Dr. Michael Timothy Parke, DO

• Migraines: one of the most prevalent types of headache, migraines typically last from two hours to three days, causing a throbbing pain on one side of the head. Nausea, sensitivity to bright lights, fatigue, and blurred vision all may accompany migraines. While migraines have no known cure, medications and lifestyle modifications may ease symptoms. Avoiding behaviors that may trigger migraines such as lack of sleep or loud, repetitive noises can improve headaches.
• Tension headaches: also known as stress headaches, these headaches are characterized by pain in the upper top part of the head and behind the eyes. Tension headaches are common and have no exact cause; however, certain practices may increase the likelihood of developing them. For example, wearing one's hair up in a tight hairstyle or wearing a restrictive hat can put pressure on the scalp, leading to a tension headache. Other causes of tension headaches may include alcohol or nicotine use, caffeine, teeth grinding, stress, overexertion, and eye strain. Some people find posture improvement, alternating sleeping positions, and neck exercise can alleviate tension headaches. Over-the-counter pain relievers such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve) may also reduce tension-headache pain.
• Sinus headaches: this type of headache causes pain in the sinuses, but may progress to pain and pressure in the eyes, forehead, and cheeks. These headaches are often accompanied by nasal congestion, fatigue, and ache in the upper teeth and may or may not be caused by sinus infections or sinusitis (sinus inflammation). Some sinus headaches are allergic headaches, which arise from allergic triggers such as seasonal allergies (pollen allergies) or hay fever, causing sinus pressure and facial pain. Other symptoms of allergic headaches include nasal congestion, irritated or watery eyes, runny nose, and sneezing. Allergic headaches may be treated with antihistamine medications such as cetirizine (Zyrtec). Allergic headaches are common during pollen season, which is usually around springtime.
• Cluster headaches: these headaches occur suddenly and cause stabbing, sharp pain from one eye down to the one side of the neck. They are often referred to as the most aggravating and painful type of headaches. Other symptoms of cluster headaches include nasal congestion, droopy eyelid, and enlarged pupil on one side of the face. In the past, it was widely believed that cluster headaches were caused by a bevy or "cluster" of multiple types of headaches, such as a combination of an allergic headache and a tension headache. Medical experts now recognize that cluster headaches are a separate and unique form of headache. Cluster headaches last for around twenty minutes to two hours. They may recur throughout the period of a day or several weeks, but usually dissipate within a month. Treatment for cluster headaches includes over-the-counter pain medications such as ibuprofen (Advil, Motren) and naproxen sodium (Aleve). Prescription Prednisone can help with swelling and Verapamil may reduce pain by relaxing the blood vessels.

Living with headaches is challenging; headaches can prevent people from fully enjoying life. Medical treatment and care in avoiding certain triggers can help those with headaches begin to feel normal once again.

Both injection and aspiration are techniques that involve inserting a needle connected to a syringe directly into the joint. Aspiration involves the removal of excess fluid, and injection is the placement of medication directly into the joint space via the needle. Both procedures may be performed at the same time. In both cases a local anesthetic may be used, the skin will be cleaned and disinfected, and then the needle will be inserted. In some cases, especially if the injection or aspiration is in a large and deep joint such as the hip or spine, ultrasound may be used to guide the needle to the exact location desired.

In some cases, irritation to the joint can cause fluid to build up so significantly that the joint hurts and can no longer move well. Aspiration removes some of the excess fluid and relieves the pressure. In addition, aspiration can be used to provide a sample of joint fluid if it needs to be examined microscopically for the presence of white blood cells, bacteria, or crystal formations.

Certain injuries and diseases that affect joints are inflammatory in nature, such as rheumatoid arthritis, tendonitis or gout. These diseases may be helped by the local injection of anti-inflammatory medications directly into the affected joint. In this case, corticosteroids such as methylprednisone are usually used. Relief from the pain may be felt right away and may last for weeks or even months.

In some cases, such as with osteoarthritis, the cartilage buffer between the two bones wears down and pain comes from bones rubbing against each other. In this case, injection of a lubricating agent such as hyaluronic acid may be beneficial. It provides a slippery cushion between the bones to relieve pain that can last for months.

• Blacklegged (deer) ticks, which spread Lyme disease in the Northeastern, North -Central, and mid-Atlantic United States.
• Western blacklegged ticks, which spread Lyme disease in the Pacific and Coastal regions of the United States.
• A mother infected with Lyme disease may pass it onto a fetus.

As background, ticks lay on the tops of grass and brush, clutching onto leaves with their legs and with their arms outstretched. This formation is called "questing" and allows ticks to quickly latch onto passers-by. Within two hours of biting a person's skin, the tick slowly begins to feed from the blood of its host, which can transmit the bacteria that causes Lyme disease. This tick activity generally occurs seasonally and tick bites mostly occur during the springtime.

After being infected, people with Lyme disease may develop symptoms like fever, exhaustion, headache, joint aches, and skin rash, usually three to thirty days after the tick bite. Lyme disease is characterized by a particular skin rash called erythema migrans, which is an enlarged red rash that starts at the site of the tick bite and expands outwards. The rash is a strong indicator that someone has developed or is at risk of developing Lyme disease.

In the following few months, symptoms may worsen and progress to include:

• Facial palsy (facial droop)
• Headache and neck pain
• Arthritis
• Nerve pain and numbness
• Spinal and brain inflammation
• Abnormal heart rhythm (Lyme carditis)

Most cases of Lyme disease dissipate over a few months. Lyme disease may be cured by a course of oral antibiotics, such as amoxicillin or doxycycline. Other treatments may include:

• Nerve blocking drugs for pain, such as gabapentin
• Topical ointments for rashes

People can take action to prevent Lyme disease by exercising caution when in environments with ticks. Using insect repellant and wearing long socks and protecting clothing can help prevent tick bites. Outdoor enthusiasts should regularly perform "tick checks," evaluating their skin for small ticks, especially in areas where ticks may easily burrow. Showering within two hours of returning indoors also can reduce the likelihood of developing Lyme disease.