Haemochromatosis

Haemochromatosis

What is Haemochromatosis?

Haemochromatosis - or genetic haemochromatosis (GH) - is a disorder that causes the body to absorb an excessive amount of iron from the diet.

We can only use a limited amount of iron and any excess is deposited around the body. This accumulates mainly in the liver, but can also affect the heart, pancreas and pituitary gland, damaging these vital body organs and resulting in a deterioration of their functional capacity.

Symptoms

Although haemochromatosis and the potential for the condition to cause problems is present from birth, symptoms don't usually become apparent until middle age. Common symptoms that might be noticed then include:

• weakness, tiredness and lack of energy
• joint pain and stiffness - particularly in the hands and fingers
• a tanned or bronzed appearance of the skin
• impotence in men
• shrinking of testicles
• weight loss
• abdominal pain

Later, more serious symptoms may develop including:

• diabetes
• arthritis
• heart problems
• enlargement or damage to the liver

Causes and risk factors

Haemochromatosis runs in families and affects around one in 300 people in Europe.

Men are more likely to be affected than women. This isn't because of genetic susceptibility, but because women lose iron each month during menstruation. This means that even when an excess amount of iron is absorbed, less iron remains in the body to be deposited in the organs.

People with haemochromatosis who drink alcohol in unsafe amounts often develop symptoms before they reach 40 because alcohol increases the absorption of iron from the diet.

Genetic haemochromatosis is now recognised as being one of the most common genetic disorders. The process of inheritance is autosomal recessive. This means that to develop the disease a person must inherit an abnormal gene from both parents. There is a one in four chance of this happening when both parents are carriers of the abnormal gene.

If someone only inherits one abnormal gene, they won't develop the symptoms of the disease but they'll be a carrier and may pass the gene on to their children. More than 1 in 10 people in Europe are carriers of the gene mutation for haemochromatosis.

The condition can also be acquired, for example, as a result of frequent blood transfusions for haemolytic anaemia (blood contains iron).

It's important that haemochromatosis is diagnosed and treated as soon as possible, before severe and life-threatening damage is done.

Haemochromatosis weakens the heart, causing heart failure. It can also cause diabetes by damaging the pancreas, while damage to the liver increases the risk of liver cancer. When treatment is given early enough, such damage can be avoided.

Blood tests can reveal unusually high levels of iron stored in the body and scanning the organs of the body, such as the liver, helps to identify any organ damage. A liver biopsy may also be performed to establish whether iron has accumulated there.

Genetic testing may help to confirm the diagnosis – one particular gene mutation is responsible for more than 90 per cent of cases. But other genetic abnormalities may also cause the condition and may be more difficult to spot. When a person is diagnosed with genetic haemochromatosis, other close members of the family are usually offered screening for the disease.

Treatment and recovery

Haemochromatosis is treated by:

• Reducing the amount of iron absorbed by the body - patients are advised to avoid iron-rich foods and alcohol.
• Removing excess iron from the body by removing blood from the body (venesection therapy or phlebotomy). Initially this may involve removing a unit of blood a week (sometimes for many months) until iron levels in the blood are normal. Then most people can be kept stable by removing a unit of blood every 2-3 months.

If phlebotomy is started before liver damage occurs the outlook is good, and the affected person can expect to live an otherwise normal life.

Acquired haemochromatosis is normally treated by a drug that binds iron and allows it to be excreted from the body.

Associated problems such as heart failure and diabetes are treated as appropriate.

Hearing loss

Hearing loss

What is hearing loss?

The ear is a sensitive organ and plays a role in hearing and balance. To hear well, you need a clear conduction system through which sound can travel and healthy sensory organs to detect the sound waves and turn them into nerve signals to the brain. If hearing loss occurs it may be 'conductive' or 'sensorineural' or sometimes a mixture of both:

• In conductive hearing loss the sound waves cannot pass properly into the inner ear, because of reasons such as copious ear wax blocking the outer ear canal, damage to the ear drum or fluid in the middle ear. As a result sounds become quieter or muffled.
• Sensorineural loss results from damage to the cochlear in the inner ear or to the hearing nerve (or both). Rarely hearing loss occurs as a result of damage to the area of the brain responsible for hearing.

