DO YOU HAVE HEADACHES?

The girl in the doctor’s office is not a nurse.  She hasn’t even graduated from college.  She might have taken some courses at a nearby tech school.  This is typical around here.  Stalwart low-pay narrow-focus females. They used to be fry cooks.  She has a list of questions to ask me before I can see the doc, because presumably that will speed things up.

“Do I have headaches?” she asks me?  

I consider what to say.  Yes, no, maybe — what KIND of headaches do you mean?  She doesn’t have those kinds of questions on her list.  This is an eye doc.  She’s expecting an eyestrain tip-off.  What do I tell her?  

Here’s an inventory:  

When I first wake up in the morning, esp. in winter, I had headaches in a sort of fuzzy global way.  I thought maybe carbon monoxide, so I got an alarm.  It’s just little and flashes a tiny light sometimes, but the siren on these things is super-loud.  THAT hasn’t gone off.  This time I got one with a battery.  The last one plugged into an outlet and every time the dirty, often-interrupted, Valier electricity faltered, it blasted me and the cats out of our skins.  An article suggested sleeping with the covers over your head, auto-suffocation.

But sometimes I have that dull ache that comes from not having time to drink coffee or maybe just forgetting.  When I have a hot idea and don’t want to stop, I forget everything, including coffee.  Once I went to stay for a few days with very fancy friends in Hollywood who had a new espresso coffee machine — this was decades ago — and they loved showing it off.  I had one cappuccino after another — I LOVE them.  By the second day my head was throbbing but I couldn't figure it out — typical Californians, they were feeding me decaffeinated coffee.  Along with peach Bellinis, which were “in” that year.  I was a mess.

Then there are those sharp little twists on my parietals — top of the skull — that always make me wonder whether they are little strokes or just muscle twitches or the mysterious “Transient Ischemic Attacks” that are like little clutches that don’t seem to leave damage but might.

Google defines five distinct kinds of headaches:

1.  Tension:  constant ache or pressure around the head, especially at the temples or back of the head and neck.

2.  Cluster:  occur in groups or cycles. They appear suddenly and are characterized by severe, debilitating pain on one side of the head, and are often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face.

3.  Sinus:  fever and pus, infection

4.  Rebound:  too much treatment, now withdrawn 

5.  Migraine:  Nausea, auras, in sequences, family trait

None of these are about eyestrain.  Going to “eyestrain” on Google, I find headaches can be a result of clenching the face around the eyes, not blinking often enough, squinting, not looking away often enough.  None define “ocular migraine” which I have sometimes and which is a result of the build-up of fluid through the eyes which creates pressure on the tissues and bone.  None define “dry eye syndrome” which I now understand that I have and which can also make eyes ache.  A contradictory mix of too much swollen and too much shrunken.

Is a neck ache the same as a headache?  How far down the back of the head does a neck ache begin?  All sorts of causes possible, even placement of the computer screen.  Maybe an abrupt stop, hitting the brakes in traffic a few days earlier, a little whiplash? The City of Portland Human Services people were constantly hiring the kind of young woman now questioning me.  Their questionnaires were all about posture and chair adjustment, accompanied by pesky demands that we change.  The changes only interfered with getting work done.  The truth is that the human body adjusts to the challenges presented, at least most of the time, and then resents having to do it again because of changes.

And then there’s the headache that comes from worry or from a pain-in-the-butt — er, neck.  Is your doc prepared to walk you through that?  One local female “doc”, who is actually a physician’s assistant rather than an MD, claims she’s better than a shrink.  Her role model is Mother Theresa.  That gives me a headache.  (My opinion is quite like that of Christopher Hitchens.)

But these days if you say “headache” and the hospital management is selling the use of big ticket machines to justify their cost, one can find oneself with one’s head in a thing like a washing machine, pounding, and the cost will bankrupt you, insurance or not.  If asked, “do you have headaches?”  best to be evasive.

When the doc asks this sort of a question, he or she watches your face for reaction, maybe asks for more detail, leaves a strategic pause to see if you might say more.  This young helper doesn’t look up from her list.  She got A’s in high school and she didn’t get them by tolerating distractions or considering alternatives.  Check the box or not — it’s a clear choice.  There are two pages of these questions to get through.  

I once managed to preoccupy two mature questioning physician assistants for an entire morning, destroying the clinic schedule, because I answered honestly, which meant at length.  It was supposed to be a free Medicare checkup using a laptop instrument, but ended up costing over a hundred dollars for lab tests they ordered.  They paid no attention to the answers I gave them — just the numbers on the lab readouts, which prescribed what the averaged scores of a multitude of people indicated.  I am not an average.  I go out of my way to avoid the average — above or below, according to which is least effort.

If a person has brain cancer, does one have headaches?  The answer I get is “it depends.”  The dogma is that the brain has no pain receptors so there’s no sensation until the tumor gets big enough to press on or block other structures, like circulatory systems or the skull lining.  But only recently have docs admitted that babies have pain.  They used to operate on them with no anesthetics.  Docs are unreliable because they operate on dogma -- it ought to be called "docma".

In the days of working in Scriver Studio, the foundry/

workshop combination, we knew we could get headaches from volatile substances, esp. the acids, solvents and plasticizers.  Not that it meant we would stop what we were doing.  

https://www.doomandbloom.net/headache-in-austere-settings/  is a website about emergency medicine.  I like that "austere" -- most of my settings are austere.  I hope this is an austere blog post.  It sounds like a relief to me.