Your child has a headache? Hold off on the pills
There were, at the last count, 150 types of headache usually readily distinguished one from another – tension, migraine, cluster, hypnic, hemicranial, exploding etc – by their characteristic symptoms.
The situation is rather more problematic with children, for while headache is an almost surprisingly frequent complaint, the description tends to be more non-specific and can vary from one episode to the next.
Most with recurrent headaches end up with a diagnosis of migraine for which the favoured remedy is paracetamol or ibuprofen plus one of the anti-migraine triptan drugs.
Prevention would be better still, and there are a range of options, including, more recently, the (admittedly costly) topiramate, demonstrated in several clinical trials to reduce the frequency of migraine episodes by at least a half, and for some, abolishing them.
That would seem worthwhile, but topiramate, it turns out, is (yet another) cautionary tale about the possible unreliability of the evidence for commonly prescribed drugs. Earlier this year, Dr Andrew Hershey of the Cincinnati Children’s Headache Center reported in the New England Journal of Medicine that, in contrast to the very favourable findings of the drug company’s sponsored clinical trials, his large-scale and independently funded investigation was terminated early on the grounds of “futility”, when it became apparent early on that topiramate was no better than a placebo.
To be sure, the placebo effect was impressive, reducing headache frequency from 11 to five episodes a month. That would imply there must be a strong psychological component to childhood migraine (if indeed it is such).
Thus, rather than reaching for the prescription pad, doctors might do better to consider other options – such as cognitive behavioural therapy, emphasising relaxation and coping and distraction strategies.
The benefits of this nonpharmacological approach are astonishing, almost unbelievably so, where the combined results of 14 studies show it to be nine times more effective in reducing headache frequency, compared with standard medication.
“The advantages of using CBT as the mainstay treatment for childhood migraine are manifold,” observes Dr Qin Xiang Ng of the University of Singapore. “It should be offered as the first-line treatment, and not just an add-on if drugs prove ineffective.”
Baffling blotches
This week’s medical query comes courtesy of Mrs JC from Guildford, who, for several years now, has developed spontaneous blotches like love bites on her upper chest, neck and around her eyes. They are painless, resolve spontaneously and are not associated with any other ill-effects. When present, to conceal them, she has to resort to “wearing sunglasses when there is no sun, and a scarf, even when it is boiling hot”. The several doctors she has consulted are apparently baffled as to what the explanation might be, and she would be more than interested to hear whether others might be similarly afflicted.
Hairdryer cure
Finally – and further to the therapeutic advantages of hot air from the hairdryer over a towel when drying sensitive areas in those with the remorseless itch of pruritus vulvae and ani – a reader recalls from his Army days the doctor commending the same as a cure for his chronic athlete’s foot. And, too, for Dhobi’s itch of the groin, also caused by a fungal infection that flourishes in moist areas of the body.
“Much more satisfactory than antifungal cream,” comments a reader from Hereford.
As for the further benefits of a hairdryer in curtailing the discomfort of insect bites, another reader claims the tip of a lit cigarette is similarly effective. When stung recently, he borrowed his wife’s cigarette and, “to her horror, applied it as close to the sting as I could bear” – with immediate and gratifying results.
The placebo effect reduced headache frequency from 11 to five monthly episodes
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