Day 107 - Temporomandibular joint disorder (TMJ)

“Temporomandibular joint disorder (TMJ, TMJD or TMD) affects the temporomandibular joint, an area that includes the hinge jaw joint (the bridge for the lower jaw or mandible) and the temporal bone of the skull located in front of each ear, the muscles surrounding the jaw and the jaw itself.

The most common factor contributing to TMJ is a bite problem affecting the joint itself. Interferences in the structure of individual teeth may force displacement of the lower jaw, leading the muscles to position the joints out of their sockets to force the upper and lower teeth to fit together. Anatomical factors within the joint or surrounding muscles (such as the presence of scar tissue) may also interfere with the bite and cause TMJ disorder.

People with TMJ may experience severe pain and discomfort in the face, jaw joint, neck and shoulders. You may also experience swelling on the side of the face, toothaches, headaches, neck aches, earaches and hearing problems.

The pain and discomfort caused by TMJ disorder may be severe, can be either intermittent or constant and may last for many years.”*

*http://www.yourdentistryguide.com/tmj/

My mother is convinced my headache is related to TMJ. TMJ symptoms are often mistaken for migraine headache, sinus trouble, ear infection, or toothache.

During the dental consultation, the dentist evaluated the possibility of having TMJ through electrical nerve stimulation. She placed some adhesive pads over my jaw joint which transfered data to a computer monitor via a tracking devise. For 45 minutes an electric-shock like pain was produced, stimulating my facial muscles and causing my jaw to jolt.

The hyperactivity of the face and of my jaw muscles was recorded to determine whether or not the jaw is in a strained position.

The entire test lasted a grand three hours. I explained that I do not grind my teeth at night, and do not have difficulty when chewing.

At the end of the consultation, the dentist determined that no structural disorder exists. Despite this, she prescribed a mouth guard to reduce the possible effects of tooth grinding and clenching.

She explained that the appliance would also possibly help improve my bite and the ability for the lower jaw to fall properly into the temporomandibular joint socket.

Following the appointment, it seems evident that my jaw is not causing the problem, but I have nothing to lose by wearing the guard at night. I might as well give it a go.

Day 103 - Kinesiology

"Kinesiology (pronounced kin-easy-ology) primarily uses muscle testing to gather information about the body's physical, chemical and emotional function and identifies any imbalances. In doing so, kinesiology can then aid the body's natural healing process by helping to correct these imbalances.

Kinesiology proposes that each muscle has a connection to an organ and also to energy that flows around the body through pathways (known as meridian channels). If a muscle test highlights an imbalance in the muscle, there could be stresses placed on the related organ and a blockage in the flow of energy. This affects a person's physical and emotional well-being.

American chiropractor George Goodheart is considered the father of kinesiology. In 1964, Goodheart proposed that muscle testing can be therapeutic as well as diagnostic. His 'Applied Kinesiology' used muscle testing methods and also utilised the Traditional Chinese Medicine philosophy of meridian channels. Goodheart's kinesiology system uses correctional techniques, massage and nutritional advice to create a holistic therapy."*

*http://www.gotosee.co.uk/therapies/Kinesiology.htm

The osteopath emailed me the other day, reassuring me that I am “not in the age group for this [fibromyalgia] condition”.

Although it has become apparent that I do not have fibromyalgia, the initial shock of possibly having the illness has really affected me. As a result, I feel hurt and let down by him and am therefore more than happy to move on and go ahead with another treatment.

A very close friend told me that her boyfriend suffered from a persistent headache for over one year when he was only 16. He did innumerable blood tests, scans, and saw doctors who were reputedly amongst the best in the UK. The story sounded familiar.

He eventually managed to fight his headache through kinesiology.

This morning I went to see his kinesiologist, who he zealously recommended.

Once again, I recounted what I have been through in the past few months. I was relieved when I was cut short and asked to lie on the bed.

Just the thought of recounting what I have done or who I have seen due to the headache is exhausting. Furthermore, the story gets longer and more complex as time goes on.

The kinesiologist worked on my back and explained I had two vertebrae out of place. I was surprised the osteopath hadn’t noticed, as a misplaced vertebra - let alone two - is not exactly something easy to overlook.

