Dr. Google gave me a headache!
It was one of those long evenings, I was looking up at the clock mumbling to myself, last out-patient for the day and I will be done.
An elderly gentleman and his son walked into the consultation room. I recognised the man - I have been seeing his wife for chronic hyponatremia. He said his son wanted to see me.
Son in his mid thirties already looking very impatient for having waited for 2 hours to see me, gave me a bunch of scans and medical records and said he wants the "Diagnosis", he has seen couple of doctors already. Seemed challenging to me. I told him I will do my best to help him.
37 year old gentleman perfectly healthy till 3 weeks ago. One night he was awakened by intense headache mainly on the right side of the head with pain radiating to right eye; severe drilling sensation lasting for about 20 minutes. It was not associated with nausea or vomiting. He had 7 such episodes in last 3 weeks. He said he was terrified about getting the next attack.
Dr. Google gave him the dire diagnosis, he thought he had brain tumor. He had seen a specialist and got the MRI Scan of the brain, which turned out to be normal (no surprises yet) and he was asked to take analgesics for couple of days. He persisted to get the attacks.
I enquired about all the possible triggers like stress at home/work, change in food habits, sleep changes, alcohol intake, caffeine, new drugs used and others. He couldn't pinpoint any specific change. His clinical examination was normal, I looked for surreptitious causes like tooth ache, sinus related and other ENT related problems. Everything was normal.
There are more than 200 types of headache, although that is an overwhelming number, it is broadly classified as primary and secondary headaches. 90% of headache fall into primary type. Primary headaches are benign, recurrent not caused by underlying disease or structural problems. For eg.migraine, tension type, cluster etc. They can cause significant disability but not dangerous. Secondary headaches are caused by an underlying disease like infection, vascular, infection, injury, tumor etc. They can be harmless or dangerous. We physicians rely on certain "Red flags"to differentiate them.
This gentleman had severe intense headache but without any red flags to say it was dangerous. Primary headaches can be diagnosed only clinically and no tests can confirm it. Based on clinical facts I said he possibly had cluster headaches; one of the tell tale symptom being headache was waking him from the sleep. Little trick of the trade, to differentiate cluster from other types of hemicranial headache we give an anti-inflammatory drug called "Indomethacin". If headache improves dramatically then it excludes cluster headache. I told him that will be our plan.
It was time to look at his medical records, my terrified patient had undergone a complete master health check up including a stool test for his headache.His investigations revealed that he was hypothyroid (TSH-11), mildly elevated triglycerides, low vitamin D3 and all others were within normal limits. None of the above investigations can in anyway explain the headache. I enquired if he had symptoms relating to hypothyroid like hair loss, dry skin, constipation, and others.
He said he has been experiencing severe hair loss since last 2 months and was worried he was going to go bald soon. Then he blurts out "Doctor I don't know if this is related but I have been using some medicated gel for hair loss for the last 1 month".
I enquired what was the gel and if it was prescribed by a doctor?
Dr. Google is back in the picture!!!
My patient sincerely asked Dr. Google all about his hair loss and got wealth of information. Dr.Google doesn't forget anything!!
Next time around when my patient was doing some work, advertisement pops out suggesting a magic hair gel for his hair loss and he promptly orders it online and gets it delivered home and starts using it.
The magic hair gel was"Minoxidil"!
Historically, Minoxidil was used as an oral drug to treat high blood pressure. However it had an interesting side effect of hair growth. Now, it is widely used for hair loss although it is an over the counter medicine, it is best used as per the directions of a physician as it has numerous cardiovascular effects. It has very little effect on male pattern baldness especially frontal baldness.To put it bluntly, Minoxidil is a hair loss band-aid, and not a cure; cessation of Minoxidil slowly abolishes the benefits to hair and returns to regular balding patterns.
Minoxidil is known to cause severe headache, it is a less common side effect seen in about 6% of the people using it. One of the mechanisms for hair growth by minoxidil being vasodilatation there by increasing blood circulation and hair growth; similarly in some people same mechanism can cause severe headache just like cluster headaches.
I promptly told him to stop his hair gel. 2 months on no sign of further attacks of headache!! Hair loss is significantly better after starting on thyroid medications.
