concerned about new headaches. If one suffer from occasional headaches, a new headache means a headache that feels different from any headache experienced before. If one never gets headaches, any headache is new. But all headaches are not dangerous. The great majority of new headaches turn out to be harmless, Many turn out to be migraine or tension-type headaches but after all, everyone with chronic migraines must have had a first new headache at the beginning. But it is important to know that if one is having new headaches, it should be evaluated by a physician.

The medical profession worry most about three specific types of new headaches. They are:
• “Thunderclap” head aches
• Head aches with fever
• Head aches with other symptoms

Cerebral aneurysm
Headaches that hit suddenly, and are severe from the moment they start, are called thunderclap headaches. They are of concern because one of their causes is subarachnoid haemorrhage—where one of the arteries that run across the surface of the brain ruptures, causing blood to pour into the fluid that surrounds and cushions the brain. These hemorrhages are very dangerous and potentially fatal, similar to what happened to Shantalal. They usually occur when there is a spot along the artery where it widens, creating a little bump or bubble called an aneurysm. Aneurysms are weak spots, where the artery can rupture and bleed. When people talk about “having an aneurysm” they are referring to subarachnoid hemorrhage, though physicians don’t use this phrase.
Although there are also harmless causes of thunderclap headaches, any sudden, severe headache that lasts more than a few minutes ought to be evaluated immediately by a physician, preferably in the emergency room. In contrast, sudden but brief headaches—jabs or jolts of pain that last anywhere from a few seconds to a minute or so, are usually harmless but it is always better to get them evaluated if they occur frequently.

Meningitis
Headache and fever can be symptoms of meningitis. The word meningitis itself just means inflammation or infection of the tissue (called the meninges) and fluid that surround and protect the brain and spinal cord. Not all forms of meningitis are dangerous. Many common viruses for example, can cause viral meningitis, which is unpleasant, but usually harmless. Bacterial meningitis, on the other hand, is a different matter; these infections can be fatal if they’re not treated quickly with antibiotics. This is the kind of meningitis you hear about in the news, often striking several children in the same school.
This does not mean that each time one has fever and a headache that one has to rush to hospital to get it evaluated. Many unpleasant but harmless infections like the common cold and flu can cause fever and headache, and these infections are thousands of times more common than bacterial meningitis.

So how does one know when to be concerned? Again, one should use one’s own experience as a guide. If the symptoms feel like those of colds or flues there is no need to be alarmed. If, however, the illness feels unfamiliar, the headache is worse, or feel much sicker than ever before, a doctor should be consulted immediately. Anyone with headache and fever who is drowsy or confused needs medical attention immediately. The safest course is to go to the hospital rather than to one’s local GP

Other symptoms
Migraine headaches, which are harmless, often come with other symptoms like nausea, sensitivity to light and sound, and shimmering lights and colors. This shows that headaches accompanied by other symptoms aren’t always too sinister, especially if they’re chronic, as migraine often is. As a rule, though, if a person develops other symptoms, either during a headache, or between headaches, it is imperative that these headaches be evaluated by a physician. These symptoms include:
• Trouble in speaking
• Blurry vision, double vision, or brief “blackouts” of vision
• Weakness, numbness, clumsiness, or tingling in one arm, one leg, or one side of the face
• Trouble with walking or balance
• A spinning sensation (what doctors call vertigo)
• Drowsiness or confusion
• New headaches with migraine-like symptoms of nausea, vomiting, lights or colors in vision
There are a number of conditions many headache-sufferers fear.

Brain tumors
Everyone who suffers from headaches, worries at some point that they might have a brain tumor. The truth is, headaches are not the first sign that one has a got a brain tumor. Other symptoms first signal this problem. Difficulty writing or speaking, weakness or clumsiness in a limb, an epileptic seizure—these are the sort of symptoms that signal trouble (though these symptoms can also be caused by many conditions other than tumors). In fact, most brain tumors don’t cause any headache at all, and when they do, these headaches are usually quite mild, not the sort of thing that would send a person to the hospital.

High blood pressure
Many people assume that their headaches are caused by high blood pressure. Actually, high blood pressure (also called hypertension) is a very uncommon cause of headache. Most people with hypertension have no symptoms at all—that’s why it is referred to as the “silent killer.”

Strokes
Many people worry that a particularly severe headache either is a stroke, or will lead to one. This is true only very rarely. A stroke occurs when a part of the brain is suddenly damaged—either when a small artery in the brain becomes blocked, or when an artery ruptures and bleeds inside the brain. The symptoms of a stroke depend on which part of the brain is damaged, and they can include any of the other neurological symptoms listed earlier, such as weakness on one side or trouble with speech. Most strokes are completely painless. Sometimes a person will develop a headache at the time of a stroke as it was in the case of Shantalal, but the other symptoms make it clear that it is a stroke, not an ordinary headache.

****

A physician’s guidelines to good health

By Dr. W.B. Wijekoon
The commonest causes of death and disease in developing countries are drugs and doctors, or to put it in other words, the rise in morbidity and mortality in Sri Lanka is due to medical mudalalism.
The worst doctor a patient can consult is a Dr. Hats – Hungry, Angry, Tired and Sick.
In my opinion, no normal doctor can properly see more than 15 to 20 patients at a sitting of two-and-a-half hours. But what we see today is a doctor seeing about 100 patients in that time. These are Dr. Hats playing ‘ducks and drakes’ with human lives. Beware of such doctors. They are worse than quacks. Avoid them like the plague.
The treatment of disease depends firstly on diagnosis, secondly on diagnosis, and thirdly on diagnosis, thus laying triple emphasis on the value of diagnosis, before embarking on treatment. Pending a proper diagnosis, a good doctor should treat only to alleviate the symptoms.
In the course of many years in the medical profession, my observations have made me divide life into four chapters.