He then ‘muscle tested’ me, whereby he examined which internal organs were weak, or not functioning properly, by making me exert pressure on my arm or leg muscles.

“Each muscle is related to an internal organ”, he explained to me. “When your arm or leg weakens as I exert pressure on one of your organs, your body is telling me it is weak and needs strengthening. Basically, that part of the body needs help.”

The kinesiologist believes my headaches are somehow related to my gut.

He has suggested taking some supplements to correct and alleviate the headache, including Vitamin C, lactose free probiotics and oil supplements.

Day 92 - Fibromyalgia

"FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the fibrous tissues in the body.

The pain comes from the connective tissues, such as the muscles, tendons, and ligaments. FMS does not involve the joints, as does rheumatoid arthritis and osteoarthritis.

Most patients with fibromyalgia say that they ache all over. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with fibromyalgia, but it shows up in people of all ages.

Musculoskeletal pain and fatigue experienced by fibromyalgia syndrome patients is a chronic problem, which tends to have a waxing and waning intensity. There is currently no generally accepted cure for this condition. According to recent research, most patients can expect to have this problem lifelong.

Patients with fibromyalgia syndrome do not become crippled with the condition, nor is there any evidence it affects the duration of their expected life span. Nevertheless, due to varying levels of pain and fatigue, there is an inevitable contraction of social, vocational activities which leads to a reduced quality of life."*

*http://www.ukfibromyalgia.com/what-is-fm.html

I went to see the osteopath again today for my second session. He is also a psychotherapist.

He asked if there had been improvement after our first session and I told him unfortunately nothing had changed.

I explained my mother suffered from terrible migraines and also had fibromyalgia.

He explained that, from a psychological point of view, there is a possibility that I may be trying to alleviate my mother’s pain thereby inflicting it on myself.

He then told me that my headache may be the first symptom of fibromyalgia.

The possibility of having fibromyalgia sounds fatuous but it is nonetheless plausible. I do not suffer from the symptoms of the illness (I ‘only’ have a constant headache), and most people do not get it until they are older anyway.

I am nonetheless very upset and terrified about possibly having it. Having lived with a fibromyalgia sufferer - my mother -, I dread to think of what my life will become should I be inflicted with this illness.

I left the clinic feeling dejected, wretched and, all in all, very depressed.

Day 88 - Trapped Nerve

"Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.

Nerve Pain (Neuralgia, Neuropathy, Neuritis), is a type of pain which originates from the peripheral and/or central nervous system. The source of the pain is commonly due to the nerve being trapped, compressed, or pinched, and less commonly due to some other disease process affecting the nerve.

The term "trapped nerve" refers to a condition in which a nerve is compressed or pinched. This causes pain, numbness, weakness or other symptoms. There are many sites and causes of nerve compression, including:

* A disc in the back or neck — Spinal discs can bulge or tear, pressing on nerves as they travel to and from the spinal cord; sciatica is a common example of a "trapped nerve" that may be due to disc disease.
* Arthritis in the wrist — The median nerve travels through the carpal tunnel, a tight space in the wrist that is easily compressed by swelling in the joint.
* Enlarged tissues — Growth of a lymph node, an abscess (an infection) or a tumor can compress a nearby nerve.
* Injury - A nerve can be compressed by swelling, fracture, or bleeding following trauma; simply leaning on your elbows can compress the ulnar nerve that travels just under the skin."*

*http://en.wikipedia.org/wiki/Neurology
http://www.painclinic.org/nervepain-introduction.htm
http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100198110

A tall, slight, well-disposed man greeted me with an amicable smile. I took an immediate liking to the neurologist, and felt at ease when recounting what I have been through with my headache.

He attentively listened and asked me to lie on the bed.

I confided my (what may sound ridiculous) fear of possibly having a brain tumour.

He told me it is highly unlikely that my headache is due to a brain tumour, given my young age (I am only 24). He also explained that the first signs of having a brain tumour are - interestingly - not headaches, rather loss of coordination and confusion.

He carried out the usual routine examination. Everything was normal.

In the past few days my back and neck have been stiff and sore, and the doctor appeared to be sure it must be a trapped nerve.

I explained that I am currently seeing an osteopath; he enthusiastically supported this, and encouraged me to carry on with more sessions.