Causes of hearing loss

Causes of hearing loss include:

Sensorineural loss:

• Exposure to loud noise
• Infectious diseases (for example rubella)
• Some medications including some anti-cancer drugs and certain antibiotics
• Genetics and inherited diseases
• Birth trauma
• Head injuries
• Tumours

Conductive loss:

• Blockage by wax
• Fluid or infection in the middle ear
• Ruptured ear drum
• Abnormal growth of the small bones in the middle ear (otosclerosis)

When to see your GP about hearing loss

You should see your GP if you notice any of the following symptoms:

• If you have difficulty hearing (deafness)
• Tinnitus (ringing or buzzing)
• Vertigo (dizziness)
• Loss of balance
• Ear pain
• Discharge from your ear
• Ear wax

Among people who have previously had normal hearing, the most common cause of hearing loss is a build-up of wax. The ear canal makes wax to protect itself from infection. The amount different people's ears make varies from large amounts to very little.

If you suspect you may have a wax blockage, apply ear drops twice a day for four days (but don't use drops if you have a perforated eardrum). This may soften the wax enough that it dissolves and falls out. It doesn't matter which drops you use - cheap olive oil drops or sodium bicarbonate drops from your chemist are just as good as expensive brands.

If you still have hearing problems, see your practice nurse, who can check your ears. If wax is present it can be syringed, or removed by suction. Although there is general agreement that syringing is effective in clearing wax, there is some controversy because there may be significant side effects, including pain, dizziness and even perforation of the ear drum.

Otitis media or glue ear

Another common cause of deafness is inflammation of the middle ear, or otitis media, especially if it persists and results in a collection of 'glue' in the middle ear (known as glue ear). This is a thick mucus which can develop when you have a cold or catarrh (normally the middle ear contains only air, so the ear drum and tiny bones can move freely). If it doesn't drain after your cold, it can prevent the passage of sound through the middle compartment of the ear, and result in hearing loss.

In four out of five cases, an acute otitis media clears up within a few days without any specific treatment. Even if the ear drum has perforated this may heal by itself. Antibiotics are not usually needed. But if the infection causing otitis media persists, or the inflammation becomes chronic, antibiotics may be prescribed. Long-term antibiotics can help prevent long-term or recurrent otitis media but they have side effects and research has not been able to prove they are the best treatment.

Other medicines may also help – simple pain relievers such as ibuprofen or paracetamol may control pain and fever, while decongestants may be worth trying. These might possibly reduce swelling of the membranes in the nose and back of throat, helping the Eustachian tubes to drain fluid from the middle ear – however this has not been proven to be an effective treatment for otitis media or glue ear. Children with recurrent severe otitis media may need an operation to insert tiny tubes called grommets (or tympanostomy tubes) through the ear drum to drain fluid, or removal of adenoids and tonsils if they are blocking the Eustachian tubes.

Rarely a chronic infection may develop (chronic suppurative otitis media) which needs specialist treatment from an ear, nose and throat (ENT) surgeon.

Hearing tests

If you are worried about your hearing, talk to your doctor, who may recommend that you have a hearing test known as an audiogram. They should be able to refer you to a hospital or local community hearing clinic for this test (although you may have to wait several weeks). Alternatively you may be able to book a hearing test yourself for free through the larger branches of certain high street chemists offering specialised hearing services.

An audiogram is a painless test that measures your range of hearing. The results show what sort of hearing loss you have and can give some idea of the cause, and what might be done to help you.

In older patients the problem is often inner ear damage which is due to deterioration in tiny hair-like structures in the cochlear. This irreversible age-related hearing loss is known as presbycusis.

In most cases a hearing aid can help to improve hearing, and there are many types to choose from. Modern hearing aids, based on digital rather than analogue technology are much more sophistacted and discrete than older types, and generally don't have problems they once had such as whistling noises or uncontrolled sound levels. Sometimes other treatments, including surgery, may be needed.

Protecting your hearing

The delicate sensory organs in your ear don't take kindly to loud noises, and when they are damaged they can't be replaced. You can protect your hearing by:

• Avoiding loud noise where possible (it’s especially important to protect your children’s ears from loud noise)
• Wearing ear plugs or ear muffs or defenders when doing noisy activities
• Not inserting anything into the ear canal
• Seeking prompt treatment if you suspect an ear infection

Head lice

Head lice

What are head lice?

