From my early teenage years, I have been suffering from migraine headaches. I can recall it as far back as my second year of secondary school. Now, I know it was related to stress and the things I was going through then. At that time, the headaches were so severe and frequent that I would be in so much pain that I would be admitted to the hospital on some occasions. I remember my parents sleeping outside my ward and my brothers and cousins following me to the hospital. But not surprisingly, because of the frequency of the headaches, they decided to do further investigations, but from the limited tests they did, for one reason or another, they could never pick up that it was not malaria, and I was suffering from migraine headaches.
Throughout the time I was in secondary school, the symptomatology of the headaches was such that they would start with an aura, which was like flashing in my eyes. Then I would have localised pounding headaches around my eyes and so on and so forth. There was no associated fever or sweating. Although the pain could become so severe that it could make me vomit. A lot of people believed I was playing sick to get pity, which caused some resentment towards me.
All the doctors who saw me from secondary school through my A-levels were diagnosing malaria, which was a common disease, so I was constantly on antimalarial medication. It was so constant and frequent that people thought I was suffering from sickle cell anaemia, and they labelled me as a sickler. I do not blame the doctors, as in Nigeria, treating any fever or headache with antimalarial medication might help. Still, it can modify the symptoms, especially if the patient is given an antipyretic (a medication that reduces fever) and an analgesic (a medication that relieves pain). But in a lot of the cases, it is malaria, and because malaria is so endemic, malaria may mask the actual disease. So, treating them with antimalarial medication will reveal the symptoms of the underlying disease.
Also, I have seen renowned doctors, including our private hospital doctor, at a clinic in Bacita and at other major hospitals. I was seen by general consultants in the general hospital, and still, they would diagnose it as 'malaria'. But by evening, I would be back to normal. This added to the suspicion that I was pretending. I felt that I was spending more time recovering from the medication, as I was often given an injection of Novalgin (active ingredient: metamizole sodium) and a chloroquine injection. This was very painful, as it is a thick fluid that must be administered intramuscularly via a wide-bore needle, very slowly.
As a doctor, throughout my time in medical school, the emphasis was on listening to the patient and getting a story. Our consultants would be mad if we made a wrong diagnosis because we did not pick up a particular symptom, and they would actually fail you in some cases. In this instance, the story was there for all to see. A preceding aura, a severe throbbing, splitting headache behind the eye, no associated fever, sweating or chills. Then, sudden relief with little or no evidence after less than 12 hours. Most of the doctors see themselves as detectives, and they listen to every word you utter to solve the case and come up with a diagnosis. Each disease has a specific story when it occurs, and the type of fever, the headache, the kind of headache, etc., can change the symptomatology and paint a different picture; hence, the doctor will reach a different conclusion and diagnosis. I would have blamed myself for not telling a proper story, but the doctor in me would blame the doctors for not extracting the symptoms and not patiently getting a story or as they say in medical school, properly clerking the patient, which is an art in itself and develops with experience. The art of clerking in itself will tell you that the diagnosis and the physical examination are there to rule out any other serious condition and focus on what you suspect. Then further investigations are just to confirm and rule out what you already know or suspect.
It was only when I got to UI in 1985 that it was diagnosed as a migraine headache, and I was given appropriate medicine. The doctor who saw me was a staff doctor at the university. It might be because he was in a university setting and seeing young adults, and migraine headaches are so common in the cohort. Immediately, he knew the story and could relate it to the correct diagnosis. Since that time, I found out that I was not actually a sickle cell patient and I was more of somebody who had migraine headaches; as long as I took medication whenever I had the aura, the painful headache could be prevented. I would take ergotamine tartrate, and it was a lifesaver, as it stopped any attack of migraine. The migraine headaches stopped occurring when I started using carbamazepine for another condition. Still, since I've been taking it daily and it is used in migraine prophylaxis, the attacks have stopped. Now, at the end of it all, if you are still unsure, you will request further investigation and tests. You will review your diagnosis and can refer the patient to a specialist, who, after reading your referral letter, will start afresh.
Also, I was given reading glasses, as I had pain when reading after 2 hours. After getting the glasses, I could read much longer; this was also common among young adults. Hence, going to UI improved my life tremendously, and I believe going there was one of the best things that ever happened to me. I would always be grateful for the nameless university staff doctor I saw in UI in 1985.
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