"Never have a headache on the same day as your husband but if you do, be sure to mention it first"
Treatment
Most Headaches in General Practice are ordinary Tension Headaches and need just an analgesic and may be a transquiliser.1. Tab. Disprin tds(analgesic) or proxyvon or paracetamol or analgesic-antiinflammatory combination. (3C).2.Tab. CALMPOSE 5mg 1/2 -1 HS (Transquiliser)3. Inj. KETANOV 1ml IM if pain is severe (3B-2) or Inj. Novalgin 2cc IM4. Take rest in a dark, quite room. Massage and press the scalp Apply counterirritants like Vicks/ Amrutanjan to forehead.In every patient of headache, you must test the following signs, as routine:Check B.P - Control Hypertension of present.Check sinus tenderness over maxillary and frontal sinuses, and look for focus of infection in teeth, tonsils and ears.Check tenderness on nape of neck or pain on neck movements.If associated fever, Check for neck stiffness.If eye is painful or red. Palpate the eye after closing the eyelid. If it is firm to feel, Refer to opthalmologist for Galucoma.If Headache is recurrent and ChronicCheck eyesight forst.Check BP, sinus tenderness and spondilitis as above.If it has started following Head injury, refer for X-ray skull and CT scans.If patient is Diabetic, is he getting hypoglycemia?If headache is severe and progressice refer for CT scanIf there is any neurological sign as weakness of cranial nerves or limbs, convulsions ets. Then refer immediately for CT sacn and Neurologist opinion.Headache with fever= Meningitis. First test for neck stiffness. Malarial fever also gives headache.Tension headache is the commonest headache. It is more towards evening and patient feels better on pressing over the scalp.A young patient or child complaining of repeated headache wil usually have refractive error. Particularly cylindrical number even when very minor, give rise to headache.Headache due to Alcohol HangoverTake 2 glasses of water- Plenty of water and fluid intake.Take Disprin or Proxyvon 1 stat.Take fruit juice, tea or coffe with plenty sugar to counter hypoglycemia.Have a full mealPrevention of Hangover:Avoid excess alcohol, stay within your limits. Avoid cocktails.Do not drink on empty stomach. Eat something alongTake a glass of water after each drink.Do not drink too fast.Tab. Disprin 1 before sleep
Rest in a quiet dark room, with cold cloth over the eyes.
Massaging back of neck and scalp.
Relaxation techniques like TM, Savasana.
Encourage physical activity, exercises for the neck (detailed under Appendix).
Injection of trigger points with long acting steroids mixed with local anaesthetic. Cervcical traction where indicdated, as spondylosis can trigger muscle spasm.
Advice to Patient
Change in life style to reduce stress, Psychologist\'s counselling as required. Training in Assestiveness.
Relaxation techniques and others as detailed under General measures. Never resort to narcotics for relief.
Follow Up
Depending on response to measures suggested. Many patients would need to e seen frequently to bolster psychological support.
Inadequate Response
To be expected. Patient persistence in offfering general and supportive measures help the most. Make sure the diagnosis is not wrong, or the patient is getting wronog drugs,is not taking the drugs prescribed, has some life situation not tackled, or one has not missed some background organic psychological cause.
