First, your doctor will take down your history. The first sign of a brain tumour is not usually a headache but rather, neurological features such as paralysis, altered vision or speech, vomiting, or altered levels of consciousness. Often these problems are intermittent, rather than constant. Pituitary gland problems usually show up as changes in the menstrual cycle, abnormal growth, or sometimes diabetes.

Other things that point to tumours are the existence of a previous cancer which is known to spread to the brain or bones, and a history of wasting or loss of weight, especially if coupled with a continuing sense of weakness or malaise. These are all symptoms which can point towards a tumour of the head or neck. On the other hand, as you will immediately recognise, most of these symptoms can occur completely separately from a brain tumour, and it is unlikely that your doctor will be able to diagnose a brain tumour without doing a lot of complex tests.

The first thing your doctor will do is to arrange for a blood test to check the Erythrocyte Sedimentation Rate (ESR). This is a broad method of working out whether there is anything odd going on in the body, and simply measures the speed with which the red cells in the blood sink to the bottom of a tube of blood. Although a raised ESR means there’s something abnormal going on, a normal ESR doesn’t necessarily exclude a malignancy, unfortunately.

Next, your doctor is likely to get an X-ray, though this doesn’t give anything like as much extra information as you might think. Secondary deposits of cancer in the skull bones usually show up clearly, as punched-out areas where bone has been replaced by non-bony, malignant tissue. In addition, the X-ray will also show the shape and size of the cavity of the hollow in the bones, under the brain, where the pituitary gland sits. Tumours of the pituitary often alter the shape of this cavity.

On the other hand, simple X-rays are often unhelpful in spotting tumours of the brain itself; sometimes areas of the tumour will show up as white flecks on the X-ray, but because the consistency of a tumour is very much like the consistency of the brain itself, simple X-rays can’t show the difference between the two.

If the symptoms point towards a tumour of the pituitary, then your doctor will measure the levels of various hormones in the blood.

Much more sophisticated tests are now available for example, a CAT scan (Computer Assisted Tomography).

MRI scans are amazing in their ability to show up detail in soft tissues. X-rays can’t do this easily – most soft tissues in the body look exactly alike to X-ray. MRI scans are being used more and more to find the cause of problems deep within the body, without needing to stick in tubes, or perform operations to look around.

Finally, the doctor can organise an Electro-encephalogram (EEC) to measure the electrical activity of the brain. This can sometimes help to localise the site of a problem.

Although brain tumours are not common, they are not that rare, either. They are, unfortunately, extremely difficult to detect in their early stages. Often, the first inkling of a brain tumour is through some odd neurological event. Perhaps you have a stroke-like attack that goes away after a couple of days, though this is more likely due to a Transient Ischaemic Attack (TIA). Perhaps there is an attack of epilepsy occurring in someone who has never had epilepsy before; a first migraine occurring after the age of fifty may also be the first inkling of a brain tumour. As a general rule, any migraine which starts after the age of fifty should be treated with suspicion, and fits starting in adult life ought to be thoroughly investigated.

But even by this time it may be too late to save the patient. By the time a malignant tumour has progressed to the point where it is causing fits, paralysis or migraines it has often become incurable.

But all is not gloom – some types of brain tumour can be successfully treated. Let’s run through the list:

Benign tumours are relatively easy to treat. Simply removing them relieves the pressure on the brain and, provided the abnormal tissues have been completely removed (which is usually not too difficult to achieve), they are unlikely to re-grow again.

Malignant tumours affect two main groups of people: – children, and the elderly. Because children don’t usually get strokes or episodes of abnormal consciousness, it’s often possible to spot a brain tumour earlier in a child than in an elderly person. And the earlier the diagnosis, the more chance there is of doing something about it. Even so, by the time a malignant brain tumour is producing symptoms it may already be too late.

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The importance of a head injury is not whether the patient has been knocked out, nor even whether the skull has been fractured in the process, but whether or not the injury has caused damage to, or pressure on the brain. This pressure can come from a number of sources, such as bleeding – either into the brain or underneath the skull – which presses on the brain, or else from a depressed fracture where the bones themselves are pressing directly on the brain.