He also suggested soaking in a hot bath every evening, and recommended wearing hot patches on my neck.

Although the neurologist is virtually sure nothing will show up, he booked me in for an MRI scan, for peace of mind.

Day 86 - Headache Specialist

"There are several different types of headache. The main types are:

* Tension headaches (also called stress headaches, muscular headaches) - a mild to moderate headache that may last minutes or days and tends to recur. The pain is fairly constant and felt in both sides of the head and neck as a pressure or tension. Most importantly, exercise doesn't make it worse and there are no additional symptoms such as nausea.

* Migraine (see Day 4 - Migraine post.) - symptoms can be variable, and there are several different types of migraine , but this is usually a moderate to severe one-sided headache that pulsates or throbs. Importantly, it gets worse with activity and there are additional symptoms, particularly nausea and vomiting, diarrhoea and an increased sensitivity to noise, light or smells. Some people experience an aura (symptoms such as flashing lights) before the headache.

* Cluster headaches - frequent, short-lived (less than an hour), one-sided headaches across the temple or around the eye and occurring once or more a day, and often disrupting sleep. Headaches recur for several weeks then subside, although another cluster may develop months later.

* Chronic daily headaches - these may be of any of the above types, and occur for at least 15 days a month for at least three months.

Headaches are generally divided into either primary (not related to another disorder) or secondary (caused by other things such as head injuries, high blood pressure or a brain tumour). With secondary headaches, it's essential to treat the underlying cause as this may prove fatal."*

*http://www.bbc.co.uk/health/conditions/headache1.shtml

This afternoon I went to see one of the best neurologists in the UK, who has been ‘a full time headache specialist for the last 12 years’, according to his website.

I described my headache to him in depth, emphasizing that I have already ruled out the possibility of the pain being related to my eyes, my sinuses, tropical diseases, low blood pressure, etc. etc.

As I recounted all the details, the doctor took notes, and explained that at the end of the session he would write a complete description of my symptoms, thereafter sending a copy to myself and to my GP with details of what medication I should take.

The doctor asked me where the pain is centred. I pointed to a specific location on my right temple. What I found very bizarre was that he did not reach out to touch the part of my head which is causing the pain. He immediately jotted down ‘right side temple headache’.

He advised taking steroid or botox injections to alleviate the symptoms.

“Botox?” I asked inquisitively. “But that’s for women who have plastic surgery”, I said. He explained that recent studies in the U.S. have demonstrated that women who suffer from headaches and who have undergone plastic surgery are no longer afflicted with headaches post surgery. As such, doctors now prescribe botox for headaches and migraines.

He thereafter told me that I will always have to carry drugs on me and take them whenever I feel the headache coming on (I guess I didn’t make myself clear when I explained that the headache doesn’t ‘come on’ - it is always there).

Needless to say, I will not be taking neither botox, nor steroids. As I believe I have a secondary headache, I need to find the underlying cause of the pain as opposed to temporarily concealing it with harmful drugs.

Once again, I am back at square one, this time £160 shorter.

Day 85 - Osteopathy

"Osteopathy recognises the importance of the link between the structure of the human body and the way it functions. Osteopaths focus on the body’s skeleton and joint function along with the underlying muscles, soft tissue and internal organs.

Osteopaths consider each person as an individual. Utilising a highly developed sense of touch, they identify problem areas of the body. Using gentle stretching and mobilising techniques as well as manipulating joints, an osteopath works with the body to create the perfect conditions to facilitate the healing process.

Treatment usually consists of a combination of soft-tissue releasing techniques, and some specific adjustments affecting joints and soft-tissues (muscles, tendons and ligaments).

Osteopathic treatment restores blood circulation, relaxing tight muscles and easing joint function, leaving you feeling less restricted and more comfortable."*

*http://www.osteopathy.org/MXENQ85VAJ
http://www.thebestof.co.uk/local/watford/business-guide/feature/backs-to-basics-osteopathy/51987

I am now back in London and very much hope to be able to solve my headache in the near future so as to resume work as soon as possible.

Lately I have thought about the possibility of having a trapped nerve.

I went to see an osteopath this morning who was recommended to me by a close friend. His step father had seen the very same osteopath who had worked wonders on him.

