After the initial injury sometimes severe and non-ending pain, usually described as a ‘burning sensation’ is felt. It is often associated with extreme instability of the blood vessels in the area.

There is often an increase or decrease in apparent temperature, sweating in the area and later a cool, purplish coloured limb may be seen with an associated deterioration of the skin and the soft tissues.

Such conditions can sometimes be diagnosed effectively and early by the use of thermography and by sophisticated skin tests which assess the function of the sympathetic nerves, which control the opening and closing of the outer blood vessels.

*78\37\8*

Brian, 27, was an unemployed sports equipment salesman whose car had rolled over in gravel on a country road several years before. Essentially, all his spinal movement had been restricted since:

‘I had all sorts of hateful thoughts about myself. About my helplessness. About being suddenly scared of the future. I had awful feelings of hopelessness knowing there was nothing I could do.

I was lying there this night. My head was throbbing. I was exhausted but I just couldn’t get to sleep. Just lying there listening to every sound magnified in the room. Lying there with black despair. I was in constant internal pain no matter what position I was in. It just wouldn’t go away. It was sheer hell on earth.’

His severe anxiety, and unwillingness to give his full co-operation, in the end proved an insuperable stumbling block to his rehabilitation. There had been very little improvement since the accident. He had been assessed by an orthopaedic surgeon who could not offer much help. A few infrequent visits for physiotherapy had also not helped significantly. He was then referred to our pain clinic for assessment regarding relaxation therapy, acupuncture and anything else that might help alleviate his constant distress.

On his first visit, Brian appeared to be almost entirely rigid during the interview. He looked profoundly unhappy and would not say very much. He was accompanied by his brother who helped him stand, sit, dress and even move. Pressed for details, Brian became a little more communicative about the accident. The accident had caused no obvious severe physical injury. He had received cuts to the head, abrasions to the arms and head and had not lost consciousness. He had been taken to hospital and then later seen by a local doctor who suggested that he commence physiotherapy.

Brian claimed that, before the accident, he had been working in the sports equipment business. He was unemployed prior to the accident for about 12 months. He described himself as having no psychiatric problems of any kind. Before the accident, he was an independent and active person who played soccer and squash, was keen on running and had no physical problems.

He had been involved with a woman before but the accident had ended the relationship.

When asked to move from his rigid sitting position, there seemed almost total rigidity of the neck. He appeared to be extremely tender over the entire back area alongside the spinal area. He was even unable to lift his leg off the couch a few millimetres without grimacing and loudly moaning. Every movement was helped by his brother who acted almost like a servant.

The medical team felt his demeanour was incompatible with any known organic problem. He demonstrated abnormal illness behaviour which appeared to have developed either as a hysterical reaction to his original injuries, or to outright malingering. He was advised that the only way he could be effectively treated was to be admitted to an in-patient program at the pain clinic. He was asked to consider this proposed admission and to complete the usual questionnaires. It was also suggested to him that he take some antidepressant medication and a mild sedative.

Over the ensuing months, several efforts were made to admit Brian to the pain clinic for further evaluation but to no avail. Eventually, after twelve months, he allowed himself to be admitted to the in-patient program. But, unlike his fellow patients, he made no real effort to change his behaviour. He did not appear to be capable of responding to the program’s psychological content and seemed to have no insight into the non-physical aspects of his pain problem.

He appeared to be obsessed with his pain which had become the ruling force in his life. Further inconsistencies in his observed behaviour confirmed the belief that he may have been deliberately exaggerating his symptoms to gain increased financial compensation and sympathy from his family and friends. (At one time he was observed to have ‘forgotten’ which side he was ‘paralysed’ on!)

*55\37\8*

Medical research into the phenomenon of stress began on the battlefield, where the devastating effects of chronic stress are unmistakable. The great Harvard physiologist, Dr Walter Cannon, along with Dr Hans Selye, the father of modern stress research, proved that psychological strain itself could cause dramatic hormonal changes and hence physical symptoms.

Selye showed that when the ‘fight or flight’ response becomes chronic, as it does in battle, long-term chemical changes occur, leading to high blood pressure, an increased rate of arteriosclerosis and depression of the immune system.

Holmes-Rahe Stress Scale

American social researchers Holmes and Rahe, working in the 1940s, devised a stress scale. At the top is the death of a spouse (100 stress points), followed by a divorce (73 points), marriage separation (65), imprisonment (63) and death of a close family member (63).

But not all stressful events are unpleasant. Marriage rates 50 points, pregnancy 40, buying a house 31 and even Christmas accounts for 12. The impact of major life events on stress has been confirmed many times.

