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Ask the Medical Expert Archives 2000-2004

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Severe Headaches
June 2000

Q. My uncle is a 41-year-old male who has suffered from severe uncontrollable headaches for at least 25 years. He has seen several specialists but nothing seems to help. Medication does nothing and it gets to the point that he physically gets sick to his stomach. The pain is located behind his eyes and in his temples. No one knows what's wrong with him and he is beginning to give up. It scares his family because he just wants to die. We need to find out what's wrong with him. What would you recommend?

A. Your inquiry regarding your uncle and headaches raises some very important questions. The immediate concern is over his mental health as he has apparently mentioned to others his desperation and wanting to die. This certainly suggests the possibility of a suicide attempt. He should be seen by a psychiatrist on an urgent basis to assess the risk of suicide and begin receiving treatment for this aspect of his problem. Thoughts of suicide are indeed common in persons suffering from chronic pain.

Of course his headache problem needs attention as well. I assume he has had some treatment after such a long time. Our basic challenge in medicine is to make an accurate diagnosis, namely defining what is wrong. If the diagnosis is established, treatment can begin along current known methods. Diagnosis is not always easy! In addition to a doctor's physical exam, other tests are often needed. For headache patients this may include lab work, imaging studies such as an M.R.I., and an E.E.G. test of brain electrical activity.

A neurologist is usually the type of doctor directing the care of a person with such a severe and persistent problem. This should clarify whether there is any underlying condition causing the headaches, or if they exist on their own (primary headaches).

Once the diagnosis is established, several treatments are available. A number of medications exist to either relieve pain or decrease the frequency of headaches. Both types of treatment are often necessary. In addition to medication, lifestyle modification is often vital to treatment. This may include improved diet and exercise habits, reduction of alcohol and caffeine, and stress reduction. Treatment of depression, if present, is important as well. Additional methods helpful to some persons include acupuncture for pain reduction, and physical therapy if muscle spasm is prominent.

HELPFUL WEBSITES:

  1. http://www.achenet.org/
  2. http://www.headaches.org/
  3. http://ahsnet.org/
  4. http://www.ninds.nih.gov/patients/disorder/headache/head1.htm
MEDICAL ARTICLE:
  1. Multispecialty consensus on diagnosis and treatment of headache.
    Neurology. 2000 Apr 25;54(8):1553
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