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MIGRAINE – MIGRAINE HEADACHES
May 15, 2009
Migraine headaches rarely last beyond one day and, if not relieved with drugs, may go once the person goes to sleep. Where the headache persists for days, it is usually initially a migraine which develops into a tension headache and the sufferer has difficulty separating them.
Ergotamine is a drug which constricts the arteries and is the treatment of choice for most vascular headaches. These drugs are often combined with an antihistamine to stop nausea and vomiting.
They must be taken at the onset of the migraine so as to abort an attack.
Ordinary analgesics, even strong ones, are of little use in relieving migraine. The stronger narcotic drugs like morphine and pethidine should be used with extreme caution.
If the attacks are infrequent, taking an ergota-mine preparation to relieve the attack is all that is necessary. More severe or frequent attacks usually require the use of one of the preventive drugs taken on a regular basis, usually for many months.
Some cases resistant to other measures do well with manipulation of the neck, hypnosis or acupuncture.
*504/71/1*
CARPAL TUNNEL SYNDROME – GENERAL INFORMATION
It is common in pregnancy and here it is believed to be due to swelling of the nerve and the overlaying band of ligament as part of the general retention of fluid in the body which may occur in pregnancy.
It may be relieved if the pregnant woman takes a diuretic; a drug that washes fluid and salt from the body. The symptoms are usually relieved following delivery.
Carpal tunnel syndrome causes pain in the hand and fingers, but this pain may spread up the forearm as well.
Pins and needles and numbness may affect the hands and fingers. The fifth finger is never involved because of its different nerve supply.
Patients may be unaware that the little finger is not involved and claim that their symptoms involve the whole hand. But when they are made aware of it and they take particular note, they will find that this finger is spared.
That is a very important point in making the diagnosis. Pressure on the nerve in the neck will usually involve all five digits. Sometimes weakness and inco-ordination of the muscles, particularly those of the thumb, may be part of the problem.
The pain appears to be worse following use of the hand but it also commonly comes on at night and may wake the person in the early hours of the morning. It is usually relieved by hanging the hand down over the side of the bed.
In mild cases the use of one of the antiinflammatory drugs to relieve the inflammatory swelling of the nerve in the tunnel may produce relief. This is often combined with the taking of a diuretic to reduce fluid retention.
If these simple measures do not work, it is worth a trial of applying a plaster of Paris splint to the wrist to be worn only at nights.
Nerve conduction studies will confirm the diagnosis. Where conservative measures fail, operation gives excellent results.
*247/71/1*