A study published by the British medical journal The Lancet reported that the incidence of fatal heart attacks rose sharply in Athens in the days following the 1981 earthquake. And a high score on the Holmes-Rahe scale is linked to elevated levels of the hormones linked with stress — adrenaline, noradrenaline and beta-endorphin. Furthermore, an Australian study on bereavement has shown that eight weeks after the death of a spouse, widows and widowers have reduced immunal responses, leaving them more vulnerable to infection and cancer. This often takes the form of abdominal or pelvic pain. One of the most common aspects of the history of chronic pain patients not on the litigation merry-go round, has been found to be the loss of a loved one or close relative in the twelve months or so prior to the onset of the chronic pain problem.

The poem by Charles Bukowski is revealing: ‘It’s not the large things that send a man to the madhouse . . .no, it’s the continuing series of small tragedies that send a man to the madhouse not the death of his love but a shoelace that snaps with no time left . . . ‘

The ’snapped shoelace’ syndrome ties in with several recent studies. For example, police sergeants in Houston,Texas, found paper-pushing more irksome than physical danger. Teachers ranked administrative details second only to dissatisfaction with pay. Air traffic controllers, whose high rate of hypertension and ulcers have been attributed to job pressure, complained more about such mundane matters as management, shift schedules and ‘irrelevant’ chores than the strain of guiding heavy air traffic. Loss of employment has a similar ‘ripple’ effect. The greatest source of stress is not losing the job; rather it is the gradual domestic and psychological changes it imposes.

*34\37\8*

The prevailing medical belief in the seventeenth century was that the brain was connected by delicate threads — the nerves. It was thought that pain was caused by a process similar to that of pulling these fibres. During the seventeenth and eighteenth centuries the nervous system was described and defined.

*11\37\8*

Direct Weather Effects

Ions are atoms or molecules which have become electrically charged – either by the removal of one or more electrons (one of the atomic particles) which gives a positive ion, or by the addition of an electron (which gives a negative ion). Transfer of electrons like this is the basis for static electricity.

Are you one of those people who feel very oppressed when a thunderstorm is due? And afterwards, do you feel invigorated as the rain splashes down? If so, you may be sensitive to electrical charges. Before a thunderstorm, the air is heavily charged with positive ions, one of the two forms of static electricity. As the thunderstorm passes, the air changes from being positively charged to being negatively charged.

Typically, before a thunderstorm the hot, humid, oppressive, positively charged atmosphere makes certain people feel tense and on edge, and this edginess often manifests itself as headaches, which are relieved as the storm eventually passes over. If you’re particularly sensitive to positive ions, and there’s thunder in the air, try taking a shower. This can help for the same reasons that being near a fountain or a mountain stream can – sprays of water create negative ions, which will relieve your symptoms somewhat.

Offices and ions

Much the same thing occurs in offices, but on a smaller scale. Positive charges tend to build up because the insides of offices are usually dry, with the humidity artificially controlled down to a low level; and the petroleum-based materials from which office carpets, furniture and equipment are made encourage the build-up of static electricity. How many times have you walked across an office and felt a slight electric shock as your hand touched the door handle? This is static electricity building up on your body, often caused by the action of your synthetic-soled shoes on synthetic carpets.

Sometimes the static in an office fills the air with positive ions. Under these conditions the office feels oppressive and stuffy, and you may suffer constant headaches. You could counteract this feeling by opening the windows to let in some fresh air, but in offices with central air-conditioning, the windows are often sealed.

Devices called ionisers can sometimes help control this situation. These push out negatively ionised air to counteract and annihilate the positive ions floating around in the office air. However, ionisers are moderately expensive to buy, and are not necessarily going to make you feel much better. Do give them a trial run before you buy, to see whether they help you or not. (Ionisers may also help remove pollen and dust from the air, too.)

Barometric pressure

We often hear of old soldiers complaining that they feel their war wounds more when there’s bad weather coming. Some arthritis sufferers also find that their joints are more painful when the air pressure is low.

The reason barometric pressure varies is simple enough. Water vapour, molecule for molecule, is lighter than the gases that make up the remainder of the atmosphere. Since water vapour displaces other gases from the air, damp air weighs less than dry air. ‘Barometric pressure’ measures the weight of the atmosphere pressing on the surface of the earth; so, in damp conditions barometric pressure is less, because the extra water displaces the gases in the air and makes the atmosphere above the measuring point that much lighter.

Quite why this should make joints more painful and war wounds more sensitive, no one knows. Is it the barometric pressure itself? Unlikely; it’s probably the humidity of the atmosphere. Some people get headaches related to barometric-pressure, being worse in damp conditions and better in dry ones.