Head lice are tiny insects that live on the head and in the hair. They're highly infectious and easily passed between children who tend to work closely with their heads together, at school and at play. Infestation of any of the hairy parts of the body is also called pediculosis. However, the type of lice found on the head are different to those that can infest the rest of the body or the pubic area.

Head lice are flat, wingless insects about 2mm to 4mm long, usually black or dark brown, which attach to the base of a hair. They are blood-sucking insects which feed on human blood several times a day. They stay close to the skin for moisture, food and warmth. The adult lice lay a large number of eggs, known as nits, that can be seen as tiny white/brown ovals glued firmly to the hair close to the scalp.

Symptoms

A head lice infection doesn't often cause symptoms. When it does the main symptom is itchiness - beware a child constantly scratching his or her scalp. Sometimes you see tiny red spots on the scalp or the lice and nits in the hair. (Nits are the eggs or empty eggshells after the lice have hatched.) Behind the ears is a favourite spot.

Causes and risk factors

Head lice are widespread in the UK and almost all schoolchildren have at least one attack, if not more. Headlice affect those with long or short, dirty or clean hair – they are not a sign of poor hygiene or dirty hair.

Head lice can be caught by direct contact or by sharing combs, brushes and hats. Whole families are often affected.

Treatment and recovery

Look for lice or nits by using a fine-tooth comb after washing the hair. Always check the whole family.

There are several ways to treat head lice. After washing the hair, apply lots of conditioner and comb it thoroughly with a fine-toothed comb - the lice and nits will be caught on the comb. (Rinse the comb in a basin of water to see them easily) You will have to repeat this for several days to catch all the lice and nits, and comb your child's hair daily to check for lice afterwards.

Alternatively, an electrically charged comb (available from pharmacies) can be used to catch and kill the lice. It must be used regularly.

Pesticide shampoo can be used, although some people are concerned about harmful side-effects and head lice in the UK are becoming resistant to chemical treatments. If you wish to use a pesticide shampoo, talk to your chemist about the most suitable one and follow the instructions as you may need to repeat the treatment.

Recently, a treatment called dimethicone has become available, which physically covers and smothers the lice.

To get rid of head lice, it's important to understand their life cycle so that you continue treatment for the right length of time. You may need to repeat treatments after 7-10 days – the time taken for the eggs to hatch- as the eggs are more resistant to treatments. If you are meticulous with treatment, there is a high chance of getting rid of the infestation.

Remember to check the whole family for nits, and to alert the parents of friends and your child's school.

Childhood head injury

Childhood head injury

What is head injury?

A head injury is any sort of accident or trauma that affects the head.

Cuts, tears or haemorrhages in the brain tissues and covering membranes can lead to a wide variety of problems, while fractures of the bones of the skull (including the face) can damage delicate tissues and increase pressure on the brain.

Other problems following head injury include damage to the spinal cord (head injuries often involve the neck, too), disruption of sight and hearing, as well as damage to the jaws and teeth, plus possible harm involving the major airways. Because all these important structures are found in the head, head injuries can take a huge toll. They can rapidly be life-threatening and are the major cause of long-term disability following an accident.

Symptoms

Symptoms include the visible effects of trauma to the head, such as a cut, bump or bruising. There may also be loss of consciousness (this may be brief), confusion, drowsiness, dizziness, headache, nausea and vomiting, blurred vision and loss of memory.

Straw-coloured or bloodstained fluid may be seen leaking from the child's nose or ears. This is cerebrospinal fluid, which normally bathes the brain, and is a sign of skull fracture requiring urgent medical attention.

Sometimes there are no (or minimal) immediate symptoms but the child collapses minutes or hours later, with a seizure or blackout. This may be caused for example when there is a slow haemorrhage beneath the skull which gradually puts pressure on the brain – this is known as a sub-dural haemorrhage and it needs urgent treatment.

Causes

Road traffic accidents are the most common causes of head injuries, especially when the child is a pedestrian or cyclist. Other common causes include falls from cots, windows or down stairs and sports injuries. Occasionally what seems to be a very small blow to the head, perhaps during some rough and tumble as kids play, leads to significant problems.

Treatment and Recovery

You should get urgent medical advice if your child loses consciousness (even for a few moments), becomes drowsy, confused, vomits persistently, has seizures, has fluid coming from the ears or nose, or seems unwell. Sometimes a parent just feels instinctively that their child isn’t right – you should always listen to these instincts.

