Everything about Mastoiditis

Mastoiditis is a bacterial infection of the mastoid bone which is located behind the ear. It develops due to the inflammation or infection of the air cells in the mastoid bone as a consequence of untreated or unresolved middle ear infection called otitis media. This infection occurs more often in children than in adults.

Usually, patients suffering from mastoiditis recover quickly when diagnosed and treated properly by ENT specialists. However, if the infection spreads outside the mastoid bone, it can result in serious consequences including permanent hearing loss, damage of facial nerve/facial paralysis, meningitis, bone infection (osteomyelitis), inflammation of the inner ear nerves (labyrinthitis), brain abscess and formation of blood clots (thrombosis).

Mastoiditis can be diagnosed by physical examination of the ear using an otoscope and culture of ear discharge, blood tests, CT scan/X-Ray/MRI and audiometric tests.

Symptoms of Mastoiditis

• A feeling of pain and discomfort in or behind the ear
• Signs of tenderness or redness behind the ear
• Ear discharge
• Swelling in the region behind the ears causing the protrusion of the earlobes
• Spinning sensation and dizziness(vertigo)
• Fever
• Headache
• Irritability/Fussiness
• Exhaustion/Lethargy
• Inflammation in the eyes
• The weakening of facial muscles
• Hearing loss in the affected ear
• Bulging or drooping of the ear

Treatment of Mastoiditis

Resolving Mastoiditis involves ear infection treatment with antibiotics, ear drops and periodic ear cleaning. It is a serious condition which cannot be resolved completely only at home. In some acute cases, antibiotics need to be dispensed through Intra Venous (IV) drips in a hospital. For chronic infection, surgery may be recommended for

• Draining the fluid in the middle ear through a procedure called Myringotomy. In this, the surgeon makes a tiny hole in the eardrum to drain the accumulated fluid and reduce the pressure on the middle ear. In some cases, a small tube may be inserted into the middle ear for ensuring continuous drainage and prevent the hole from closing. Subsequently, the tube usually falls off on its own within a period of six months to one year.
• Removal of a portion of the severely affected mastoid bone by an operation called Mastoidectomy. This is recommended in case the symptoms don’t improve by the usage of IV antibiotics or further complications like abscess or bone erosion happen. Recovery period post mastoiditis surgery usually lasts for one to two weeks.

It is important to do regular follow-up appointments with the doctor in Mastoiditis treatment to rule out hearing problems and other serious medical conditions.

Some of the other home remedies that provide relief from pain and other symptoms of Mastoiditis include - 

• Wearing earplugs while bathing and swimming to prevent the entry of water to the ears which can worsen  the infection
• Using over the counter (OTC) medications for reducing fever and aches
• Taking sufficient rest
• Remaining well hydrated
• Giving a warm compression over the ears to reduce pain
• Avoiding travel by air as it aggravates the pain

Prevention of Mastoiditis

It is possible to prevent the occurrence of Mastoiditis by avoiding ear infections and treating periodic or recurring ear infections (especially in the middle ear) with antibiotics. Ways to prevent infection of the ears are

• Stopping  the spread of cold and flu virus by maintaining proper hand hygiene and washing
• Taking  children away from secondary smoke as they are more susceptible to infection attacks  if they are surrounded by smokers
• Ensuring that the flu vaccine prescribed for children is administered annually
• Limiting constant exposure from patients having cold and flu 

There are many renowned ENT doctors in Coimbatore who can treat Mastoiditis successfully to avoid further health impediments. For more information regarding such ear infections and hearing loss treatment, please visit this website of ENT Hospital at Coimbatore.

5 Ways of Improving Hearing in Elders

Age-related hearing loss is one of the most common health issues that affect the elderly adults. It is also called Presbycusis and this condition manifests itself slowly as one grows older. Usually, this hearing loss affects both the ears equally and may often go unnoticed as the process is gradual. Many elders realize that they have this problem only after they have lost a substantial amount of their hearing ability.

Loss of hearing has dramatic effects on the quality of life that elders can lead. It can make social interactions difficult leading to isolation and depression.