All other considerations are secondary. To be honest, after a head injury, it really doesn’t matter if the patient has sustained a fractured skull – the bones of the skull are just like other bones of the body, and will heal. A hairline crack or fracture is really of little importance (other than that it causes pain), as long as there is no bleeding underneath, or swelling of the brain substance.

This can’t be emphasised enough. All too often, people imagine that it’s the concussion that we should look out for, or the fractured skull that is so important. That isn’t the case. The only reason for admitting a patient to hospital after concussion or a fractured skull is that a blow big enough to cause concussion is hard enough to rip nerves and blood vessels within the brain or cause swelling of the brain itself; and where there is a fractured skull there may also be treacherous and unseen underlying bleeding. So the patient” is admitted, and observed carefully for the next twenty-four hours, to spot any signs of progressive internal injury.

Most head injuries result in simple superficial bruising; a small proportion concuss the patient. Harder blows may cause a skull fracture, though the position and angle of the blow often determines whether or not the skull will fracture. One part of the head is particularly prone to direct fracture – the temple (at the side of the head, between the eye and ear) is the most vulnerable area for fractures that are the result of a direct blow from a small object, such as a golf ball.

A simple undisplaced fracture of the skull (where the bones haven’t moved) is usually relatively unimportant. Provided there is little bleeding from the broken edges of the bone, then a crack in the skull bones can be treated much like a crack in any other bone, such as at the wrist. In fact, because the skull is such a solid, well-constructed egg shape, even if there is a crack, the edges of the bone are usually held closely together and will soon heal without needing bandaging or plaster to hold the ends of the broken bones opposite one another.

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Once a stroke has occurred there is often little that can be done, at least as far as the stroke itself is concerned. The doctor will want to check to see if a part of the body is throwing off little clots – such as a damaged heart valve. If a source of clots is found it may be appropriate to thin the blood to prevent these clots forming, and later becoming lodged in the brain. In some cases, it may even be necessary to surgically remove the offending area.

At the moment, most stroke victims have to wait for the body to recover naturally, by itself. On the horizon, however, are some interesting clot-dissolving drugs, and in the future it may well be that stroke victims immediately get sent to hospital for clot-busting injections given directly into the veins, as is often done now with heart attacks.

Good post-stroke treatment can make a lot of difference to the patient’s quality of life. Much of the treatment centres around physiotherapy, leaching people to re-learn movements; speech therapy; and so on.

Because most stroke victims are elderly, all other types of headache affecting the elderly can combine to multiply their effects and cause greater headaches. For example, a patient with a stroke may also have a considerable degree of osteoarthritis of the neck, which irritates the neck further, causing even more headaches from muscular tension. As well as muscular imbalance, which aggravates the neck problem, there may also be anxiety, tension or depression as a result of worrying about the illness itself. This further knots up the neck muscles and causes yet more headaches.

Prevention of stroke is important. You’re more likely to have a stroke if you’ve had high blood pressure for a long time, – and by .that I mean many years. We now know that bringing the blood pressure down, and keeping it down, reduces the chance that you’ll suffer a stroke. This is why doctors are so keen to discover those who’ve got high blood pressure. Treating a thirty-year-old’s high blood pressure may prolong his life by years

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There are no complementary treatments for meningitis. Orthodox medicine is what you need – and very quickly, too. In meningitis, delay might be fatal. Dial 999 immediately, and while waiting (and only if the patient is conscious) you might try giving him or her arnica or aconite every ten minutes until help arrives. Alternatively, sipping valerian tea while waiting will ease the pain and shock, and provide a distraction.

Try rubbing Rescue Remedy (a Bach Flower remedy) into the pulse points and behind the ears of the patient, while waiting for help. Lavender and camomile oils can be soaked in a handkerchief and pressed to the nostrils, or as a compress to the forehead. All of these therapies provide some relief from the symptoms of meningitis while you wait. Orthodox medical attention must be sought immediately.

Severe headaches following meningitis can be treated with lavender oil, in any of the popular aromatherapy forms. lavender tea with a pinch of rosemary, or as a tincture, acts as a stimulant, and strengthens the system. Some therapists recommend Royal jelly as a supplementary nutrient source.