The child may need to be closely observed for 24 hours in hospital, where skull x-rays (to look for fractures), CT and MRI scans (to check for damage to or haemorrhage in the brain tissues) can easily be done. Surgery may be needed to repair damaged skin or bones, or to relieve pressure from bleeding inside the skull.

Hair loss in women

Hair loss in women

What is hair loss in women?

One of the commonest forms of hair loss in women (and men) is a condition called telogen effluvium, in which there is a diffuse (or widely spread out) shedding of hairs around the scalp and elsewhere on the body.

This is usually a reaction to intense stress on the body's physical or hormonal systems, or as a reaction to medication.

The condition, which can occur at any age, generally begins fairly suddenly and gets better on its own within about six months, although for a few people it can become a chronic problem.

Because telogen effluvium develops a while after its trigger, and causes generalised thinning of hair density rather than a bald patch, women with the condition can easily be diagnosed as overanxious or neurotic.

Fortunately, it often gets better with time. Telogen effluvium is a phenomenon related to the growth cycles of hair.

Hair growth cycles alternate between a growth phase (called anagen, it lasts about three years) and a resting phase (telogen, which lasts about three months). During telogen, the hair remains in the follicle until it is pushed out by the growth of a new hair in the anagen phase.

At any one time, up to about 15 per cent of hairs are in telogen. But a sudden stress on the body can trigger large numbers of hairs to enter the telogen phase at the same time. Then, about three months later, this large number of hairs will be shed. As the new hairs start to grow out, so the density of hair may thicken again.

Many adults have had an episode of telogen effluvium at some point in their lives, reflecting episodes of illness or stress.

Another common type of hair loss in women is androgenetic alopecia, which is related to hormone levels in the body. There's a large genetic predisposition, which may be inherited from the father or mother.

Androgenetic alopecia affects roughly 50 per cent of men (this is the main cause of the usual pattern of balding seen as men age) and perhaps as many women over the age of 40.

Research shows that up to 13 per cent of women have some degree of this sort of hair loss before the menopause, and afterwards it becomes far more common - one piece of research suggests that over the age of 65 as many as 75 per cent of women are affected.

The cause of hair loss in androgentic alopecia is a chemical called dihydrotestosterone, or DHT, which is made from androgens (male hormones that all men and women produce) by the action of an enzyme called 5-alpha reductase.

People with a lot of this enzyme make more DHT, which in excess can cause the hair follicles to make thinner and thinner hair, until eventually they pack up completely.

Women's pattern of hair loss is different to the typical receding hairline and crown loss in men. Instead, androgenetic alopecia causes a general thinning of women's hair, with loss predominantly over the top and sides of the head.

Another important cause of hair loss in women is a condition called alopecia areata, an autoimmune disease that affects more than two per cent of the population. In this, the hair follicles are attacked by white blood cells. The follicles then become very small and hair production slows down dramatically, so there may be no visible hair growth for months and years.

After some time, hair may regrow as before, come back in patchy areas, or not regrow at all. The good news is that in every case the hair follicles remain alive and can be switched on again; the bad news is that we don't yet know how to do this.

Myths about female hair loss:

• It means you're not a proper women with two X chromosomes.
• It's caused by washing your hair too often.
• It's caused by too much brushing or combing.
• Hair dyes and perms can cause permanent loss.
• It may result from wearing hats and wigs.
• Shaving your hair will make it regrow thicker.
• Standing on your head will help it grow back.
• It's a sign of an overactive brain.
• There's a miracle cure out there waiting for you.
• Scan the internet and you'll see all sorts of miracle cures for baldness on offer, from strange herbal lotions to mechanical devices. Perhaps the most useful first step you can take is to avoid the myths.

After this there are several options. You can find some way to accept the change and live with it (let's face it, this is a tall order - most men struggle to come to terms with their baldness and for them at least society equates it with maturity and power).

You can try cosmetic treatments such as wigs or hair thickeners, or you can try medical therapies. The last option is hair-replacement surgery.

The drug minoxidil was first developed for treating high blood pressure, which was found to have the side effect of thickening hair growth in some people. It's now available as a lotion to apply directly to the scalp.

No one really knows how it works, however, and it's not effective for everyone. Studies show that only about 20 per cent of women between 18 and 45 have moderate regrowth using the drug, while another 40 per cent experience minimal regrowth.