Types of Hearing Loss

• Conductive Hearing Loss which occurs due to problems associated with the ear canal, eardrum, middle ear or ear bones. Common reasons for this include ear infection, fluid accumulation in the middle ear, allergies, malformation in the ear structure, excessive earwax, hereditary conditions, benign tumours and presence of foreign objects in the ears.
• Sensorineural Hearing Loss which happens due to problems in the inner ear and is related to the nerves. Some causes for this are aging, presence of tumours, constant exposure to loud noises, head injury/trauma, heredity, auto-immune disease, abnormalities in the inner ear including ear inflammation and Meniere’s disease.
• Mixed Hearing Loss which can occur due to a combination of the above reasons.

Age-Related Hearing Loss is essentially a type of Sensorineural Hearing Loss. Symptoms include-

• Facing difficulties in understanding and comprehending conversations especially in noisy environments
• Having a perception that others are mumbling even when they are speaking clearly
• Overwhelmed by  specific sounds as they are annoying or loud to bear
• Experiencing tinnitus(ringing sound in the ears)

Elders who feel that they are facing such difficulties in their hearing function should consult the ENT doctor immediately for diagnosing the type, cause and severity of the condition by appropriate hearing evaluation. Based on this, the appropriate treatment roadmap may be recommended.

Hearing Loss Treatment

• Using Hearing Aids - Hearing Aid Treatment involves the use of electronic devices called hearing aids in or behind the ears. These devices amplify the sound to enable better hearing. Various styles of hearing aids include Behind-the-ear(BTE), In-the-Ear(ITE), In-the-Canal(ITC), Mini BTE and Completely-in-Canal(CIC).
• Cochlear Implants - These are electronic devices which are surgically implanted in the inner ear to aid people who are completely deaf or have severe hearing dysfunction.
• Bone-Anchored Hearing Systems - These are so designed as to utilize the body’s natural ability for transferring sound by bone conduction. A sound processor relays the sound through vibrations to the inner ear.
• Assistive Devices - Several devices as amplifiers for telephones and cell phones, hearing loop systems and electronic apps for smart phones may be helpful for better hearing.
• Lip and Speech Reading - Here special training may be given to the elders through therapy for following conversational speech through body language and lip movements.

Ways for Improving Hearing in Elders

• Solving puzzles - Hearing loss is associated with brain atrophy where brain cells and interlinking connections are damaged. This may be prevented by doing various puzzles like crosswords, Sudoku and word searches to sustain and enrich brain functioning.
• Doing yoga and exercise - Yoga and exercise enhances the circulation in the brain and ears thereby improving nervous functions and detoxification process. Yoga poses that improve hearing include tree, lotus, cobra and triangle pose. Exercises may include walking, gardening and even doing routine household work regularly.
• Avoid loud sounds - Elders must avoid constant exposure to loud noises and use headphones in comfortable volumes.
• Performing Meditation - Meditation and deep breathing improves blood flow and increases oxygen content. This helps in deciphering sounds in noisy environments.
• Quitting smoking - The nicotine and carbon-monoxide content in the cigarettes deprive the inner ear of oxygen supply and affect the neurotransmitters in the auditory nerves. Hence it is strongly advisable to quit smoking. 

Healthy Sleep Healthy Aging

The role of sleep in maintaining good health increases with age. That is because the body never outgrows the need for sufficient sleep. Additionally, as one grows older sleep is vital for repairing the damaged body cells and sustaining mental concentration and memory retention. Research also reveals that the quality and quantity of sleep impacts the overall well-being and quality of life that elders lead.

Usually, it is seen that older adults get less duration of sleep than they need. One of the primary reasons for this is that they often experience trouble falling asleep. Aging also brings about a change in sleep patterns. So elders are less likely to have deep sleep during the nights and tend to wake up often. They also may frequently take naps during the day which sleep quality. There may be variations in the sleep schedules too (getting drowsy by evening and waking up very early in the mornings).

Not sleeping well can lead to a variety of problems in seniors that includes depression, excessive usage of over the counter drugs, more night time falls, attention deficiency, memory issues and excessive day time sleepiness. While it is inevitable that sleeping patterns vary with age, disturbed sleep and daytime exhaustion are detrimental to health. 

