Try yoga to get rid of chronic headache
‘The cause of these paroxysms is unknown, though in some it may be psychosomatic’
Those prone to recurrent headaches resort to complementary (or “alternative”) medicine more frequently than any other group – although this has always been something of a lottery. There are so many different types of headache (migraine, tension, chronic, cluster etc) and such an abundance of forms of complementary therapy (acupuncture, massage, homoeopathy, naturopathy and so on) that the chances of any individual finding the “right” treatment for their particular condition must be fairly random.
To their credit, complementary practitioners have made considerable effort to clarify this situation, so a recent comprehensive review of the outcomes of the many clinical trials comparing their therapies is of considerable interest.
The highlights, briefly, are as follows. For migraine, acupuncture is the complementary “treatment of choice” – as effective as the standard drugs in reducing the frequency and severity of attacks. Manual therapy (spinal manipulation and massage) is predictably favoured for tension headache – though a third of patients will experience transient effects of dizziness and neck pain. Yoga is the best all-purpose treatment in alleviating most forms of chronic headache, while the benefits of naturopathy are equivocal. Useful to know.
White coat anxiety
The merits of an automatic home blood pressure machine in reducing the need for medication and its untoward effects, as recently mentioned in this column, has generated much interest. “I started the year taking three different anti-hypertensive drugs,” writes one gentleman. He is now down to taking just one (Amlodipine) at a reduced dosage, and only every other day. “I have been on this regime since July and only rarely has my systolic pressure been higher than the recommended 140,” he adds.
This variability (or lability) of blood pressure – raised when taken in the surgery or clinic, normal when measured at home – is attributed to the anxiety associated with seeing the doctor; so-called “white coat hypertension”. It is, however, undoubtedly compounded by the tendency of busy doctors to save time by taking just a single measurement. The more accurate (and correct) method adopted by this reader is to take three consecutive readings over a period of 10 minutes, discard the first and calculate the average of the remaining two.
That is all pretty straightforward, and there is no better Christmas present for a spouse or loved one taking antihypertensives than to give him or her one of these very useful machines. More problematic is the situation where periodically the blood pressure suddenly, and for no apparent reason, shoots up to 200/110 or more – often with alarming symptoms such as headache, chest pain, palpitations and so on. This is known as “paroxysmal hypertension” and may very rarely be due to a benign adrenalin-secreting tumour (phaeochromocytoma) warranting surgical removal.
For most, however, the cause of these “paroxysms” is unknown, though it is suggested that in some it may be a psychosomatic response to past trauma. They are, perhaps surprisingly, not intrinsically dangerous and often resolve spontaneously over an hour or so. Those wishing to know more should google and download “Severe paroxysmal hypertension” by Prof Samuel Mann (Hypertension journal 2016).
The horse’s mouth
Finally, the upper lip squeeze technique for terminating nocturnal leg cramps has put a couple of readers in mind of its equine equivalent. Seeking to calm an anxious horse, vets and owners resort to “the twitch” – a stick with a loop of rope at the end through which the horse’s upper lip is passed and then tightened like a tourniquet.
“This might sound very unkind,” writes one woman, “but the horse almost immediately falls into a trance like state and raises no objection to being shod or having an injection.”