Dawn R. Ball, DNP

• 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 injection and aspiration are techniques that involve inserting a needle connected to a syringe directly into the joint. Aspiration involves the removal of excess fluid, and injection is the placement of medication directly into the joint space via the needle. Both procedures may be performed at the same time. In both cases a local anesthetic may be used, the skin will be cleaned and disinfected, and then the needle will be inserted. In some cases, especially if the injection or aspiration is in a large and deep joint such as the hip or spine, ultrasound may be used to guide the needle to the exact location desired.

In some cases, irritation to the joint can cause fluid to build up so significantly that the joint hurts and can no longer move well. Aspiration removes some of the excess fluid and relieves the pressure. In addition, aspiration can be used to provide a sample of joint fluid if it needs to be examined microscopically for the presence of white blood cells, bacteria, or crystal formations.

Certain injuries and diseases that affect joints are inflammatory in nature, such as rheumatoid arthritis, tendonitis or gout. These diseases may be helped by the local injection of anti-inflammatory medications directly into the affected joint. In this case, corticosteroids such as methylprednisone are usually used. Relief from the pain may be felt right away and may last for weeks or even months.

In some cases, such as with osteoarthritis, the cartilage buffer between the two bones wears down and pain comes from bones rubbing against each other. In this case, injection of a lubricating agent such as hyaluronic acid may be beneficial. It provides a slippery cushion between the bones to relieve pain that can last for months.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.