If you suffer from anxiety following meningitis, try camomile or orange blossom tea, or vervain. Aconite, ignatia and phosphorous would be recommended by the homoeopath. Geranium lavender, melissa, neroli and rose oils can be used in a vapouriser, in the bath, or, mixed with a carrier oil, lightly massaged into the temples, shoulders and neck.

Depression may be treated with Bach flower remedies, various herbal preparations, homoeopathic medicine and many other forms of treatment, in particular art and music therapies . It is essential that you consult a registered practitioner following any severe illness, and certainly when suffering from depression of any kind.

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Although we don’t know the precise biochemical mechanism of migraine, we certainly know a lot about the things that trigger it. The following things are all known to trigger off attacks in some patients. They are in no particular order.

Food

There’s a very complex relationship between migraine and food. Insufficient food – such as missing or delaying a meal, or fasting – may trigger a migraine in susceptible people, and about one in five migraine sufferers claims that a particular food or foods will trigger an attack. Chocolate and cheese are high on the list of culprits, but alcohol, citrus fruits and dairy products are all well known triggers.

There are three completely distinct mechanisms by which food can cause problems.

•    A drop in glucose levels in the blood, caused by a sudden lack of food.

•    Direct stimulation of cells in the brain from the lyramine content of certain foods. Tyramine is an amino acid (a chemical compound found in protein) and it is present in high concentrations in some foods – particularly chocolate and cheese. The effect of tyramine is directly related to the close the patient receives. A smal dose might have a small triggering effect, and a larger close gives a correspondingly larger effect on the brain. Tyramine and related chemicals are thought to trigger migraine’s because people who are susceptible to tyramine don’t have the enzymes to remove these chemicals as quickly from the body; they remain for longer, affecting the blood vessels and triggering an attack.

Stress

Stress is probably the most common trigger for migraine. Stress is a blanket term which can also include excitement and anticipation. Like food allergies, stress can also trigger migraine when it is removed; for example, causing a ‘weekend migraine’, when you’re away from the busy office. Migraines can also be brought on by the stress of social situations – such as parties, travel, and going to the cinema or dancing.

There is also the stress brought on by a fear of what the migraines might mean (for example, fear of an underlying brain tumour). This merely serves to multiply whatever stress you have, bringing on more migraines.

Too much or too little sleep can precipitate a migraine; for example, lying in bed at the weekend may start off an attack. There is an increased frequency of migraine in anxiety and depression.

Anything which causes excitement – particularly in children – can trigger migraines. Certain types of physical stress, such as jogging or lovemaking can act as triggers, too.

If it is erratic, exercise can trigger migraine. On the other hand, regular exercise is beneficial. Bending or stooping (as in gardening) can trigger attacks, as can lifting heavy weights and straining, as well as physical or mental fatigue.

Car journeys

Car journeys can trigger migraines. A lot of other triggers can be involved, too -the stress and fatigue of the journey; motion sickness; flashing lights at night as cars zoom past in the other direction; windscreen wipers flicking across your field of view, especially where there are bright lights in front (causing flicker). And, when the sun is low and to one side, travelling through a treelined avenue can create immense flicker.

Hormonal changes

This is exclusively confined to women. Migraines may be triggered by the drop in oestrogen at the time of the monthly period and may be improved (but sometimes worsen) during pregnancy; often improve (but sometimes worsen) at the menopause, and can be made worse by the Pill, which in rare cases can trigger off a most dangerous type of migraine attack.

Environment

Heat, cold, light and noise can all precipitate migraine. The weather can also act as a trigger. The most famous account of this is Dr Edward Wilson, who was on Captain Scott’s doomed expedition to the South Pole. He invariably suffered a migraine attack ten to twelve hours before a blizzard started.

In most migraineurs it is probably the increased glare which does the damage. This is made worse by high-altitude thin cloud, which heralds a cold front; the cloud causes the glare, and the rain follows the front.

Bright light and especially high contrast can trigger attacks. Even something as simple as sitting talking to a friend who is silhouetted in front of a sunlit window can bring on a migraine. Some people get migraines from staring at computer screens, particularly when they are not set up very well.

