Director, Emergency Services, Bikur Cholim Hospital
Yes, finally someone did a good look into the literature and
confirmed what we felt all along: stress can cause heart
attacks. So it was no surprise when I was sent an article
from a reader about stress being "crippling." Controlling
stress is imperative as not only does it cause heart disease,
but it can lead to impaired immunity and all that goes with
that.
Controlling stress in our lives is extremely difficult. Life
in Israel is stressful enough, and dealing with large
families and money problems can make life even more anxiety
producing.
This column's purpose is not to give strategies in organizing
your life, and reducing stress, but only to warn you about
its effects and to also warn about some outlets that are
used. Smoking, drinking coffee, and drinking are poor ways of
dealing with stress, as well as eating your way out of
anxiety.
We all have stressful times, and an occasional tranquilizer
may be necessary. One should be careful about taking one too
often, but once a week or less often is OK if you live a
particularly stressful life and are not successful in
controlling it.
I was sent a letter about headaches: oh, are these trouble
for the emergency physician. While the public mostly fears a
brain tumor, these are rare in emergency practice because
they are usually a slow boring headache that persists. Most
headaches are nothing serious: tension headaches or
migraines. But the fearsome ones must be ruled out. One is
meningitis — the viral type doesn't have to have fever,
but if the person looks well it is usually benign.
The bacterial one is treacherous. It usually has a high fever
or a low one. In kids it can be a tough call especially if
they are infants or newborns. The diagnosis is made by a
spinal tap and it is treated with immediate antibiotics.
While the test looks fearful and does indeed hurt, it is
absolutely necessary and rarely has any complications.
Because every minute in this disease counts, if the diagnosis
is being entertained, then this is not the time to call your
husband or neighbor for advice.
There is another feared disease, and that is a bleed in the
brain. These are catastrophic events that are usually clear
clinically. Sometimes there is a little leak before the
vessel blows. That presents with a sudden "thunderclap"
headache. If you catch it at this point, a life can be saved.
A CT scan will make the diagnosis 75 percent of the time but
it can miss, so if the diagnosis is being entertained and the
CT is negative, you must proceed with a spinal tap again.
Other causes of headaches that come to the emergency
department include carbon monoxide poisoning, post spinal tap
headache, and electrolyte abnormalities, especially
dehydration. Sinusitis is a common cause and can be dangerous
if it is in the sinus located in the forehead accompanied by
fever. The article sent to me was about a headache in a
person who had a leak of spinal fluid. This is a rare cause
of headaches that is also not going to be recognized in the
emergency department. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. If we are talking about headaches we must speak
about Imitrex, the first and still the standard for headache
treatment. It is available in nasal spray for quick relief,
injection for those who are vomiting, and pills for longer
relief. Consider it for your headache. It works.
