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The complexity of the Brain

About a week ago, I was going through my medical records of when I was first admitted to the hospital following the rupture of my aneurysm. Something caught my attention that has led me to a new conversation… or perhaps just digging deeper into the complexity of life. This was on my neuro checks at the section where they had to record my level of consciousness. At one point, it was indicated that I was unconscious and the other times, it was indicated that I was semi-conscious. It got me thinking…what is the difference/relationship between brain and mind, alert and conscious? Does the brain control the mind? If you are alert, can we assume that you are also conscious?

In Biology, we are told that the brain is part of the tangible and visible world of the body. You can see it and you can feel it. The mind, however, is the part of the invisible, transcendent world of thought, feeling, imagination, and attitude. In other words, the mind is the devil’s right hand. It is responsible for all the negativity, laziness, restlessness, doubtfulness…etc. The mind cannot manipulate the brain but the brain can manipulate the mind by what we commonly refer to as intuition. Intuition can only be successful at influencing the brain if the person if fully conscious.

From the healthcare standpoint, to be alert, you only need to be awake and responsive. To be conscious, you need to be: alert, attentive, able to follow commands and be aware of your surroundings.

Doctor Jacob Sage, a neurologist and one of the well-known bloggers, defines conscious as nothing more than the ability of our brain to acquire information (which is the state of being awake)  AND all the content that the information contains AND the ability to get all that information into and out of memory. The key word is “ALL”. If you have all that, you are conscious of the blue sky and the red sun. Nothing more is needed to be conscious of that beautiful sky.

The Complete Headache Chart

How well do you know your headaches? Here is a complete list of the different types of headaches.

The Complete Headache Chart

Allergy Headaches

Symptoms: Generalized headache; nasal congestion; watery eyes

Precipitating Factors: Seasonal allergens, such as pollen, molds. Allergies to food are not usually a factor.

Treatment: Antihistamine medication; topical, nasal cortisone related sprays; or desensitization injections

Prevention: No

Aneurysm

Symptoms: May mimic frequent migraine or cluster headaches, caused by balloon-like weakness or bulge in blood-vessel wall. May rupture (stroke) or allow blood to leak slowly resulting in a sudden, unbearable headache, double vision, rigid neck. The individual rapidly becomes unconscious.

Precipitating Factors: Congenital tendency; extreme hypertension

Treatment: If aneurysm is discovered early, treat with surgery.

Prevention: Keep blood pressure under control to prevent.

Arthritis Headaches

Symptoms: Pain at the back of head or neck which intensifies on movement. It is caused by inflammation of the blood vessels of the head or bony changes in the structures of the neck.

Precipitating Factors: Cause of pain is unknown

Treatment: Anti-inflammatory drugs, muscle relaxants

Prevention: None

Caffeine-Withdrawal Headaches

Symptoms: Throbbing headache caused by rebound dilation of the blood vessels, occurring multiple days after consumption of large quantities of caffeine.

Precipitating Factors: Caffeine

Treatment: Treat by terminating caffeine consumption in extreme cases.

Prevention: Avoiding excess use of caffeine

Chronic Daily Headaches

Symptoms: Refers to a broad range of headache disorders occurring more than 15 days a month; two categories are determined by duration of the headache (less than four hours and more than four hours).

Precipitating Factors: Typically evolve from transformed migraine. Although not related to chronic tension-type headache, they can evolve from episodic tension-type headache. Can be associated with medication overuse.

Treatment: Depending on the type of CHD, different treatment options exist. It is important to limit analgesic use.

Prevention: Based on diagnosis of headache, how long they last, and the number experienced per month.

Cluster Headaches

Symptoms: Excruciating pain in the vicinity of the eye; tearing of the eye; nose congestion; and flushing of the face. Pain frequently develops during sleep and may last for several hours. Attacks occur every day for weeks, or even months, then disappears for up to a year. Eighty percent of cluster patients are male, most between the ages of 20 and 50.

Precipitating Factors: Alcoholic beverages; excessive smoking

Treatment: Oxygen; ergotamine; sumatriptan; or intranasal application of local anesthetic agent

Prevention: Use of steroids; ergotamine; calcium channel blockers; and lithium

Depression and Headaches

Symptoms: People with painful organic diseased tend to become depressed.

Precipitating Factors: Causes can originate from a wide variety of complaints that can be categorized as physical, emotional, and psychic.

Treatment: The presence of depression is often subtle and the diagnosis is frequently missed. Depression is a wide spread affliction that can be treated, but first it must be unmasked.

Prevention: Physicians can prescribe tricyclic antidepressants, selective serotonin re-uptake inhibitors, or monoamine oxidize inhibitors in the treatment of headaches associated with depression.

Eyestrain Headaches

Symptoms: Usually frontal, bilateral pain directly related to eyestrain. It is a rare cause of headache.