Chapters of life
1-25 years: A person may enjoy life regardless of consequence, for death during this period will not be consequential.
25-50 years: Preservation of the human machine. I advise a middle path in everything – ¬diet, exercise, relaxation and dissipation. This second chapter is the most important of the four.
50-75 years: The well-preserved and serviced human machine is now in a balanced state of health, and can be utilised for social welfare and other acts of humanity in general.

75-100 years: Second childhood – Live like a child, and to hell with public opinion. For some, of course, life starts after 70.
Churchill, de Gaulle, Mao Ze Dung, Den Zia Peng, Nelson Mandela, and Sri Lanka’s own J. R. Jayewardene flowered into political maturity when they passed the age at which lots of others called it a day.

If you are unable to sleep the recommended eight hours a day, do not worry about it. The Buddha is supposed to have slept only three to four hours a day and he lived to be 80 and performed so well. President Premadasa slept only four to five hours a day, we were told, but he was very active and alert.


If I may be permitted to wax personal, my father who lived up to 96 years has slept 40 years! When friends used to complain to him about their inability to sleep, he used to comment about his 40-year sleep. In addition to one third of the day (average eight hours), he added seven to eight years for the extra hours slept during childhood! He used to emphasise that when one contemplates this wastage of years of wakefulness, sleep automatically dawns!

You are in control
If you are constipated, do not worry too much about it. Whether the desire is there or not, visit the toilet at a fixed time everyday, sit down (or squat) and spend a few minutes in contemplation. Soon the bowels should open, this is bowel training.
Do not let laxatives control your bowels – you control them. Any normal human being could remain healthy, without opening the bowel even up to two to three months. So do not consider ‘bada eliye yama’ as ‘Nuwara Eliye yama.’ Do not worry too much if the bowels refuse to open for a few days – you control it!
From 35-55 years of age, the best eating pattern should be as follows: A fairly heavy breakfast, moderate lunch, and a very light dinner (dinner should be merely to cheat the stomach as it were).
After 55 years, a mild breakfast, moderate lunch, and a very light dinner, would be ideal. Try to stick to the three main meals after 50 years of age. Avoid eating in between meals.

Smoking and drinking
Smokers and drinkers can be classified in to two main groups – ‘slavish’ and ‘stylish.’ If you are a slavish smoker or drinker, you cannot do without it, but stylish smokers and drinkers are those who indulge in these twin vices only at parties, picnics, weddings and similar social functions. They do so as they do not want to be ‘left out’ or taken for sissies, or to impress the dames. The fools!

Cigar and pipe smokers are said to live long. I would not exactly vouch for that, but well-known cigar smoker, Winston Churchill, lived to be 91, and my own father who lived to be 96 was smoking strong Kanakalingam cigars ever since 1 can remember.
When we were children, he would stretch out in his armchair after dinner, puffing away at his cigar, while my mother made every endeavour to drag him into arguments on domestic issues, but to no avail.
Dad would not, or rather could not, open his mouth, as the mighty Kanakalingam cigar needed a good grip to keep it in place. Mother died at 63 of hypertension and a stroke, while father batted on merrily up to 96! Got the moral?
A dog’s example

Good eating habits can be learnt from man’s best friend. If a dog does not feel like eating, he does not deign to even look at his food, but we humans think that it is compulsory to eat three whopping meals a day, whether we are hungry or not. Try skipping a meal or two and see how fine you feel.

Diarrhea and indigestion – that exasperating, trying thing. The best treatment for it is to starve for 24-48 hours, depending on the severity, take only bland liquids. Most often, no drugs are required. Just rest your gut and soon you will be alright.
There is only one medicine that will help you give up smoking and/or drinking. It is called the WYT – Will Power Tablet.
Tea and coffee should ideally be taken without any sugar at all. Most foreigners laugh at us because we load our cup of tea or coffee with sugar, thus killing its exquisite taste and flavour.
Once the tongue gets used to sugarless tea and coffee, you will find sugary tea and coffee absolutely revolting – and as a result you will lose weight and get back that slim, svelte figure (I can almost see our middle-aged housewives crossing sugar out on their marketing lists).

There are three things in life that you must never be stingy to spend on. They are when building a house for you to live in, court cases, and when you (or someone you love) is sick. Spend through your nose and go for the best, lest you regret it later.
Guidelines

If you wish to live a happy, trouble free life, keep at arm’s length (but never get angry with) these five categories of people: Politicians, clergy, relatives, armed forces personnel, and neighbours.
My advice to all newly-wedded couples is to always live separately, and never with the in-laws, even if you have to beg or starve!
Always work according to your conscience, and strive to be simple, sincere and truthful.
Life is short, never run through it, always walk through it. Learn how to die, and then you learn how to live. When you handle responsible jobs, remember to observe all, ignore much and correct the few that are amenable to correction.
Finally remember that perfect human beings evolve by the way they live and what they eat, viz, avoiding jealousy, hatred and anger, and eating moderately.
Dear readers, now start living a little! Health is wealth!

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