The osteopath in question specialised in cranial osteopathy and worked on my head, shoulder and facial muscles. He moved my muscles and joints using a number of diverse techniques including stretching, gentle pressure and resistance.

After the treatment, I felt light headed, dizzy and somewhat tearful. The osteopath explained that given all the work he had done on my body, these feelings were normal.

He asked me to return next week for the second treatment. In the meantime, he told me to try and relax and enjoy myself as much as possible as he believes this will very much contribute to ameliorating my headache.

Day 65 - Stress

"Stress is the way that you feel when pressure is placed on you. A little bit of pressure can be productive, give you motivation, and help you to perform better at something. However, too much pressure or prolonged pressure can lead to stress, which is unhealthy for the mind and body.

When faced with a situation that makes you stressed, your body releases chemicals, including cortisol, adrenaline and noradrenaline. These invoke the 'fight or flight' feelings that help us to deal with the situation.

The fight or flight response was first noted by one of the early pioneers in stress research, Walter Cannon. In 1932 he established that when an organism experiences a shock or perceives a threat, it quickly releases hormones that help it to survive.

If the chemicals that are released during stressful situations accumulate from not being used, their effects are felt by the body. A build-up of adrenaline and noradrenaline increases blood pressure, heart rate, and the amount that you sweat. Cortisol prevents your immune system from functioning properly, as well as releasing fat and sugar into your blood stream.

Excess stress can manifest itself in a variety of emotional, behavioral, and even physical symptoms, and the symptoms of stress vary enormously among different individuals. Common somatic (physical) symptoms often reported by those experiencing excess stress include sleep disturbances, muscle tension, headache, gastrointestinal disturbances, and fatigue."*

*http://www.nhs.uk/Conditions/Stress/Pages/Introduction.aspx
http://www.stress.org.uk/What-is-stress.aspx
http://www.medicinenet.com/stress/page3.htm#symptoms

A number of people have asked me if my headache could be related to stress.

The human body is so complex that each and every one of us reacts to external circumstances in different ways. Maybe it is stress related.

Admittedly, we’re working very long hours here in Banjul: most days more than 14.

I have therefore decided to have body and head massages on a regular basis to try and relax a bit.

Luckily I am in living in The Gambia, where I can easily afford a masseuse.

I asked her to spend some time working on my temples - I told her to place a lot of pressure, especially on the right hand side, as this slightly alleviates the pain.

The intensity of the headache magnifies as soon as I lie down. Consequently, as much as I try and relax during a massage, I now become more tense and weary.

Day 58 - Wisdom Teeth

"Adults can have up to 32 teeth. The third molar teeth (commonly referred to as wisdom teeth) are the last to come through, right at the back. They usually appear between the ages of 17 and 25, although sometimes they appear many years later.

Nowadays people often have jaws that are too small for all 32 teeth – 28 is often the most we have room for. So if all the other teeth are present and healthy there may not be enough space for the wisdom teeth to come through properly.

Wisdom teeth can contribute to headaches. If a wisdom tooth is impacted or somewhat erupted, swelling can occur and gum tissues may be infected. The swollen gums and teeth can leave an individual with a badly aligned bite, which may then cause pain in the jaw area.

Inflammation and additional pain in the jaw joints and muscles leaves a person with what is called a wisdom tooth headache. If left untreated, pus may form and further inflame jaw muscles."*

*http://www.dentalhealth.org.uk/faqs/leafletdetail.php?LeafletID=43
http://www.headacheexpert.co.uk/DentalConnection.html

The drops for my low blood pressure that the Senegalese doctor prescribed have not alleviated my strong headache. I have been taking them religiously but have not seen any sign of improvement.

I was recently put in touch with a family friend who has suffered from similar headaches to mine - similar in the sense that no one knew what was wrong with him until he eventually found out what was causing the pain: his wisdom teeth.

I have therefore decided to have my teeth checked. The only problem is that I am currently in Banjul and there are hardly any dental clinics. I have asked around and have been told about one which is known to be fairly good.

As our car came to a halt off the dusty road, a hand painted wobbly wooden sign vaguely indicated that the Swedent Clinic was a few metres ahead.