It works best on younger people with early hair loss. A big disadvantage is that you have to carry on using minoxidil indefinitely or the new hair will fall out.

Another drug, finasteride, which was developed for treating prostate cancer, has also been found to be effective but is only available for men.

Surgical techniques for restoring hair have improved greatly in the past couple of decades, but this is still an option that requires careful consideration.

There are two main options:

• Hair transplantation - tiny punch-holes of skin containing a few follicles of hair are taken from elsewhere in the body (such as the back of the head, if this is still well covered) and implanted into the thinning areas. Some surgeons use a needle to sew in just one or two hairs. However, as women are more likely to have diffuse loss of hair all over the scalp, this technique may not be possible. There has been little success with implanting artificial fibres.
• Scalp reduction - devices are inserted under the skin to stretch areas of scalp that still have hair, then the redundant bald areas are removed. Alternatively, flaps of hairy scalp can be moved around the head.

Key points

• Many causes of female hair loss are temporary - check your general health and be patient.
• Take a look at your family for an idea of your risk of female pattern baldness.
• Don't be taken in by claims for wonder products - there's no cure for female pattern hair loss.
• Many women cope well by using cosmetic products, hats and wigs, so persevere until you find your own style.

Hair loss in men

Hair loss in men

What is male hair loss?

Male pattern baldness occurs in a distinct way (and sometimescan affect women too). Hair may start Hair may start to disappear from the temples and the crown of the head at any time. For a few men this process starts as early as the later teenage years, but for most it happens in their late 20s and early 30s. A little thinning of the hair may be noticeable first, followed by wider hair loss allowing more of the scalp to become visible.

Some men aren't troubled by this process at all. Others, however, suffer great emotional distress associated with a lack of self-confidence and sometimes depression.

Causes and risk factors

In male pattern baldness, which tends to be inherited, the hair is usually lost at the temples and the crown. This happens because of an excess of a chemical called dihydrotestosterone, or DHT, which causes the hair follicles to make thinner and thinner hair until they eventually pack up completely.

Other causes of hair loss, which may not follow this pattern, include:

• Iron-deficiency anaemia
• Under active thyroid
• Fungal scalp infection
• Some prescribed medicines
• Stress

Can I stop it?

If there's a reversible cause, it's normally possible to stop hair loss. For instance, if it's caused by iron deficiency you can stop hair loss by replenishing the body's iron stores.

A huge number of treatments have been tried to slow down and even reverse the process of male pattern hair loss - some are successful, others aren't. But many men find their hair loss slows down or stops for no apparent reason at a certain age anyway.

Should I see a doctor?

It's a good idea to ensure an illness isn't responsible, particularly if the hair loss is patchy rather than being in the typical male pattern distribution. Moreover, if the hair loss is accompanied by other symptoms (such as tiredness) then blood tests may be necessary.

Treatments

• Wigs, weaves and hair transplants are, obviously, the most direct form of treatment, while some advocate shaving or close cutting which simply makes the hair loss less obvious. Different hairstyles can create the appearance of a fuller head of hair, or a close shave cut can make baldness less apparent.
• Herbal preparations that contain zinc, magnesium, iron, vitamin E and other substances in various combinations can help.
• Minoxidil is a lotion available from the pharmacist that you rub on to the scalp. It slows down the process of hair loss and can cause new hair growth but you have to keep on using it or it will stop being effective.
• Finasteride (Propecia) is the latest drug treatment. It comes in tablet form and works by slowing down hair loss; it's also reported to cause new hair growth. In the UK it's only available on private prescription from your GP and is only effective while you take it.

Heart attack

Heart attack

What is a heart attack?

The heart beats on average 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries. When this process is interrupted or doesn't work properly, serious illness and even death can result.

A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle. The clot, often caused by rupturing or tearing of plaque in an artery, is sometimes called a coronary thrombosis or a coronary occlusion.

If blood supply is cut off for a long time, the muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage.

Diseases that narrow the coronary arteries can reduce the supply of blood and cause a shortage of oxygen and essential nutrients in the heart muscle. This triggers chest pain known asangina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain.

A heart attack can occur if the shortage of oxygen to an area of heart muscle is severe and prolonged. Heart attacks (also known as a myocardial infarction or MI) can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.