Precipitating Factors: Muscle imbalance; uncorrected vision; astigmatism

Treatment: Correction of vision

Prevention: Correction of vision

Exertional Headaches

Symptoms: Generalized head pain of short duration (minutes to an hour) during or following physical exertion (running, jumping, or sexual intercourse), or passive exertion (sneezing, coughing, moving one’s bowels, etc.)

Precipitating Factors: Ten percent caused by organic diseases (aneurysms, tumors, or blood vessel malformation). Ninety percent are related to migraine or cluster headaches.

Treatment: Cause must be accurately determined. Most commonly treated with aspiring, indomethacin, or propranolol. Extensive testing is necessary to determine the headache cause. Surgery is occasionally indicated to correct the organic disease.

Prevention: Alternative forms of exercise; avoid jarring exercises

Fever Headaches

Symptoms: Generalized head pain that develops with fever and is caused by the swelling of the blood vessels of the head.

Precipitating Factors: Caused by infection

Treatment: Aspirin; acetaminophen; NSAIDs; antibiotics

Prevention: None

Giant Cell Arteritis

Symptoms: A boring, burning, or jabbing pain caused by inflammation of the temporal arteries; pain, often around the ear, when chewing; weight loss; eyesight problems. This rarely affects people under 50.

Precipitating Factors: Cause is unknown. May be due to immune disorder.

Treatment: Steroids after diagnosis; confirmed by biopsy

Prevention: None

Hangover Headaches

Symptoms: Migraine-like symptoms of throbbing pain and nausea, but it is not localized to one side.

Precipitating Factors: Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue.

Treatment: Liquids (including broth); consumption of fructose (honey, tomato juice are a good source)

Prevention: Drink alcohol only in moderation

Hunger Headaches

Symptoms: Pain strikes just before mealtime. It is caused by muscle tension, low blood sugar, and rebound dilation of the blood vessels, oversleeping, or missing a meal.

Precipitating Factors: Strenuous dieting or skipping meals

Treatment: Regular, nourishing meals containing adequate protein and complex carbohydrates

Prevention: Regular, nourishing meals containing adequate protein and complex carbohydrates

Hypertension Headaches

Symptoms: Generalized or “hairband” type pain that is most severe in the morning. It diminishes throughout the day.

Precipitating Factors: Severe hypertension: over 200 systolic and 110 diastolic

Treatment: Treat with appropriate blood pressure medication

Prevention: Keep blood pressure under control

Menstrual Headaches

Symptoms: Migraine-type pain that occurs shortly before, during, or immediately after menstruation or at mid-cycle (at time of ovulation).

Precipitating Factors: Variances in estrogen levels

Treatment: At earliest onset of symptoms, treat using biodfeedback, ergotamine, dihydroergotamine, or a 5-HT agonist. Once pain has begun, treatment is identical to migraine without aura.

Prevention: Biofeedback; betablockers (propranolol, timolol); anti-convulsant (divalproex sodium); calcium blockers; and NSAIDs

Migraine with Aura

Symptoms: Warning signs develop, which may include visual disturbances or numbness in arm or leg. Warning symptoms subside within 30 minutes followed by severe pain.

Precipitating Factors: There is a hereditary component. Other factors include: Certain foods; the Pill or menopausal hormones; excessive hunger; changes in altitude; weather; lights; excessive smoking; and emotional stress.

Treatment: At earliest onset of symptoms, treat using biofeedback, ergotamine, dihydroergotamine, or a 5-HT agonist. Once pain has begun, treat with: ice packs; isometheptene; mucate; combination products containing caffeine; ergotamine; DHE injectable and nasal spray; 5-HT agonists; analgesics or medications, which constrict the blood vessels. Steroids may be helpful for prolonged attacks.

Prevention: Biofeedback; betablockers (propranolol, timolol); anti-convulsant (divalproex sodium); calcium blockers; and NSAIDs

Migraine without Aura

Symptoms: Severe, one-sided throbbing pain, often accompanied by nausea, vomiting, cold hands, sensitivity to sound and light

Precipitating Factors: There is a hereditary component. Other factors include: Certain foods; the Pill or menopausal hormones; excessive hunger; changes in altitude; weather; lights; excessive smoking; and emotional stress.

Treatment: Ice packs; isometheptene; mucate; combination products containing caffeine; ergotamine; DHE injectable and nasal spray; 5-HT agonists; analgesics or medications, which constrict the blood vessels. Steroids may be helpful for prolonged attacks.

Prevention: Biofeedback; betablockers (propranolol, timolol); anti-convulsant (divalproex sodium); calcium blockers; and NSAIDs

New Daily Persistent Headache

Symptoms: Best described as the rapid development (less than three days) of unrelenting headache. Typically presents in a person with no past history of headache.