Importance of Good Sleep

• Poor sleep can lead to obesity as it causes hormonal imbalances and decreases motivation to exercise.
• Good sleep maintains metabolism rates and appetite hormone levels which ensure that elders do not overeat.
• Sufficient sleep aids in proper functioning of the brain for improving the capabilities of cognition, concentration, productivity and performance.
• Longer sleep also enhances athletic and physical strength.
• Insufficient sleep increases the risk for cardiovascular diseases and stroke.
• Sleep also impacts glucose metabolism which is vital for maintaining blood sugar levels and insulin sensitivity for preventing diabetes.
• Reduced quality of sleep leads to mental ailments including depression and suicidal tendencies.
• Sound sleep enhances the body immunity mechanisms thereby preventing frequent sickness and infections.
• Bad sleep increases inflammation of body cells leading to various digestive disorders, Crohn’s disease and even cancer.
• Good sleep influences emotional regulation and social interaction which is crucial for maintaining mental health.

Tips for Sleeping Better

• Maintain consistent sleep routines and schedules
• Exposure yourself to natural sunlight for short interval during the day
• Be physically active
• Cut down consumption of caffeine products, tobacco and alcohol
• Do not  use self -administered sleeping medications
• Limit daytime naps
• Improve sleeping environment including using a sturdy mattress, ambient lighting, maintaining quietness and appropriate room temperature.
• Avoid heavy meals and use of electronic devices during the night
• Remain well-hydrated
• Consume foods for healthy sleep like almonds, walnuts, cheese, lettuce, cherry or cranberry juice, cereals and chamomile tea
• Take a bath or use relaxation techniques like meditation before bedtime

Sleep-Related Problems

• Insomnia - A common sleep disorder where adults take a long time to sleep, have disturbed sleep and wake up exhausted.
• Snoring-This causes loud sounds during sleep due to obstructions in the airways from the nose to the lungs via the mouth.
• Sleep Apnea-Persistent snoring can lead to potentially disorder called sleep apnea where a person’s breathing stops for 10 to 60 seconds intervals during sleep leading to depletion in oxygen levels. Causes of sleep apnea include being overweight, abnormal anatomy of upper airways, smoking, certain medications, abuse of drugs and alcohol and aging.
• Digestive problems like Gastro-Oesophageal Disorder (GERD) and neurological disorders like Restless Leg Syndrome (RLS) are also caused by sleep deprivation.

Do not neglect sleeping issues- consult the ENT Specialist for proper treatment to prevent serious complications. After all, healthy sleep leads to healthy aging!

Impact and Importance of Good Sleep

The vital role of good sleep cannot be undermined in the good health and well-being of our lives. Sound sleep at the right time protects our safety, physical and mental health and also the quality of life that we lead. That is because, during the sleeping phase, the body is continuously working to support the healthy functioning of the brain and maintain our physical fitness. These processes are interrupted due to irregular sleep.

The importance of sleep can be entailed as follows -

• Controls body temperature and metabolism
• Maintains the working of the body  immune system
• Helps in controlling the proper functioning of the brain and aids the memory restoration process
• Ensures proper circulation in the blood vessels for maintaining a healthy heart
• Stimulates tissue repair and growth(in children) as growth hormone is released during the sleeping phase
• Sustains the blood glucose levels and regulates the appetite

Impact of Good Sleep

• Maintains cardiac health by controlling the blood pressure and cholesterol levels which are the major risk factors for causing stroke and heart attacks.
• Helps in preventing cancer, particularly breast and colon cancer, by regulating the melatonin hormone levels which prevents tumour growth.
• Reduces stress which would otherwise cause hypertension. The production of stress hormones impairs the normal functioning of the organs and creates hurdles in falling asleep easily.
• Prevents deterioration due to aging by decreasing inflammation which is known to cause diabetes, heart problems and cancer.
• Increases mental alertness to keep you fully energized and active during the day. This constructive engagement helps in doing our routine tasks efficiently which in turn, induces better sleep cycle at night.
• Enhances the memory by assisting the brain in creating linkages between the memory, sensory inputs, feelings and events resulting in better mental processing abilities.
• Assists in losing weight by balancing the hormone levels of ghrelin and leptin which regulate appetite and control the metabolism for proper nutrient assimilation.
• Decreases the chances of depression by preventing deficiency of the serotonin hormone.
• Stimulates the body to repair itself due to the damage caused by exposure to ultraviolet rays, stress and other harmful substances. This is because the body produces proteins during sleep which are the cellular building blocks for repairing the damages caused.
• Taking a few short naps during the day boosts productivity and decreases stress levels. It is also beneficial in enhancing the moods, memory and cognitive functioning of the brain and is a refreshing alternative to caffeine consumption.

