Dr. Sonam Verma, MD

• Visual evoked potential, which tests how the brain reacts to visual stimuli. During the test, electrodes will be applied on the scalp and patients are shown a flashing checkerboard pattern. The electrical signals the patients' brain produces in response to the pattern will be recorded. This test is able to identify issues in the optic nerve and is a helpful tool in diagnosing multiple sclerosis, as optic nerve damage is an early sign of that disease.
• Auditory evoked potential, which measures how the brain responds to sound. In this test, the electrodes will be applied on the earlobes and on the scalp. Different sounds, such as clicks and tones, will be played through headphones, and responses to those sounds will be recorded. Aside from hearing loss in children, this test also diagnoses acoustic neuromas, which are noncancerous tumors in the ear canal that affect hearing and balance.
• Somatosensory evoked potential, which tests how well the brain communicates with the spinal cord and the rest of the body. Faint electrical signals will be sent through electrodes that are applied on the wrist or the back of the knee. Electrodes on the scalp will measure how long it takes for the brain to receive the signals. This evoked potential test is often used to diagnose multiple sclerosis. In addition, since it can identify spinal cord issues, it may also be given to individuals who experience numbness following a spinal injury.
• Motor evoked potential, which measures how the motor pathways function. These pathways deliver signals from the brain and spinal cord to the motor neurons, which are specialized cells directly responsible for controlling muscles. The test uses a device to send magnetic or electrical pulses to any part of the body. Patient response will show if motor neurons can adequately receive signals from the brain and spinal cord. Because this test detects communication issues in the motor pathways, it is used to diagnose multiple sclerosis, as well as to evaluate stroke recovery.

Each test takes between 30 to 60 minutes to complete, and can be done at the doctor's office. Application and removal of the electrodes do not hurt, but since they are placed on the scalp, patients should wash their hair with shampoo and avoid using conditioner or other hair products prior to the test.

• 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.

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.