Most of the deaths from heart attack are sudden, occurring within one hour of onset of symptoms and before reaching hospital, and are often due to dangerous heart rhythms. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems.

Heart attack symptoms

Unfortunately, for many people the first indication that something's wrong is a heart attack. This happens when the blood supply to a part of the heart muscle is completely interrupted or stops, usually when a blood clot forms in a diseased coronary artery that's already become narrowed by atherosclerosis.

The symptoms of a heart attack include:

• Chest pain, usually a central crushing pain that may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes. Unlike angina, the pain doesn't subside when you rest. Sometimes it can be mild and be mistaken for indigestion. Some people have a heart attack without experiencing pain
• Stomach or abdominal pain
• Shortness of breath or difficulty breathing
• Nausea or vomiting
• Sweating
• Unexplained anxiety
• Weakness or fatigue
• Cold sweat or paleness
• Feeling light-headed or dizzy
• Palpitations or an abnormal heart rate

Heart attacks must be recognised and treated as quickly as possible because once a coronary artery is blocked, the heart muscle will die within four to six hours.

If you suspect you or someone else is having a heart attack, seek medical help immediately by calling 999. Modern treatments can restore the blood supply to the heart muscle. The sooner treatment is given, the less permanent damage there will be.

Causes of a heart attack

The UK has one of the worst heart attack rates in the world. It's estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal.

Common causes include:

• Atherosclerosis, where fatty plaques build up on the inner lining of the coronary arteries (often compared to the furring up you see inside a kettle)
• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Family history of heart disease

Men are also more likely to have a heart attack than women.

There are many steps you can take to change your lifestyle andreduce your risk, including quitting smoking, eating healthily and keeping your weight under control, and getting regular exercise.

Headache

Headache

What is a headache

Headache is pain of any sort in or around the head.

Symptoms

There are several different types of headache. The main types are:

• Tension headaches (also called stress headaches, muscular headaches) - a mild to moderate headache that may last minutes or days and tends to recur. The pain is fairly constant and felt in both sides of the head and neck as a pressure or tension. Most importantly, exercise doesn't make it worse and there are no additional symptoms such as nausea.

• Migraine - ssymptoms can be variable, and there are several different types of migraine , but this is usually a moderate to severe one-sided headache that pulsates or throbs. Importantly, it gets worse with activity and there are additional symptoms, particularly nausea and vomiting, diarrhoea and an increased sensitivity to noise, light or smells. Some people experience an aura (symptoms such as flashing lights) before the headache.

• Cluster headaches - frequent, short-lived (less than an hour), one-sided headaches across the temple or around the eye and occurring once or more a day, and often disrupting sleep. Headaches recur for several weeks then subside, although another cluster may develop months later.

• Chronic daily headaches - these may be of any of the above types, and occur for at least 15 days a month for at least three months.

This is just a rough guide. Every individual will have different symptoms, so the diagnosis must be confirmed by a doctor.

Causes/Risk Factors

Headaches are generally divided into either primary (not related to another disorder) or secondary (caused by other things such as head injuries, high blood pressure or a brain tumour). With secondary headaches, it's essential to treat the underlying cause as this may prove fatal.

Primary headaches won't kill you, even if they're able to destroy your quality of life. Treatment involves identifying and dealing with any underlying triggers, then using simple pain-relieving techniques and treatments, followed by more powerful drugs if simple remedies are inadequate.

You may be able to prevent headaches or reduce their number and severity with exercise. Regular aerobic exercise reduces stress, decreases the frequency of headaches and can even abort an ongoing headache.

Also avoid common triggers such as certain foods, alcohol or preservatives, eat a healthy balanced diet and eat regularly to avoid drops in blood sugar.

Treatment/Recovery

Simple painkillers are effective for most types of headache if used properly, while more powerful and specific medicines such as triptans or 5HT drugs have revolutionised migraine management. A wide range of other treatments can help in headaches, including complementary therapies and, for migraines, the cosmetic treatment Botox.

Standard oral painkillers aren't usually effective for cluster headaches because they don't act fast enough. Inhalation of high flow rate oxygen is an effective treatment for many, as is the drug sumatriptan when given as an injection.

However, there's a risk that taking medication too often can lead to worse headaches or chronic daily headaches. These are known as analgesic-induced or drug-rebound headaches. The only way to reduce these is to stop taking the painkillers, which is usually best done with some help from your doctor.

