In recent years the early administration of the anti-viral drug Zovirax also appears to reduce the severity of the rash and subsequent pain in this condition, and the related conditions of Herpes Simplex Type I causing cold sores, and Type II which causes genital herpes.

Another new medication is a cream which contains capsaicin — a derivative of chili peppers — which appears to selectively exhaust substance P, a pain-causing natural chemical in the nerve endings. This cream, known as Capsig in Australia, must be applied at least 3-4 times per day for periods of up to 3 months to be of any long term effect.

Physical therapy may be of use in the early stages of the disease. Accordingly, acupuncture and perhaps TENS may have a role in the early treatment of post-herpetic neuralgia.

*76\37\8*

Such splitting of the mind and body is impossible, as any successful healer knows.

The ‘nobody will touch me’ game sounds as if it’s a patient-directed one. But this has been found to be rare. Despite much talk about doctors wanting their patients back from specialists, neurosurgeons and pain specialists, they do not go about it in a way that will achieve this. Some doctors treat patients who have major neurological problems like lepers. This can often happen with those suffering intractable pain and those who are failures of traditional medical and surgical therapy, and patients with implanted stimulators. (Implanted stimulators include dorsal column stimulation,in which wires are placed inside the vertebral column to directly stimulate the spinal cord to produce pain relief.) This is an extremely expensive, and sometimes painful, procedure which often fails to produce pain relief for more than six months.

*53\37\8*

A stress may be congenital, muscular, immunological, infectious, neoplastic, chemical, degenerate, emotional, psychological, or even environmental, such as accident or shock.

Why the pressure’s on

Unlike our ancestors, who picked up a rock and hurled it at a menacing animal, it’s a lot harder for a New Technology tribe member to pick up a computer terminal and hurl it at the menacing deadline pressures, at a tyrannical boss pacing up and down for a late report, to hit back blindly at creative burnout when a sales strategy/adver-tising campaign for a truly awful product is demanded.

*32\37\8*

Each individual learns the application of the word through experiences related to injury in early life. In an earlier definition of pain Dr Harold Merskey, the Canadian psychiatrist working in the pain area, drew attention to the fact that pain was almost always associated with some form of visible or audible behaviour. Califor-nian psychologist Richard Sternbach had already proposed that pain had three components: a component pointing to the pain source as a harmful stimulus signalling possible tissue damage: a pattern of responses permitting recognition of the pain by an observer; and, finally, the subjective or private feeling of hurt.

*9\37\8*

Some people are allergic to tobacco smoke, and can get severe headaches when in smoky atmospheres. This effect seems to be allergic rather than pharmacological, so even a small amount of tobacco smoke will be enough to trigger a headache. The only true remedy here is to avoid smoky conditions.

Detailed methods to help you give up smoking are beyond the scope of this book, but the essence of them all is will-power. All the aids to stopping smoking will be completely useless if you don’t try – hard! (And it is hard, too.)

Complementary treatment

Tobacco smoke is toxic because of the tars (cancer-causing substances), nicotine (artificial stimulation) and carbon monoxide. Smoking also increases the risk of heart disease, stroke, bladder disease and cancers of the stomach and the neck of the womb.

Regular exposure to smoke depletes the body of Vitamins A, B, C and D, as well as bioflavanoids and zinc. Do ensure that you are getting adequate quantities in your diet; if you are a heavy smoker you may need supplementation.

Acupuncture can help to relieve the pain of tobacco-induced headaches, and, if you are a smoker, help you to give up. Oats, skullcap and valerian will help deal with the headaches caused by exposure to tobacco smoke. A combination of colt’s foot and plantain can be given to clear out the respiratory system after stopping.

Bach flower remedies can help deal with negative emotions while trying to give up smoking; for example, there is impatiens for impatience and irritability; gentian for despondency, and cherry plum for uncontrolled, irrational thoughts. Controlling your emotions will prevent them building up to become another cause of headaches. For irritability, B-complex vitamins. Niacin can be used under a doctor’s supervision to detoxify the body.

There are numerous homoeopathic remedies available to help with headaches caused by tobacco withdrawal, passive smoking, and oversmoking.

An aromatherapist might suggest massage with anti-depressant oils like bergamot, camomile, clary sage, jasmine and rose. Detoxifying oils, used in the hath or the vapouriser, include fennel and juniper. All are useful for headaches caused by smoking, even passive smoking.

Reflexology offers a programme to help you give up smoking.

*137\20\2*

Why does PMS occur? There are many theories, most of which revolve around imbalances of the female hormones. Note that word ‘imbalance’; there isn’t an absolute amount of each hormone that needs to lx’ present, but a relative balance between them. The honest answer is that we don’t yet know precisely why PMS occurs.