Dr. Google definitely did not go to a recognised medical school. Choose your doctor wisely!!!!
An elderly gentleman and his son walked into the consultation room. I recognised the man - I have been seeing his wife for chronic hyponatremia. He said his son wanted to see me.
Son in his mid thirties already looking very impatient for having waited for 2 hours to see me, gave me a bunch of scans and medical records and said he wants the "Diagnosis", he has seen couple of doctors already. Seemed challenging to me. I told him I will do my best to help him.
37 year old gentleman perfectly healthy till 3 weeks ago. One night he was awakened by intense headache mainly on the right side of the head with pain radiating to right eye; severe drilling sensation lasting for about 20 minutes. It was not associated with nausea or vomiting. He had 7 such episodes in last 3 weeks. He said he was terrified about getting the next attack.
Dr. Google gave him the dire diagnosis, he thought he had brain tumor. He had seen a specialist and got the MRI Scan of the brain, which turned out to be normal (no surprises yet) and he was asked to take analgesics for couple of days. He persisted to get the attacks.
I enquired about all the possible triggers like stress at home/work, change in food habits, sleep changes, alcohol intake, caffeine, new drugs used and others. He couldn't pinpoint any specific change. His clinical examination was normal, I looked for surreptitious causes like tooth ache, sinus related and other ENT related problems. Everything was normal.
There are more than 200 types of headache, although that is an overwhelming number, it is broadly classified as primary and secondary headaches. 90% of headache fall into primary type. Primary headaches are benign, recurrent not caused by underlying disease or structural problems. For eg.migraine, tension type, cluster etc. They can cause significant disability but not dangerous. Secondary headaches are caused by an underlying disease like infection, vascular, infection, injury, tumor etc. They can be harmless or dangerous. We physicians rely on certain "Red flags"to differentiate them.
This gentleman had severe intense headache but without any red flags to say it was dangerous. Primary headaches can be diagnosed only clinically and no tests can confirm it. Based on clinical facts I said he possibly had cluster headaches; one of the tell tale symptom being headache was waking him from the sleep. Little trick of the trade, to differentiate cluster from other types of hemicranial headache we give an anti-inflammatory drug called "Indomethacin". If headache improves dramatically then it excludes cluster headache. I told him that will be our plan.
It was time to look at his medical records, my terrified patient had undergone a complete master health check up including a stool test for his headache.His investigations revealed that he was hypothyroid (TSH-11), mildly elevated triglycerides, low vitamin D3 and all others were within normal limits. None of the above investigations can in anyway explain the headache. I enquired if he had symptoms relating to hypothyroid like hair loss, dry skin, constipation, and others.
He said he has been experiencing severe hair loss since last 2 months and was worried he was going to go bald soon. Then he blurts out "Doctor I don't know if this is related but I have been using some medicated gel for hair loss for the last 1 month".
I enquired what was the gel and if it was prescribed by a doctor?
Dr. Google is back in the picture!!!
My patient sincerely asked Dr. Google all about his hair loss and got wealth of information. Dr.Google doesn't forget anything!!
Next time around when my patient was doing some work, advertisement pops out suggesting a magic hair gel for his hair loss and he promptly orders it online and gets it delivered home and starts using it.
The magic hair gel was"Minoxidil"!
Historically, Minoxidil was used as an oral drug to treat high blood pressure. However it had an interesting side effect of hair growth. Now, it is widely used for hair loss although it is an over the counter medicine, it is best used as per the directions of a physician as it has numerous cardiovascular effects. It has very little effect on male pattern baldness especially frontal baldness.To put it bluntly, Minoxidil is a hair loss band-aid, and not a cure; cessation of Minoxidil slowly abolishes the benefits to hair and returns to regular balding patterns.
Minoxidil is known to cause severe headache, it is a less common side effect seen in about 6% of the people using it. One of the mechanisms for hair growth by minoxidil being vasodilatation there by increasing blood circulation and hair growth; similarly in some people same mechanism can cause severe headache just like cluster headaches.
I promptly told him to stop his hair gel. 2 months on no sign of further attacks of headache!! Hair loss is significantly better after starting on thyroid medications.
Dr. Google definitely did not go to a recognised medical school. Choose your doctor wisely!!!!