Common Sleeping Problems

• Insomnia - Here there is difficulty in falling asleep, staying asleep or awakening at unusually early hours of the day. Treatment may include behavioural, psychological, medical approaches or a combination of these.
• Snoring – Loud and unpleasant sounds called snores are generated during sleep due to blocked airways. In mild cases, the cure for snoring can involve making simple lifestyle changes. Treatment for snoring in severe cases includes using nasal snoring solutions or oral appliances and treating chronic allergies. Surgery for snoring may be inevitable for correcting structural problems in the nose. Laser surgery for snoring using Laser Assisted Uvulopalatoplasty is an effective treatment that tightens the throat tissues.
• Sleep Apnea - In this the breathing process is disrupted frequently during sleep. Symptoms of sleep apnea include very loud snoring, gasping for breath, insomnia and morning headaches. The effects of sleep apnea can cause serious consequences like high blood pressure, stroke, depression, heart attacks and worsening of hyperactivity. Sleep apnea treatment includes usage of airway pressure devices. Chronic cases need surgery for tissue removal, jaw repositioning, implantation or endoscopic sinus surgeries for improving sinus ventilation.

Poor sleep has several long-lasting detrimental effects on our health, unfortunately. So please consult the ENT Doctor immediately for any sleeping problem.

Common disorders of ear, nose and throat

The only time when you realized your ear, nose and throat were interconnected was when you applied ear drops and their residue passed down your throat. These organs, the ear, nose and throat are interconnected and share the same internal lining and hence the same infections. Here is a list of the common disorders of the ear, nose and throat which affect us frequently.

EAR DISORDERS

EAR INFECTION

The most prevalent among ENT illnesses, an ear infection is caused by the clogging of the Eustachian tube by fluid, mucus, or microbes. Less frequent among adults, an ear infection causes symptoms like ear pain, difficulty in hearing, loss of balance, nausea or vomiting or fluid discharge from the ears.

Ear infections can be of the outer ear, middle ear or inner ear. The outer ear infection or swimmer's ear is due to the excess water retained after swimming or bathing causing bacterial infection. It may also be due to injury to the external ear by scratching or putting sharp objects into the ear.

OTITIS MEDIA

A middle ear infection is called otitis media. It is usually due to an upper respiratory tract infection or strep throat causing a fluid discharge into the Eustachian tube, leading to bacterial infection. Otitis media causes ear pain, loss of sleep, headache, difficulty in hearing etc. Consulting an ENT specialist is best for its treatment and administering pneumococcal conjugate vaccines (PCV) can prevent otitis media in children.

HEARING LOSS

Hearing loss can be either partial when the audibility level is poor or complete as in the case of total deafness. Hearing loss may be temporary or permanent. A temporary hearing loss may be due to injury or infection or accumulation of ear wax and it can be corrected by ENT treatment or surgery. A permanent hearing loss is often due to damage to the auditory nerves and might be irreparable. However, hearing loss may be remedied by the use of cochlear implants or hearing aids with consultation with an expert ENT specialist.

CHOLESTEATOMA

Cholesteatoma is a non-cancerous growth occurring like a cyst in the middle ear behind the eardrum. It may be due to middle ear infections and can affect hearing and balance and even the functioning of your facial muscles. Symptoms of Cholesteatoma are pain or foul-smelling fluid discharge from the ear. If untreated, Cholesteatoma may result in facial paralysis, vertigo or permanent hearing loss.

BAROTRAUMA

Barotrauma is an ear disorder caused due to a variance of air pressure. This is usually caused by flying, scuba diving or rock -climbing or driving in mountains. Pain, dizziness, ear stuffiness and hearing loss are the symptoms. With medication prescribed by ENT specialists, barotrauma can easily be healed.

NASAL DISORDERS

NASAL CONGESTION

This most common nose disorder is nasal congestion caused by common cold, flu or allergies. The nasal lining is inflamed and swollen due to infection and cause mucus discharge and a  stuffy nose. Decongestants and antibiotics prescribed by the ENT doctor will help relieve nasal congestion.

NASAL POLYP

Nasal polyps are small non-cancerous growths in the sinuses or the nasal passage. They are caused by allergy, asthma, nose infections or immune disorders. Running nose, post-nasal drip, headache, snoring, loss of smell or taste are the symptoms. Nasal polyps can be cured with surgery or medication.