*139\20\2*

There are many different versions of the combined Pill, varying in dose and type of oestrogen, proportion of oestrogen to progesterone, and so on. The combination that suits one woman may not suit another, so if you find one brand of Pill gives side-effects, often all that you need is to change to a different brand.

There are many potential side-effects of the combined Pill. These can include bloating and abnormalities of menstrual bleeding.

‘Ordinary’ headaches

Headaches can be a side effect of the combined pill, and if these are of a general, non-migrainous type, often all that is needed is to switch to a different brand of Pill containing slightly different amounts of oestrogen and progesterone. Often this makes all the difference and the headaches disappear. Occasionally switching from the combined pill to the mini-pill can do the trick.

Migraine and the pill

If you already suffer from migraine with certain types of aura, some doctors advise that you don’t go on the Pill. There is no problem with those who get migraine without aura. However, a sizeable percentage of migraine sufferers find their existing migraines occur more frequently on the Pill. If you’ve had migraines in the past, then the treatment of the migraine itself is exactly the same as the treatment you’ve been accustomed to using.

On occasion, taking the combined pill can make your migraines less frequent or less severe. However there are two specific and potentially very dangerous types of headache associated with the ‘Pill’. This is when a woman who has never had migraines before gets her first-ever migraine while taking the Pill. For reasons not yet clear, migraines which start on the Pill are potentially very dangerous and can lead to strokes. If you have a true migraine attack while on the Pill and you have never had a migraine before then you need to stop the pill immediately.

Having a first migraine attack while on the Pill means you should not take the combined contraceptive Pill again. The mini-pill only contains progesterone and is still acceptable, though it doesn’t provide quite the same degree of protection against pregnancy. Exactly the same precautions need to be taken if your existing migraines suddenly change their nature (not their frequency) while you’re on the combined Pill. The development of an aura where previously you didn’t have one, numbness of fingers or lips, are reasons to stop the Pill straightaway.

Self-help

If you’ve had migraines in the past, before you went on the Pill, then you can continue to take the Pill as long as the nature of the migraines hasn’t changed.

Complementary treatment

If you’ve had migraine in the past, then the same complementary treatments are likely to work if you’re on the Pill. See the chapter on migraine for details of those therapies most likely to help.

*96\20\2*

Because we’re not normally aware of our bite, abnormalities here can have very subtle effects. There are two areas that can cause difficulties. The first is when the jaw over-closes – perhaps too many teeth have been removed, or else you’ve always had a slightly asymmetric shape to your mouth or teeth. But for whatever reason, you may end up with a jaw that closes slightly more than it ought to. This puts stress on the joint between the jaw and the skull – the temporo-mandibular (TM) joint. You can feel this joint very easily, just in front of the ear canal. Try putting your finger into your ear, and open and close your mouth; you will feel the joint mewing underneath.

The TM joint can become strained in a number of ways. If it closes more than it should, eventually it gets accustomed to working from an abnormal position and the stresses occurring within the joint can cause pain locally. As soon as the temporo-mandibular joint (TM) becomes painful, it will start causing spasm in the muscles surrounding it. This spasm may radiate pain into the head and cause headaches; in fact, some TM joint strains can even trigger off migraines.

Another cause of TM joint pain is when one side of the jaw closes properly and the other side doesn’t, so there is a rocking effect. Finally, the TM joint, like any other joint in the body, is susceptible to arthritis. Inflammation within the joint, and wearing-away of joint cartilage, can be potent sources of discomfort. It can also dislocate, either with a blow, or on wide yawning.

Clicking noises within the joints can indicate problems of arthritis, but can also occur where there is excess muscular tension.

Orthodox treatment

Changing the angle and level of the bite can be very effective. Altering false teeth; or filing off proud bits of filling may all settle the bite down into a much easier, more balanced state that causes much less strain at the TM joint.

Alternatively, your dentist may want to put in a bite-raising appliance, which is about an eighth of an inch thick, made of clear acrylic, and fits over the back four teeth (usually of the upper jaw). Its function is simply to prevent the jaw over-closing. It isn’t easy to eat with a bite-raising appliance such as this, and so it is often worn only during the night. (For some reason people tend to clench their jaws at night.) Even if a bite-raising appliance is used only at night, it can give marked relief during the day.

The object of using a bite-raising appliance is to re-position the jaw in the TM joint socket, altering both the range of movement of the joint and the pressure points within the joint. This relieves the stresses on the joint, and stops the pain. TM joint problems are made much worse by stress: stress increases the level of muscle tension, which causes the joint faces to be rammed together more firmly, thereby causing more pain and damage. Therefore, stress management will help to relieve the pain of TM joint problems.

