Nov

15

Over the years I have written several articles on headaches.  This is because there are so many types and causes of head pain that there is much to write about.  Headaches remain one of the top three reasons why people go to the doctor.  The most common types of headaches are tension headaches and migraine headaches.  Tension headaches are typically a constant squeezing-like pain around the head whereas a migraine headache has a throbbing or pulsating component.  Many people believe the term migraine headache is used simply to describe a very severe headache.  This is not the case.  Migraines are a specific group of headaches which have a vascular cause and thus have a throbbing component.  Compounding diagnosis, headaches of the same type can have many different causes.  In my office we address many migraine causes as well as tension headaches which are caused by brain based inabilities to perform appropriate eye movements.  This becomes confusing for many patients as once you mention the eyes as a cause of headaches you inherently think to see an optometrist.  In reality, optometrists are interested in the focusing ability of the eyes and in diseases of the eyes.  Movement of the eyes to targets however is brain based and not typically assessed by eye doctors.  This is an extremely overlooked cause of headaches as few practitioners have appropriate diagnostic equipment to evaluate brain based eye movements.  Additionally, many headaches are perpetuated through poor eating habits and deficient nutritional needs.  This can easily be addressed by changing poor dietary habits in favor of better eating habits and thus augmenting nutrition.  It is most unfortunate however that the vast majority of headaches are managed through inappropriate drug therapies, most all of which do not fix the underlying cause of headaches but rather are typically an opiate based drug prescribed to deal with symptoms.  Recent studies are uncovering more and more deficits associated with these-type drugs which can be extremely addictive and require increasing dosage to maintain any level of symptom control.  If you suffer from headaches you would be well served to contact my office to schedule an appointment for a complete neurologic examination.  For many, it is their last headache consult.

Nov

7

Each week I see patients who have recently been examined by their primary doctors and are told that have findings of high blood pressure, elevated blood sugar or both. They are ill advised to return for followup in 8 weeks for a second test. I am not suggesting that it is wrong to followup when you have such finings. It is however foolish to make no management recommendations and expect a different outcome on a subsequent visit. Often on the next visit medication will be prescribed as now there is a trend and not just a single visit finding which may have been just coincidence. It is necessary to show a trend vs. a single visit reading to prescribe drug therapies unless hypertension is severe. It is reasonable that if someone is found to have high blood pressure, or, blood work reflects elevation in blood glucose, that rather than simply recording such data for record keeping that lifestyle modifications would be immediately discussed and proposed as being not only appropriate but necessary. Again, it could be argued that simply having an elevation in blood glucose does not mean that you are diabetic. Currently the diagnosis of diabetes is based on a blood test called the Hemoglobin A1c. However, if your blood test is demonstrating elevation in glucose, you are currently in a prediabetic state that needs to be addressed, not just monitored until such point that you definitely have diabetes, as is the case with an enormous number of Americans. If you have either elevated blood glucose or high blood pressure there are definitive lifestyle changes that you need to be making, now, not later. These changes do not merely mean kicking back and awaiting a drug therapy. It is this combination of blood glucose elevation and hypertension that constitutes the metabolic syndrome, a leading cause of disabilities, stroke, heart disease and death in this country, and it is getting worse each year despite drug therapies. When I meet with my patients I routinely discuss all aspects of their health. Most patients come to see me for dizziness and balance problems as well as other brain based disorders, but this doesn’t mean that I can’t help them get their life back if they are dangerously hypertense or prediabetic. In fact, I believe it is my job.