DEVIATED NASAL SEPTUM 

When the nasal wall between the 2 nostrils is displaced to one side, it is called a deviated nasal septum. It may obstruct breathing and cause snoring, breathlessness, nosebleeds, facial pain etc. A deviated nasal septum can be treated using nasal dilators or by surgery.

HAY FEVER

Hay Fever has symptoms similar to the cold like itchy or running nose, sneezing, coughing, sinus pressure. But unlike cold, it is not caused by viruses but by allergens like pollen, dust mites, pet hair or feathers etc. Also called Allergic Rhinitis, Hay fever can be treated with nasal sprays and anti-allergic drugs prescribed by an ENT physician.

TONSILITIS

When the 2 oval-shaped pads or tonsils at the back of the throat get inflamed, the condition is called Tonsillitis. Tonsillitis is caused by viral or bacterial infection and results in difficulty in swallowing, sore throat, headache, fever etc. Mild cases can be treated with antibiotics while severe ones may need surgery.

PHARYNGITIS

Pharyngitis or sore throat can cause difficulty in swallowing and a scratchiness of the throat. Measles, chickenpox, common cold, flu, whooping cough etc may cause pharyngitis. The infection is mostly viral and is treated with antibiotics. Rare cases of bacterial pharyngitis may be due to Chlamydia, Corynebacterium or gonorrhoea.

ORAL CANCER

Mouth or oral cancer is characterized by persistent mouth ulcers and sores, mouth swelling, jaw pain, loose teeth, pain while swallowing etc. Cigarette smoking, tobacco chewing, drinking etc are the main risk factors part from genetic reasons. Oral cancer treatment begins with surgery for removal of malignant tumours, followed by skin and dental implantation etc.

Big or small, all ENT disorders must be attended only by a professional ENT specialist as the ENT tract is interconnected and may affect the adjoining organs as well. Head to the best ENT hospital in town for the thorough treatment of ENT disorders and have a healthy life.

Tips for better communication

You can see the lips moving and forming syllables but you cannot hear properly. Or sometimes you hear a roaring sound like that of a pouring waterfall, which does not permit you to hear anything. If these are your symptoms, then it is unfortunate but your hearing may be impaired.

Hearing loss, be it partial or complete is a crippling ailment as it prevents the affected person from performing his routine activities normally. It not only restricts communication with others but also affects the confidence and composure of the patient. 

Hearing problems can be easily remedied with ENT treatment which may include simple cleaning, use of hearing aids or even minor surgery, depending upon the patient's condition.

If a person has a hearing problem, does it mean he cannot communicate? He/she very well can with the help of these tips for better communication.

Tips for better communication for the hearing impaired

1. Keep people informed of your hearing problem

No man is free of illness these days and hearing loss is just another disability like any other. Do not be shy of informing people about your difficulty in hearing. It is better to keep people informed of your hearing disability in order to avoid awkwardness and confusions later.

Before a conversation, group discussion or meeting, inform people that you have a hearing problem. This will induce them to speak louder or grab a seat in the front or speak slowly for your benefit. Remember, you can achieve a lot more by keeping people informed of your hearing ailment rather than keeping it a secret.

2. Specify your needs for good hearing

You might be suffering from a hearing problem only in on ear. So specify to people which side you will be able to hear better. They can move over to the side where you can hear best and speak to you.  You can even ask them to change the direction of their face while speaking to hear better.

Unless you specify your hearing needs, people will assume that your hearing is fine and this will not help. Specifying your hearing needs is the best way to promote effective communication.

3. Ask people to be open with you

It is not only you who is uncomfortable with your hearing loss. Others too find it difficult to express to you that they are having difficulty in communicating with you. 

It is better to put people at ease and ask them to be open in expressing their difficulties in communication so that you can remedy them. Tell others that if you stare transfixed as if you have not understood a dialogue, it means you have not heard it and they should repeat it again. Use humour to get people to feel comfortable in communicating with you in spite of your hearing problem.

4. Use gestures to communicate

Non-verbal clues come handy when you try to communicate in spite of your hearing problem. Sometimes gestures and body language can express more than words. Use them rightly for the best results.

For example, leaning towards the speaker, cupping your hand near you ear for a louder tone or swivelling your hand asking for a repeat can help you to communicate without interrupting the other person.

