Evaluating headaches

Headache is a common affliction and one of the most frequent causes of referral to opthmalmologists. Multiple intra- and extra-cranial disturbances may be responsible for severe head pain and the many structures contained within the head make diagnostic confusion common. Ocular causes of head pain include trauma, inflammation, ocular hypertension, painful neuropathies and asthenopic symptoms. Other than trauma, inflammation is the most common cause of orbital pain but ischaemia and painful neuropathies are not uncommon. In addition, disease involving the para-nasal sinuses is often referred to the eye or orbit. Ocular tumours are infrequent causes of head pain and when pain is present it is usually associated with secondary glaucoma or inflammation. Similarly, pain is uncommon in otherwise silent orbital tumours, but lachrymal gland lesions may be painful in the absence of other outward signs of abnormality. When faced with the patient with unexplained head pain, the opthalmologist must first establish if an ocular cause is present. If none is found, a systematic work-up should be initiated and the patient referred to the appropriate specialist. (AU)

Sickle cell disorder and orofacial pain in Jamaican patients

AIM: the aim of this study was to investigate the prevalence of orofacial pain in a large group of sickle cell disorder (SCD) sufferers. METHODS: In 1996, 51 Jamaican adults and teenagers with SCD and 51 matched subjects (non-SCD) without any sickle cell problems were questioned about their experience of pian in the maxilla or mandible, and pain in their teeth. The subjects, aged 13 to 45 years, had oral examinations and the state of the teeth was recorded together with the presence or absence of deep periodontal pockets, vertical or horizontal mobility, sepsis, trauma and servere erosion. RESULTS: Mandibular or maxillary pain during the previous 12 months was reported by 49 percent of those with SCD and only 8 percent of the non-SCD subjects. Among the SCD group reporting this pain, 68 percent were found to have no dental problems which could have caused the pain. Dental disease accounted for the facial pain in all non-SCD subjects. Headaches were experienced by 77 percent of the SCD group and only 47 percent of the non-SCD group. Experience of toothache during the previous year was reported by 67 percent of the SCD group and 57 percent of the non-SCD. In half on these SCD subjects there was no obvious dental pathology to account for the dental pain but none of the controls had dental pin in the absence of dental pathology. CONCLUSION: People who suffer from sickle cell disorders are likely to suffer orofacial and dental pain in the absence of dental pathology and this is probably because of sickling crises within the microcirculation of the facial bones and dental pulps and small areas of necrosis in the bone marrow(AU)

Headaches in persons attending polyclinics in Barbados

Headache is a very common problem in the community, but only a small proportion of people who have it presents to the health services. In the Caribbean little is known of its prevalence, the resulting morbidity or the nature of self care used. This paper reports on a survey of 679 adults who attended three polyclinics as patients, or accompanying young, elderly or acutely ill relatives. 68.9 percent reported having experienced a headache in the previous month. Headaches were more prevalent among respondents aged 25-44 years (78.6 percent) than among those in other age groups; in women (73 percent) than in men; in those living in households of four or more people (72 percent) than in those living in smaller households; in those whose family members were reported as using alcohol, tobacco or marijuana singly or in combination (70-72.5 percent) compared to those whose families did not use any of these substances (55 percent); and in those whose family members were reported as having allergy, asthma and migraine (72.5 to 77.1 percent). No significant association was shown in relation to employment. 18.4 percent of the respondents visited the doctor for their headache. In the clinical evaluation of these patient, the number of costly investigations may be reduced by attention to the epidemiological variables such as age and gender, domestic factors such as stress, and family disease such as migraine, asthma and allergy.(AU)

Headaches in patients attending polyclinics in Barbados

679 adults attending three polyclinics in Barbados were interviewed using a standardised pre-coded questionnaire. 468 (68.9 percent) reported having a headache in the past month, and these were tabulated with variables such as age, gender, number of persons living in the home, the use of alcohol, cigarettes, marijuana and cocaine by family members, and the presence of migraine, allergy, and asthma in family members. The results demonstrate that headache was more prevalent in women, and in those aged 25 - 44 years, but there was no relationship between headace and employment, or headaches and the use of alcohol, cigarettes and other substances by family members. As the number of persons in the household increased, so did the occurrence of headaches, there being a three-fold increase in headaches between person living alone or with one other person and those with five in the household. There were more headaches (313/93) in those who reported migraine in the family, and also more headaches (158/47) in those reporting an upper respiratory allergy in their families. Eight-six persons with a headache in the past month (18.4 percent) would visit their doctor for this, a higher percentage than reported from other countries, while 313 (66 percent) reported self-medication with over the counter medicines. The study confirms, as have epidemiological studies in other countries, that a vast majority of persons with headaches do not present to the health services. In the clinical evaluation of the person with a headache, costly investigation may be reduced by attention to epidemiological variables such as age and gender, and domestic factors such as stress, migraine and allergy. (AU)

Nutrition study in British Honduras

Height-weight measurements were performed and diet questionnaires distributed to 1,649 8- and 9-year-old children in Belize city. The children were divided into three groups; Creole, Spanish extraction, and miscellaneous for specific reasons mentioned. Analysis of the height-weight measurements and returned questionnaires indicate that the diets of these children are nutritionally poor; they are much smaller than American children of the same age; and have a high incidence of colds and headaches. No consistent difference was noted with regard to the height-weight measurements of the children receiving and not receiving a CARE supplement in their schools. Height-weight measurements when compared with private school Puerto Rican children assumed receiving a good diet were consistently above British Honduran values. When compared with prewar English children receiving a poor diet and postwar English children receiving a better vitamin and mineral supplement diet, the British Honduran values were greater than those of the first group and less than those of the second. "Anemia indices" of the three ethnic groups were compared and the diferences commented on. Frequency of colds and headaches and evaluations of the health of the children by the parent were tabulated and compared for the three groups of British Honduran children.(Summary)