Sunlight reflecting or shimmering off water can act as a trigger. Polarised glasses, which selectively cut out reflected light, can help greatly in reducing the amount of reflected flicker.

An excessively dry atmosphere can act as a trigger – dry air tends to contain increased amounts of dust particles, which are thought to start the migraine process in some people. There are more likely to be excessive numbers of charged particles about in dry conditions, which would explain why susceptible people get migraine in dry weather, and also why migraine is associated with certain winds which blow in the eastern Mediterranean and Switzerland.

Positive ions in the atmosphere can also trigger migraines. These ions occur in large quantities before a thunderstorm. As the storm passes, the charge changes from positive to negative, but by then the migraine may have started. Sprays of water fill the air with negative ions, so having a shower may help counter the effects of thundery weather.

Positive ions are also present in large quantities in centrally heated and air-conditioned offices; there are many ions in the air, but the metal ducting used in air conditioning systems tends to attractive negative ions more quickly than positive ones, thereby stripping the air of negative ions and leaving positive ones behind. Opening the windows, or using an ioniser, may help. Hot baths can trigger migraines in some people.

Dental causes

It is now recognisd that some types of dental problems can trigger migraines. One particularly strange one is that alterations of the bite can lead to different tensions in the muscles on either side of the head, and this in turn can cause migraines. Sometimes the problem occurs when so many teeth have been lost that the jaw over-closes. Altering the angle of the bite can stop the provocative effects.

Unconscious grinding of the teeth often occurs during sleep, causing tension in the muscles that form the cheeks; this may also prompt an attack. Relaxation therapy may help to reduce the over-all level of stress.

Neck pain

Spasm of the muscles in the neck, which often occurs as a result of minor malpositioning of the vertebrae, can set off migraines. Improvement in the care of the neck – sometimes by manipulation, sometimes by better ergonomic planning – may bring dramatic improvements.

Smoking

Smoking can generate migraines, too. There is a cross-over effect with a food allergy to potatoes, tobacco and tomatoes, as these plants are all closely related.

Body clock

Changes to the body clock such as jet-leg, or going on to night shift may trigger migraines; also, holidays and weekends (with relaxation from stress, late rising, and erratic bedtimes) may do the same.

Anaemia

Anaemia can both worsen migraine attacks, and increase their frequency. Why Me?

Only one form of migraine is known to be completely genetic in origin. This is familial hemiplegic migraine, a specific (and rare) type of migraine. In this form of migraine, the migraineur suffers from transient paralysis of one side of the body; and other close members of the family suffer from an identical type of migraine.

Although a direct genetic link hasn’t been established in other types of migraine, migraine does seem to run in families. Nearly half of migraine sufferers have a near relative with the disease, compared to one-sixth of non-migraineurs.

There may be several reasons for this. Firstly, some people have migraines because of food allergies. The tendency to be allergic is probably a single inherited gene, but the allergen to which you are sensitive and how it manifests itself depends on many other things – such as what substances you’ve been exposed to, especially at certain vulnerable times of your life. Therefore, migraines caused by food allergies are not solely genetic in origin.

The second reason is that there are probably several different genes involved in migraine, and whether you tend to get migraines or not depends upon what mix of genes you receive in your own genetic make-up.

The third reason migraines run in families is that stressed parents often teach their children stressful behaviour by example. Or, more relevantly, they don ‘/teach them how to cope with stress, because they don’t know how to do so themselves. Stress therefore runs in families, but in a non-genetic way.

There is no relationship between migraines and class, race or intelligence.

A slight statistical relationship exists between migraine and epilepsy. Both share a number of neurological features, such as visual symptoms, and a spread of the effect within the movements of the brain. In particular, temporal lobe epilepsy can share some features with migrainous attacks; and in those with both migraine and epilepsy, a high proportion started their epilepsy in the years immediately after the migraines started.

There is also a relationship with Meniere’s disease (one-sided deafness, dizziness and tinnitus); people with Meniere’s disease have a higher-than-average incidence of migraine.

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