For the past six months I have had sporadic tenderness on the top left of my scalp. My doctor said it was a migraine and prescribed Migraleve, which didn't help. I cannot touch the area without feeling discomfort; even showering and combing my hair is uncomfortable. I am very worried and I no longer want to be kicked off by my doctor. I'm 43 and I also have an underactive thyroid.
Shanaz Bobat, London.
Your description of a recurring left-sided headache is what led your doctor to diagnose migraine.
However, based on the information provided, such as you, I am not convinced that this is the problem – migraine is not associated with sensitive scalp.
There is a more likely option; a cause of headache that is rarer but that fits your description better: occipital neuralgia. This condition is thought to be the result of the irritation or confinement of one of the three nerves that feed the head and scalp – the larger occipital nerve, the third occipital nerve, and the smaller occipital nerve.
Fact: The pain of occipital neuralgia comes and goes, has variable intensity and can be caused by activities such as hairbrushes
This can happen due to muscle tension or injury. The condition is most common in people with neck problems, such as osteoarthritis, which can lead to inflammation that irritates the nerve – it is also more common in people with gout, infection (this causes inflammatory reactions throughout the body), or, in rare cases fallen cases, a tumor that presses on the nerve.
The pain of occipital neuralgia comes and goes, is of variable intensity and can be caused by activities such as hair brushes, or by the impact of shower water; exactly the symptoms you describe.
The sensation is usually on one side (although it can sometimes occur on both sides), starting at the point where the top of the neck meets the skull and extends to the top of the head.
There may be sensitivity if you press on the affected area, and some patients report both tingling and pain. It may also be that touching your fingers across the affected area causes painful spasms.
The diagnosis can be confirmed by the actual treatment – with each of the nerves in turn being blocked with local anesthetics and steroid injections. This provides immediate relief that can last for weeks or even permanently, but it must be done by an experienced neurologist or neurosurgeon.
Treatment: The diagnosis can be confirmed by the actual treatment before it – in turn block each of the nerves with local anesthetics and steroid injections
Usually the condition stops spontaneously weeks or months after it starts. If the procedure is not effective, the cause of the pain is not occipital neuralgia and a specialist should further evaluate your symptoms.
My advice is therefore to consult your doctor again, to explain that the prescribed medication did not help and to describe your symptoms again.
Mention the sensitivity of your scalp, your lack of visual symptoms and nausea (which many people with migraine will experience), and ask for a referral to a neurologist to consider the diagnosis I mentioned.
I do not believe that your slow-acting thyroid gland is related to the symptoms that you describe.
Anorexia has been diagnosed with my 16-year-old niece. I noticed last year that she often talked about calories and was obsessed with sports. Then it suddenly got a lot worse.
She has weekly hospital appointments, but she cannot go to school because she is so underweight. My sister is devastated and it affects the whole family: my niece has gone into her shell. Will recovery be a long process?
Name and address specified.
People with anorexia nervosa avoid eating and exercise obsessively to satisfy their motivation to weigh less, even though the weight reduction they are trying to achieve is below what is healthy.
However, they do not see it that way, rather than believing that they are fat and adopting complex strategies and abnormal behaviors to minimize or avoid eating.
Patients often wear baggy clothing to try to hide how thin they are, and will strongly deny that there is a health problem. The condition is often associated with poor self-esteem and patients see thinness as a way to improve their value.
People with anorexia avoid food and exercise obsessively to satisfy their urge to weigh less
But in fact they are starving themselves. As a result, malnutrition is common, so periods normally stop, bones can be weakened, and cardiac arrhythmias can occur.
Normal brain function is also strongly influenced, leading to depression and anxiety. Problems with sleep, memory and clear thinking are also typical – just like the social isolation or withdrawal that you see in your cousin.
The cause of this disorder, which affects approximately 0.3 percent of adolescents and more than 2 percent of adults, is unknown, although there is some evidence of a genetic basis.
As the condition develops, the patient experiences changes in brain function, some of which can be identified in scans – although it is currently unclear whether these changes are causal or a consequence of malnutrition.
Your niece will be cared for by a specialized unit, usually with a consultant psychiatrist who specializes in eating disorders as a team leader, assisted by specialized nurses, dietitians, clinical psychologists and psychotherapists.
It is unlikely that it will recover quickly. Your niece can be treated very well for a year or two – or longer. British research shows that about 50 percent of patients arrive and have good results, but others may withdraw and be resistant to treatment.
However, many of the studies that reveal these rather bleak figures are based on specialized hospital departments, and the results may be more favorable in patients who are not so severely affected and who need hospital treatment.
Those who are able to stay home with their families during their treatment have better prospects. With the right help, there is no reason why your niece should not have a healthy, happy life, free from anorexia.
I very much hope that this is the case.
IN MY OPINION … PLEASE NOTE THE TELEPHONE CONSULATION
I recently appeared in court as an expert witness after the death of a child from appendicitis. For a number of days, the parents had consulted three general practitioners by telephone about the symptoms – no appointments were available – and each time they were told: & # 39; it's just a winter vomit virus, there's a lot around & # 39 ;.
No doctor has examined the child despite the fact that it remained so unwell.
This week I heard that an acquaintance went to our local operation with abdominal pain just to be met by someone who considered himself a & # 39; practitioner & # 39; called – not a nurse or doctor – who asked about the history of symptoms, but seemed to read questions from a typed list. No diagnosis was made and the patient was not convinced at all.
Neither of these stories fills me with confidence. Practitioners are brought in to do much of the routine work of GPs, but they can never take the place of a doctor.
Like police officers, they are supporting officers who were brought to our streets to create the perception that we were better protected; while they are doing great, they are not fully trained police officers.
Similarly, the use of doctors leads to second-rate medical care.
But the current system must change clearly – children must not die because they cannot see a doctor.
My proposal is that GPs, such as small businesses, are no longer outsourced, but pay a salary and housed in teams in local hospitals, with each GP receiving a specified patient list to ensure the continuity of care.
Patient access would inevitably improve, as would coordination with consultant care, and there would be better communication. There would be direct access to other services, such as laboratory tests, scans, physical therapy and other paramedical treatments, with one set of medical notes and improved out-of-hours care with well-structured coverage.
To resolve the crisis we are facing, we need this kind of root and branch reform, instead of trying to remedy the gaps in the current system with another patch.
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