The rundown building, with rolls of paint peeling off the walls, was open and I was greeted - to my great surprise - by two Swedish female dentists.

They explained they were living in the country for a few months training locals in dentistry.

I happily sat on the dusty reclining chair. I wondered how many people had (if any) sat on the chair before me.

I was surprised to hear the clinic had xray facilities.

“Your teeth are in excellent condition, and you haven’t even had any fillings” I was told. The dentist told me she couldn’t see any wisdom teeth but I begged her to do an xray just to make sure.

She did some xrays with an obsolete machine which nonetheless processed the results immediately: “You will never have wisdom teeth. Thirty percent of people never get them, and you’re one of them.”

Great, I thought to myself - at least I won’t have to go through all the pain of removing wisdom teeth.

But now another possible cause of the headache has been ruled out. The dentist nonetheless advised carrying out some small exercises by stretching and moving my jaw, should my headache be related to problems with my mandible.

I am however - once again - back at square one, with no concrete results.

Day 50 - Low Blood Pressure

"Blood pressure is the force exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs of life, which also include heart beat, rate of breathing, and temperature. Blood pressure is generated by the heart pumping blood into the arteries and is regulated by the response by the arteries to the flow of blood.

Low blood pressure (hypotension) is pressure so low it causes symptoms or signs due to the low flow of blood through the arteries and veins. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidney, the organs do not function normally and may be permanently damaged.

For example, if insufficient blood flows to the brain, brain cells do not receive enough oxygen and nutrients, and a person can feel lightheaded, dizzy, or even faint."*

*http://www.medicinenet.com/low_blood_pressure/index.htm

The doctor measured my blood pressure yesterday during the physical examination and said it was abnormally low. He did not take any measures as he said he would check it again today when picking up my test results.

This morning I was told all blood tests are normal and there is no sign of any parasites or tropical diseases.

The doctor measured my blood pressure again - it was still very low. Given the normal blood results, he is utterly convinced my headache is due to my low blood pressure.

I myself feel that my headache is caused by something elementary that is being overlooked.

I am therefore highly enthusiastic about this new diagnosis and firmly believe the doctor may well be right.

Furthermore, the fact that the pain intensifies when lying down leads me to think that my headache may well be related to low blood pressure, as the blood circulates differently when standing or lying.

The doctor has prescribed some drops to take for three weeks on a daily basis; this, he says, should raise my blood pressure thereby putting an end to my headache.

I have now promised myself that whosoever may solve my headache will receive a bunch of flowers, a box of chocolates and a card explaining how grateful I am for having finally resolved my mysterious headache.

Day 49 - Tropical Diseases

"Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. Insects such as mosquitoes and flies are by far the most common disease carrier or "vector".

These insects may carry a parasite, bacterium or virus that is infectious to humans and animals. Most often disease is transmitted by an insect "bite", which causes transmission of the infectious agent through subcutaneous blood exchange.

The so-called "exotic" diseases in the tropics have long been noted both by travelers, explorers, etc., as well as by physicians. One obvious reason is that the hot climate present during all the year and the larger volume of rains directly affect the formation of breeding grounds. It is possible also that higher temperatures may favor the replication of pathogenic agents both inside and outside biological organisms.

Socio-economic factors may be also in operation, since most of the poorest nations of the world are in the tropics."*

*http://en.wikipedia.org/wiki/Tropical_disease

Needless to say I did not take the medication the Spanish doctor prescribed. Migraine tablets did not improve my symptoms over Christmas, and they certainly weren't going to do so now.

I am now in West Africa. On Friday, my colleague and I drove from Banjul, the capital of The Gambia, to Dakar, Senegal, to seek medical advice.

Health care in The Gambia is very limited so a trip to Dakar for some more blood tests was the only viable option.

The Clinique de la Madeleine, a privately funded French hospital, is a modern, soulless building located in the centre of Dakar.

I was seen immediately.

It has been nearly two months now and I am keen to try everything possible to rid my body of this tempestuous headache.

Maybe I caught a bug in Nigeria, and it may well be that a parasite is causing my infamous headache.

I told the doctor that I wanted to ‘do every possible test available on the face of the earth, in particular all tests to detect any possible tropical diseases’.

I need to return to the hospital on Monday morning to get my results.