Dr. Michael Joseph Cruz, MD

• Migraines: one of the most prevalent types of headache, migraines typically last from two hours to three days, causing a throbbing pain on one side of the head. Nausea, sensitivity to bright lights, fatigue, and blurred vision all may accompany migraines. While migraines have no known cure, medications and lifestyle modifications may ease symptoms. Avoiding behaviors that may trigger migraines such as lack of sleep or loud, repetitive noises can improve headaches.
• Tension headaches: also known as stress headaches, these headaches are characterized by pain in the upper top part of the head and behind the eyes. Tension headaches are common and have no exact cause; however, certain practices may increase the likelihood of developing them. For example, wearing one's hair up in a tight hairstyle or wearing a restrictive hat can put pressure on the scalp, leading to a tension headache. Other causes of tension headaches may include alcohol or nicotine use, caffeine, teeth grinding, stress, overexertion, and eye strain. Some people find posture improvement, alternating sleeping positions, and neck exercise can alleviate tension headaches. Over-the-counter pain relievers such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve) may also reduce tension-headache pain.
• Sinus headaches: this type of headache causes pain in the sinuses, but may progress to pain and pressure in the eyes, forehead, and cheeks. These headaches are often accompanied by nasal congestion, fatigue, and ache in the upper teeth and may or may not be caused by sinus infections or sinusitis (sinus inflammation). Some sinus headaches are allergic headaches, which arise from allergic triggers such as seasonal allergies (pollen allergies) or hay fever, causing sinus pressure and facial pain. Other symptoms of allergic headaches include nasal congestion, irritated or watery eyes, runny nose, and sneezing. Allergic headaches may be treated with antihistamine medications such as cetirizine (Zyrtec). Allergic headaches are common during pollen season, which is usually around springtime.
• Cluster headaches: these headaches occur suddenly and cause stabbing, sharp pain from one eye down to the one side of the neck. They are often referred to as the most aggravating and painful type of headaches. Other symptoms of cluster headaches include nasal congestion, droopy eyelid, and enlarged pupil on one side of the face. In the past, it was widely believed that cluster headaches were caused by a bevy or "cluster" of multiple types of headaches, such as a combination of an allergic headache and a tension headache. Medical experts now recognize that cluster headaches are a separate and unique form of headache. Cluster headaches last for around twenty minutes to two hours. They may recur throughout the period of a day or several weeks, but usually dissipate within a month. Treatment for cluster headaches includes over-the-counter pain medications such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve). Prescription Prednisone can help with swelling and Verapamil may reduce pain by relaxing the blood vessels.

Living with headaches is challenging; headaches can prevent people from fully enjoying life. Medical treatment and care in avoiding certain triggers can help those with headaches begin to feel normal once again.

Both hypothyroidism and goiters are caused by an autoimmune reaction where the body produces antibodies that attack the thyroid cells for unknown reasons. The thyroid reacts by releasing too little or too much T3 and T4 thyroid hormones, impairing thyroid function and causing irregular metabolism. Goiters develop from the autoimmune reaction causing continued antibody damage to the thyroid over time. Thyroid goiters are large, swollen lumps that can be felt near the base of the neck. Obstructive goiters can cause pain, coughing, and abnormal breathing. Hypothyroidism may also be caused by iodine deficiency, as iodine is needed to produce thyroid hormones.

The exact cause of thyroid cancer and thyroid nodules or cysts is unknown. While thyroid cancer and thyroid nodules or cysts can occur in individuals with thyroid disorders, they are not associated with a malfunctioning thyroid.

Physicians may prescribe thyroid surgery if blood tests reveal patients' thyroid stimulating hormones (TSA) are outside of the acceptable range, indicating a malfunctioning thyroid. Thyroid biopsies (tissue samples) and tests for thyroid-attacking antibodies are also criteria for surgery.

An ENT or general surgeon performs thyroid surgery. While a patient is placed under anesthesia, the surgeon makes an incision at the center of the neck and removes the thyroid gland. Two alternative methods of thyroid surgery are transoral (incision through the mouth) and endoscopic, where a surgeon operates a video camera for live footage to help guide the removal process.

Thyroid surgery requires minimal aftercare. Most patients recover quickly and resume normal activities within a few days of surgery. However, thyroid surgery patients must take daily synthetic thyroid medication (levothyroxine) for life to replace their removed thyroid.

Tonsillectomies are usually performed on children; however, many adults also undergo the procedure. A tonsillectomy generally only lasts for about half an hour following the administration of anesthesia. The otolaryngologist (ENT) or surgeon performing a tonsillectomy may employ a variety of medical techniques, such as:

• Cold Knife Dissection: A cold knife dissection is the most popular tonsil removal method. A surgeon removes the tonsils using a steel scalpel and repairs the region with sutures (stitches) or electrocautery (high heat) to stop bleeding. This technique is favored for those with obstructed breathing.
• Electrocautery: Other tonsillectomy methods include a full tonsil removal by electrocautery, where the surgeon uses a high heat device to burn off the tonsils and cauterize the bleeding tissue. Electrocautery is more painful than cold knife dissection.
• Harmonic Scalpel: A third technique is where the surgeon uses a harmonic scalpel (vibrating bladed device) to first cut off the tonsils, and then coagulate bleeding using the harmonic scalpel's heat and vibration. Harmonic scalpel is the most precise form of tonsillectomy.
• Radiofrequency Ablation: To perform the radiofrequency ablation technique, the surgeon places small probes into the tonsil that transmit radiofrequency energy to the tonsil tissue. The delivered energy damages and scars the tonsils, gradually minimizing the tonsils' size. Unlike the other three methods, radiofrequency ablation is performed in-office with or without general anesthesia and has minimal recovery time. Patients can expect to return to daily activities nearly immediately and may receive radiofrequency ablation every few months. While radiofrequency ablation does reduce tonsil inflammation, it is not often prescribed to those with severe tonsillitis or breathing disorders.

Patients are typically able to return home shortly after having their tonsils removed. Tonsillectomy recovery time may range from around ten days to two weeks. During this time, it is common for patients to have a sore throat, neck pain, and a hoarse voice. Patients are advised to consume soft foods such as ice cream and applesauce to avoid further throat irritation. After recovering from tonsillectomy, many patients experience improved breathing, reduced irritation, and an overall improved quality of life.