Head injury

Head injury

Head injury symptoms

Minor head injuries may cause headache, bruising, swelling and cuts, which may bleed profusely even if small.

What's usually more worrying than any obvious trauma to the outside of the head (although this can in some instances cause very serious problems) is the possibility of damage to the delicate structures inside the head – to the brain and related tissues. This is referred to as traumatic brain injury or TBI. With any head injury, there's a risk of permanent damage to the brain, especially if the injury is not treated quickly.

The following symptoms may occur soon after the head injury or appear more slowly hours or days later. They are a sign there may be an injury to the brain that needs urgent investigation:

• Headache with nausea and vomiting.
• Blurred or double vision.
• Slurred speech.
• Confusion or drowsiness.
• Loss of consciousness - this is usually a sign that more serious damage to the brain may have occurred.
• Blood or clear fluid (cerebrospinal fluid which normally bathes the brain) from the ears or nose.
• Excessive thirst - this may be an early warning sign that the pituitary gland has been damaged during the injury.
• Loss of sense of smell - this is common in more severe injury and may be prolonged.

These symptoms must always be taken seriously and given proper medical attention.

Longer term symptoms of head injury

Damage or scarring of the brain’s tissues (even sometimes following what appears to have been a minor injury) can lead to chronic disruption of brain function. This may result in a myriad of symptoms such as :

• Headache - scarring of the tissues can disrupt the normal flow of cerebrospinal fluid around the brain, leading to a build-up of fluid (known as hydrocephalus) which may be accompanied by increased pressure within the skull. This is just one of several causes of headache after a traumatic head injury.
• Depression - mood changes ranging from depression to irritability are common after head injury. These can persist indefinitely, and there's a significantly increased risk of suicide.
• Memory problems - loss of memory, including an inability to retain new information or lay down new memories, can be prolonged.
• Movement problems - damage to the motor cortex, which controls movement, can result in paralysis or problems controlling movement.
• Processing difficulties, which interfere with a person’s ability to plan and carry out tasks.

It can also causes a range of symptoms which reflect hormone changes in the body. These may occur when the pituitary gland at the base of the brain is damaged (often by disruption of its blood supply during an injury). The pituitary gland is normally the 'master controller' of many of the body’s hormone systems and may stop producing its own hormones following injury, leading to a condition known as hypopituitarism. Hormone production by other glands of the body falls as a result leading to problems such as:

• Erectile dysfunction in men.
• Loss of libido.
• Loss of periods in women.
• Infertility.
• Weight problems.
• Depression.
• Fatigue.

It's important to note to symptoms may not be immediately apparent but may develop some time after injury.

Head injuries can also cause skull fractures, which may not be apparent unless an x-ray is taken, but which increases the risk of bleeding and significant damage to the brain inside the skull. So it's usually important to x-ray the skull after anything more than a very mild injury and especially when any of the above symptoms are present.

Head injury causes

Road traffic accidents are the single largest cause of head injuries. Other common causes include falls, assaults and sports injuries. Worldwide, traumatic injuries during war, or in some countries damage from falling objects from trees, are also important causes.

Being aware of potential dangers and wearing protective headgear when on bicycles or motorbikes and when playing contact sports can reduce the risk of head injury.

Head injury treatments

Although most head injuries are minor, around one million people each year in the UK need emergency medical care as a result of head injury. Around one in four of these needs to be admitted to hospital. Symptoms can develop some time after a head injury and a history of injury should always be taken into acount in consequent illness.

Treatment of a head injury depends on its type and severity. It may involve:

• Observation at home or in hospital.
• First aid treatment, for example stitching of wounds.
• Medication such as painkillers, corticosteroids and antibiotics.
• Urgent hospital treatment including surgery, for example to decompress the brain, remove blood clots, repair damaged tissues or stop bleeding.
• Management of the consequences and complications of traumatic brain injury - there may be long-term disruption of a person’s ability to look after themselves. Physiotherapy, occupational therapy, speech therapy and emotional and other types of support may be needed, for months and sometimes years. Particular complications may need specific treatment – for example in panhypoituitiarism following TBI, hormone replacement therapy may be necessary for an indefinite period.

If brain damage has occurred, there may be long-term disruption of a person’s ability to look after themselves. Physiotherapy, occupational therapy, speech therapy and emotional and other types of support may be needed, for months and sometimes years.