5. Interrupt when you have to

Follow the conversation to the best of your ability. But if the voice is low or the speaker is fast, there is no harm interrupting and asking them to repeat or clarify.

6. Maintain good health

Apart from your hearing loss, keep yourself fit with a balanced diet, exercise and enough sleep. Even for your hearing care,  consult an ENT surgeon or specialist regularly.

7. Visit the ENT specialist regularly

There is no dearth of ENT specialists in India. Go for an ENT check-up frequently as new innovations and treatments can help you cope with your hearing problem better.

Do not let hearing loss deter you from reaching the pinnacle of success. Consult the best ENT doctors in Coimbatore to climb the great walls of victory.

Managing with Headache

Headache happens to be one of the most prevalent health complaints in the daily lives of people. It may occur in one side or multiple parts of the head. It can also affect anybody irrespective of their age, gender or inheritance. According to the World Health Organization (WHO) statistics, nearly half of the adult population experience headache at least once annually.

Usually, all patients assign paramount importance to finding immediate relief to a headache by taking self-medication. But caution must be exercised particularly if they take other medicines which are likely to cause reactions with these drugs or have pre-existing medical conditions which can result in health complications. It is also crucial to closely watch the symptoms, signs and potential triggers that cause a headache. 

Types of Headache

Based on the cause, Headache is categorized as-

• Primary headache - These are not caused by any external factors and are stand-alone ailments. They occur due to over-exertion of the brain or problems in the head parts that are prone to pain like the blood vessels, muscles or nerves connecting the head and the neck. These headaches may also be an off-shoot of changes in the brain due to various chemical activities. Types of Primary Headache include-

• Migraine which are due to throbbing or pulsations only on one side of the head. Accompanying symptoms may include feelings of nausea or light-headedness, blurring of vision and auras (sensory disturbances).It may last for a few hours or days.
• Tension headache wherein there may be a feeling of tightening around the head, neck pain or a prevailing dull ache on either side of the head. It may occur in isolated episodes or last longer as in chronic cases.
• Cluster headache which are severe one-sided aches that may result in red, swollen areas around the eyes, drooping of eyelids and blocked nasal passages. It occurs in clusters of few days to months coupled with headache-free periods in-between.

• Secondary headache - These usually occur due to underlying causes which stimulate the pain-sensitive nerves in the head. This includes -

• Over usage of painkillers causing Rebound Headache.
• Thunderclap Headache caused by Reversible Cerebral Vasoconstriction Syndrome (RCVS) which causes constriction of blood vessels hampering the blood supply to the brain.
• Hangovers resulting from alcohol consumption.
• Brain tumours.
• Toxic effects of carbon monoxide.
• Brain freeze (ice-cream headache).
• Panic attacks.
• Life-threatening ailments like Haemorrhage (bleeding) in or around the brain, Meningitis (brain fever), Aneurysms (artery enlargements) and Cerebral Venous Thrombosis (blood clots in the brain).
• Medical conditions like glaucoma, stroke, hypertension, Upper Respiratory Tract Infections and influenza
• Sudden caffeine withdrawal
• Head injury or trauma
• Head and Neck Cancer which mostly manifests itself as Oral and Oropharyngeal Cancer

It is advisable to consult the ENT Doctor for identifying the secondary causes like respiratory infections and influenza for taking appropriate ENT Treatment.

Treatment for Headache

• Medications - Usually generic pain medications available as Over-the-Counter (OTC) drugs or preventive medicines prescribed by physicians like anti-depressants, anti-epileptic drugs or serotonin receptors are used.
• Surgical Remedies - For removal of brain tumours, surgery may be required. Cancerous growths additionally require chemotherapy and/or radiation therapy.
• Alternative Treatments - Alternative approaches like Meditation, Hypnosis, Acupuncture, Cognitive Behavioural Therapy, Herbal and Nutritional Remedies may be used for tension headache.
• Lifestyle Modifications - Regular exercise, sufficient sleep, healthy eating habits, avoiding stress and reducing caffeine consumption can prevent headache episodes substantially.

Please consult the Head and Neck Doctor or the ENT specialist to diagnose the exact cause if the headache worsens or becomes more severe, persistent or frequent. Any accompanying symptoms like fever, epilepsy, mental confusion, neck stiffness and sensory modifications require an emergency intervention for the headache or the neck pain treatment.