This may be a cause of headache in a small child. Very often the child may not be able to
distinguish the source of pain and may complain of a "headache" when he or she has an earache.
The diagnosis is fairly obvious as this type of headache will occur in a small child during a
febrile disease and there may be a discharge from the ear (Figure 1.19(80)).
Extra-Cranial
Glaucoma
This consists in a raised intra-ocular fluid pressure. It is rare before middle-age. It may cause a
headache around or behind the eyes which is easily mistaken for migraine. It is usually worse in
the evening and is accompanied by the appearance of "halos" around lights and blurred vision
(Figure 1.20(81)).
Cervical Spondylosis
This term includes arthritis of the cervical spine or cervical disc degeneration. This causes an
occipital headache with ache extending to the top of the shoulders and neck (Figure 1.21(82)).
There is marked tenderness on pressure on the neck and shoulder muscles.
X-rays of the cervical spine usually show a narrowing of the intervertebral spaces and
osteophyte formation.
Trigeminal Neuralgia
This is an inflammation of one or more of the three trigeminal nerves (which are part of the
cranial nerves). It is usually seen in the elderly. The pain is unilateral and it is usually very
intense lasting for a short time. The pain can occur on the forehead and eye, cheek or temple and
jaw according to the nerve involved (Figure 1.22(83)).
Finally, a word should be said about Western medication for headaches. Of all the various drugs
used for migraine, ergotamine tartrate (Cafergot) is, in my opinion, the most detrimental one. It
not only produces side-effects such as nausea and tingling of the limbs, but, in my opinion, its
long-term use only makes the headaches more frequent. This occurs for two reasons: first of all,
ergotamine tartrate (with a chemical structure somewhat similar to LSD) is a powerful
vaso-constrictor (this stops the acute headache), but vaso-constriction is inevitably followed by
vaso-dilatation which is going to cause the next headache. Secondly, most preparations of
ergotamine tartrate also include caffeine which is also a vaso-constrictor, but, as for ergotamine,
vaso-constriction is only followed by a worse vaso-dilatation. The role of caffeine in headaches
has already been discussed in this chapter (see also note 2). For these reasons, I always advise
patients who take this medication, to come off it if at all possible. There is no danger in stopping
this drug abruptly.