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SPECIAL INVESTIGATIONS OF HEADACHES
In the present scientific era, there is a tendency to rely too much on machines, requests being made for every possible test in the hope that something will show up. This is not only wasteful but the results, instead of being reassuring, can be grossly misleading. Statistically, the more tests that are done, the greater the number of abnormal results. This produces a vicious circle where a healthy patient is investigated extensively to explain a chemical abnormality at great expense; the abnormal results could well be fortuitous or valueless in the first place.
With preparatory thought, these disadvantages could be avoided. The purpose of special investigations is to provide information beyond that given by the history and clinical examination so that it is important to define the questions which it is hoped the investigations will answer. The tests most useful in the diagnosis of a headache can be divided, for convenience, into those on the blood and others.
Blood tests
When a sample of blood is analyzed, information is obtained about the state of the blood cells and the fluid (serum) in which they float.
Blood cells.
The main cell in the blood is the red blood corpuscle which contains a chemical that carries oxygen (hemoglobin). Anaemia occurs when the level of hemoglobin drops but, in certain circumstances, there can be too much hemoglobin so that the blood becomes thicker and passes through the small vessels less readily, and this may cause migranous symptoms.
Another important test is to examine the rate at which red blood cells settle when put in a vertical glass tube. This is called the erythrocyte sedimentation rate (e.s.r.). In a patient with headache due to sinusitis or temporal arteritis, the rate of sedimentation will be rapid and produce a high e.s.r.
Another important type of cell is the white blood corpuscle which helps ward off infection. These can fairly easily be counted and when the count is too low this means there is either an abnormality in production, or they are being destroyed too rapidly. During many types of infection, there is a high count and, as there are several varieties of white blood corpuscle, the group that is increased indicates the type of infection. This estimation may be of value, for example, in distinguishing a migraine attack, where the white cell count will be normal, from sinusitis, where the count will be high.
Tests can also be done on platelets to see how easily they clump together (aggregate). This is done by separating the platelets from the rest of the blood and putting them in a chamber through which a beam of light is shone; a substance which aggregates platelets is added to the platelet suspension so that the transmission of the beam of light through the chamber becomes stronger. Some migraine patients have platelets which are particularly prone to aggregate.
The serum
In patients with rarer types of headache it may be necessary to perform tests on the serum, which is obtained by spinning blood in a centrifuge to separate off the cells. In certain allergic illnesses which can cause headache, antibodies to foreign substances can be estimated.
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