Orthodox treatment

One of the most potent ways to help sufferers of PMS is to make sure that both the patient and her family realise that they are dealing with a physical illness. The trouble with PMS is that sufferers feel that they’re going mad. for women to recognise the fact that it’s PMS, and to understand that her partner and her family also know that it’s PMS, is a great relief.

Water retention is a common symptom of PMS. Certainly, giving a mild diuretic (a drug that encourages the kidney to excrete more fluid) often gels rid of PMS symptoms, especially bloating, weight gain and breast tenderness. Vitamin B6 is also used in PMS, taken in doses of about 50mg-100mg per day. There is as yet no completely objective evidence that it works, though many doctors use it. Vitamin B6 is thought to exert its action on the brain, possibly by affecting the way in which the pituitary gland releases the hormones which control the female cycle. However, Vitamin B6 can cause inflammation of the nerves if given for long periods and especially if used in high doses, Evening Primrose Oil may help in some cases. Its active constituent, gamolenic acid, is now available on prescription.

As far as hormone treatment of PMS is concerned, one of the most helpful methods is to take extra progesterone in the week before the menstrual bleed starts. Progesterone is normally released from the ovary during the second half of a cycle, and the extra progesterone in tablet form boosts its effects. In severe cases it may help to add progesterone for two or even three weeks leading up to the period. Extra oestrogens, which must be used with extra progesterone (see below) can sometimes improve pre-menstrual symptoms. Oestrogen and progesterone together make up the combined contraception pill, so putting the patient on the contraceptive pill could help. Sometimes the preparations used in hormone replacement therapy (HRT) can also be used to boost the levels of oestrogen and progesterone in PMS.

Bromocriptine can reduce pre-menstrual breast pain, but it’s not appropriate if you’re planning a family.

Some types of painkillers such as mefenamic acid help reduce PMS symptoms, and relieve the pain of any headache directly. The drugs in this group are of a type often used to reduce inflammation in rheumatism and other musculo-skeletal problems. Anti-depressants may also be of use in some cases of PMS, especially where there are psychological symptoms such as anxiety or depression.

Self-help

Acknowledging that you are a PMS sufferer is a great ’step forward. It doesn’t mean that you’re hiding behind a convenient syndrome.

Diet can sometimes help. Follow the rules of low-fat, high-fibre, low-sugar diet, with lots of fruit and vegetables. Cut down on caffeine and alcohol, which will encourage mood swings. Keeping your sugar level as constant as possible may help; in some cases changing to a three-hourly starch diet, which includes lots of unrefined carbohydrates, will also make a difference. However, you’ll have to make sure that your total daily intake doesn’t rise and cause you to gain weight.

Complementary treatment

If you suffer from pre-menstrual craving for sweet things, a chromium supplement might help – this is because chromium is linked to our insulin levels, and this in turn controls the amount of sugar in our bloodstream.

Sometimes reducing fluid and/or salt intake before the period may lessen the sensation of bloating.

Relaxation and exercise, which both reduce tension, will help alleviate symptoms.

A supplement of Vitamin B6 can be helpful, starting two days before your symptoms normally begin and stopping just after your menstrual cycle has started. Evening Primrose Oil works for some women, taking it alongside Vitamin B6. Note that Evening Primrose Oil can cause fits in those suffering from temporal lobe epilepsy, so beware.

Acupuncture can help with many symptoms, including bloating (by helping the body eliminate excess fluid), cravings (by suppressing your appetite), mood swings (by calming your nervous system), painful breasts and headaches (through various methods of pain relief and reduction). Obviously, when the other symptoms of PMS are relieved, a great deal of pressure may be lifted from the sufferer. Simply controlling mood swings can provide relief from headaches by making the patient feel she is back in control of her own body – and that’s a good starting point for banishing emotionally linked stress.

Aromatherapy has much to offer PMS sufferers. Geranium and rosemary are said to help prevent water retention. A head, neck and shoulder massage with lavender, sandalwood, camomile or geranium helps to relieve tension and relax the muscles, in the case of headache. Geranium, bergamot, rosemary and lavender (singly or in a Mend) may act as stimulants to overcome lethargy and tiredness. Cold lavender compresses can relieve painful breasts. Where muscle tension is a feature, any of the manipulative therapies are likely to help.

Homoeopathy will work, best if remedies are prescribed according to your specific symptoms – or group of symptoms. In general, however, lachesis and nat mur are used to relieve water retention; mood swings can be treated with kreasote, lycopodium and causticum; sore breasts may be relieved by Pulsatilla.

The clinical intuitionalist might suggest some of the following. Vitamin B6 acts as a mild and natural diuretic, as does Fenugreek lea or dandelion root coffee. A low-fat, low-sugar, low-salt diet (as above) should he implemented, especially the week before, and the week of, your worst symptoms. Supplements of Brewer’s yeast and adrenal glandulars can help with cravings and mood swings (included anxiety and depression). A calcium, supplement, taken along with evening primrose, is said to reduce headaches by restoring the hormone balance between oestrogen and progesterone.