Type of pain

TM joint problems can give rise to several different types of pain – local, sharp, stabbing pain within the TM joint itself, often accompanied by dull, sore, muscle-contraction pain radiating over the sides of the face and head. In extreme cases, it can also trigger migraines.

Self-help

Make sure that you get regular check-ups, and don’t assume that because you’ve got a complete set of false teeth you can’t have a dental cause for your headache. If you’ve had your false: teeth for a very long time – and, particularly if you have a lot of thinning of the gums as well, or if your false teeth don’t fit as well as they used to and slip around your mouth rather more than you would like – then it’s time to go to your dentist for a check. Do tell him if you are suffering from headaches, because although dental causes of headaches are not all that common, if there is a dental cause and you don’t gel it soiled out, you’ll continue to suffer.

Complementary treatment

Obviously the only way to treat temporo-mandibular (I’M) joint problems is by bailing specialised work done by your dentist. Until the work is done, however; headaches can be controlled by a number of different therapies.

Any of the analgesic aromatherapy oils will help to ease the pain – try bergamot, camomile, lavender, marjoram and rosemary in the hath, rubbed gently on the jaw area in a light carrier oil, or in a vapouriser.

Bach flower remedies can be taken before any dental treatment (to help alleviate fear). To soothe bruising following dental treatment, take arnica in homoeopathic doses. For shooting nerve pain, try hypericum, or belladonna.

Osteopathy or cranial osteopathy can he successfully used to treat skeletal pain. Acupuncture and Shiatsu can also bring relief. Gently exercising the joint can help relieve some kinds of pain; and a medical herbalist might suggest an infusion of any of the following: balm, camomile, lavender, rosemary, skullcap, while willow and vervain.

Since the headaches are often caused by stress – jaw-clenching, etc -relaxation therapy and biofeedback are recommended.

*83\20\2*

Uraemia comes on slowly and is accompanied by a large number of other symptoms – protein in the urine, weakness, high blood pressure, anaemia, loss of appetite, nausea and vomiting, diarrhoea, itching, hiccups, and sometimes confusion. Headaches are common – both from the uraemia (and all the other changes) and also because of the rise of blood pressure.

Severe kidney failure is not necessarily a disease of older people; it does occur in younger people. Sadly, in uraemia there is little that can be done to improve the kidney’s function. Sometimes low protein diets reduce the amount of urea that is formed; in the later stages careful control of the amount of fluid that you drink can also help; but, if you’re getting a headache from uraemia then there are only three things that are likely to cure you: dialysis using an artificial kidney or a technique called peritoneal dialysis (whereby fluid is pumped in and out of artificial holes in the abdominal wall) or else a kidney transplant.

Long-term untreated urinary infections can damage the kidneys and cause them to fail, so it is important to make sure that infections in children and young people particularly are fully treated, and that the infection is completely gone from the urinary system. Otherwise, if the infection is left to grumble on for month after month, and year after year, it may damage the kidneys progressively.

However, don’t get too alarmed about this. Intermittent attacks of cystitis or other urinary tract infections will not produce this sort of damage to the kidneys. It is not the frequent infections that do the damage, it is the continuous, unremitting infections, present for months and years that damage the kidney in this way.

Therefore, as far as prevention is concerned, if you are prone to infections in the bladder make sure that you go to your doctor to get appropriate antibiotic treatment. This will remove the infection and stop any possibility of damaging the kidneys.

Complementary treatment

Constitutional homoeopathy can be helpful for both preventative measures and treatment of existing uraemia

*119\20\2*

Quite seriously, this brings up a most important problem; even if a serious cause for your headache has been ruled out, it is easy for a vicious circle to develop in which the pain associated with intercourse so puts you off sex that the next time you’re so anxious about it that you get a tension headache. And, because you had a tension headache that time, you get one the next time, through worrying about it – and the time after that and the time after that.

To prevent this vicious circle from developing you need to do two things: firstly, recognise that your headache isn’t life-threatening or serious, just painful. This will take at least some of the worry out of the situation. Secondly, start to treat the problem with whatever medical, alternative and self-help techniques are appropriate.

In true coital headache, it’s important to reassure yourself that the tendency to have headaches at intercourse lasts only for a short time, seldom occurs at each act of intercourse, and – most important – can be prevented with drugs. Just knowing that it is harmless, that it will eventually go, and that there are good medical treatments that can stop the headache starting, may all be enough to help you relax and minimise your headache.

True coital headache is not the same as tension headache and so relaxation techniques are unlikely lo be so important, although they may help a bit, especially if you’re getting wound up about the problem. On the other hand, because there is a relationship between true coital headaches and migraine, maintaining good control of your migraines may reduce the frequency of true coital headaches.

*106\20\2*