In terms of medical herbalism, you might try coughgrass and cleavers, drunk as a tea, which acts as a diuretic. Gentian can control blood-sugar levels; skullcap or oats can control mood swings; camomile, peppermint or feverfew can reduce headaches by improving circulation and relieving tension; and chaste tree or white deadnettle are said to improve the circulation, reducing congestion and pressure.

Royal jelly is also said to be helpful. Reflexology and biofeedback are also often recommended.

*94\20\2*

Some of the reactions we get to chemicals are caused by a direct effect of the chemical on the body. The effect may be related to the dose we receive – a pharmacological response. In other cases the reaction is allergic. This works by a completely different pathway, with the offending substance triggering off the body’s immune system. In this case you get a maximum response for anything other that the tiniest dose.

Although pharmacological and allergic responses work through completely different routes, treatment is much the same. The only difference between the two is that it will be harder to completely remove something to which you are allergic, because even tiny amounts of the offending chemical may trigger symptoms.

Let’s look at some of the more common sources of chemicals that can cause headaches.

*129\20\2*

The weak link in the chain is the canal connecting the ventricles with the outside of the brain. If this is obstructed, CSF cannot get out from the inside of the brain. Unfortunately, this fluid continues to be formed, gradually increasing the pressure within the brain, blowing it up like a balloon. This condition is called hydrocephalus, commonly known as ‘water on the brain’.

Conditions that obstruct the outflow of CSF include a congenital narrowing of the drainage channel; a tumour pressing on the channel; or, after meningitis, which scars the canal so that it become blocked and can no longer drain CSF properly.

Hydrocephalus is a disease which affects those at the extremes of life. It is common in young children because they are more prone to those conditions which obstruct The outflow canal. These are congenital malformations, meningitis and brain tumours. Hydrocephalus also occurs in adults, but is significantly different from that in children. Most childhood tumours are tumours of brain tissue itself, whereas in adults many tumours are secondary growths spreading from other parts of the body. Hydrocephalus in adults gives severe headaches, with vomiting and confusion. Again, the skull is unyielding, and the brain tissue is severely compressed by the rise of pressure. Treatment is difficult. If by any lucky chance it is due to a benign tumour obstructing the outflow canal then it can be removed, but often hydrocephalus in adults occurs from inoperable malignant tumours.

Benign intracranial hypertension

Benign intra-cranial hypertension is a permanent rise of pressure within the CSF, but without any obstruction of the drainage (outflow) canal. It is more common in obese women; occasionally it occurs following pregnancy or miscarriage; it can also be related to brain infections and mild head injuries in certain people.

Ultra-cranial hypertension causes generalised swelling in the brain, due to the presence of excess water, a condition called oedema. Its symptoms are very similar to the effects of hydrocephalus in an adult – there is headache, vomiting and impairment of consciousness.

Benign intra-cranial hypertension responds well to steroids and they can often keep it completely under control.

Lumbar puncture headache

The brain floats inside the skull – moored in the cerebrospinal fluid (CSF). If CSF is drawn off, then the brain tends to sink down inside the skull, pulling on its moorings – and this is exceptionally painful.

Normally, of course, this doesn’t happen. However, when a lumbar puncture is performed some of the CSF fluid is drawn off. This causes the brain both to tug on its moorings and also to swell slightly to make up for the fluid that has been drawn off. This hurts. It is quite common for a headache to develop for twenty-four hours, following a lumbar puncture, while the body is replenishing the level of CSF. During this time the patient is encouraged to lie still and Hat (he usually wants to) and the headache is usually lessened if the patient stays in this position, lying in bed.

*117\20\2*

The pain of a true coital headache is a sharp, one-sided, sudden onset, explosive pain which lasts anything from a few minutes to a few hours.

What else could it be?

There is no one disease called ‘headache during intercourse’; headaches with intercourse could be any one of the conditions that have been outlined above.

Because a severe, sudden onset of head or neck pain occurring for the first time at intercourse could be due to a sub-arachnoid haemorrhage you must get medical help immediately. On the other hand, if you’ve already had headaches with intercourse, and this is just another of the series, then it is unlikely to be a subarachnoid haemorrhage.

Headache with intercourse is often due to (or made worse by) tension headache, and, depending upon the sexual techniques used and the position of the neck, it might also be related to previous neck or hack injury, or neck muscle spasm., especially if the head is held in an abnormal position for some time. In particular, bending the head back for any length of time can induce severe neck pain of the muscle spasm variety. The distinguishing features of tension headache, neck injury and neck muscle spasm are that there is often a previous history of injury to the neck, local tenderness of the neck or its muscles, stiffness on bending the neck to the side, and the neck muscles can often be felt in spasm.

*104\20\2*