Precipitating Factors: Does not evolve from migraine or episodic tension-type headache. It begins as a new headache and may be the result of a viral infection.

Treatment: Can resolve on its own within several months. Other cases persist and are more refractory.

Prevention: Does not respond to traditional options, but anti-seizure medications, Topamax, or Neurontine can be used.

Post-Traumatic Headaches

Symptoms: Localized or generalized pain, can mimic migraine or tension-type headache symptoms. Headaches usually occur on daily basis and are frequently resistant to treatment.

Precipitating Factors: Pain can occur after relatively minor traumas, but the cause of the pain often difficult to diagnose.

Treatment: Possible treatment by use of anti-inflammatory drugs, propranolol, or biofeedback

Prevention: Standard precautions against trauma

Sinus Headaches

Symptoms: Gnawing pain over nasal area, often increasing in severity throughout day. Pain is caused by acute infection, usually with fever, producing blockage of sinus ducts and preventing normal drainage. Sinus headaches are rare. Migraine and cluster headaches are often misdiagnosed as sinus in origin.

Precipitating Factors: Infection, nasal polyps, anatomical deformities, such as deviated septum that blocks the sinus ducts

Treatment: Treat with antibiotics, decongestants, surgical drainage, if necessary

Prevention: None

Temporomandibular Joint (TMJ) Headaches

Symptoms: A muscle-contraction type of pain, sometimes accompanied by a painful “clicking” sound on opening of the jaw. It is an infrequent cause of headache.

Precipitating Factors: Caused by malocclusion (poor bite), stress, and jaw clenching

Treatment: Relaxation, biofeedback, and the use of a bite plate are the most common treatments. In extreme cases, the correction of malocclusion may be necessary

Prevention: Same as treatment

Tension-Type Headaches

Symptoms: Dull, non-throbbing pain, frequently bilateral, associated with tightness of scalp or neck. Degree of severity remains constant.

Precipitating Factors: Emotional stress, hidden depression

Treatment: Rest; aspirin; acetaminophen; ibuprofen; naproxen sodium; combinations of analgesics with caffeine; ice packs; muscle relaxants; antidepressants, if appropriate; biofeedback; psychotherapy; temporary use of stronger prescription analgesics, if necessary.

Prevention: Avoidance of stress; use of biofeedback; relaxation techniques; or antidepressant medication

Tic Douloureux Headaches

Symptoms: Short, jab like pain in trigger areas found in the face around the mouth or jaw; frequency and longevity of pain varies. It is a relatively rare disease of the neural impulses and is more common in women after age 55.

Precipitating Factors: Cause unknown, pain from chewing, cold air, touching face. If under age 55, may result from neurological disease, such as MS.

Treatment: Anticonvulsants and muscle relaxants, neurosurgery

Prevention: None

Tumor Headache

Symptoms: Pain progressively worsens; projectile vomiting; possible visual disturbances speech or personality changes; problems with equilibrium; gait, or coordination; seizures. It is an extremely rare condition.

Precipitating Factors: The cause of tumor is usually unknown.

Treatment: If discovered early, treat with surgery or newer radiological methods.

Prevention: None

Brain Aneurysm: Recovery continues…

As I had mentioned before, recovery following treatment of a ruptured brain aneurysm is a lifetime process. Based on my own experience, I think the recovery process mimics the stages of grief in the Kubler-Ross Grief Cycle .


  1. Denial

From the moment I regained my consciousness while in the ICU unit and had to face the facts, I went right into denial. This could not be happening to me, I thought. I convinced myself that it was only a dream and I would soon wake up from it. The last thing that I remembered was going to bed in our house in Kampala on a Friday night and I was feeling alright. How could I have woken up on a Wednesday morning in a Hospital bed in South Africa? Then when the physiotherapy tried to help me initially with ambulation, I thought that I did not need her help but the reality was different.

2. Anger

This stage lasted for quite some time and I must admit that I haven’t fully recovered from it. I have spent a lot of days questioning myself and God for why it had to be me. 5 months prior to that I was back in the US to have my second child when I ended up having her at 35weeks due to elevated blood pressure. I witnessed God’s miracle during that childbirth. We proved to science that God rules over everything.

When we returned to Uganda, we had just stabilized ourselves and ready to make the very best of our stay when things turned upside down overnight. I was angry for not having a chance to say goodbye to our staff and friends. I wanted to find out who did this to me and why. I was angry that because of me, my husband’s job, my son’s school, and our staff’s jobs had been impacted forever.

3. Bargaining

I slowly transitioned into the bargaining stage. I started to avoid talking to people and just begged God to take me instead. I was blaming myself for having turned my family’s life into a completely different direction. This feeling became more intense when I heard my son talk about all the things that he missed while in Kampala especially his school, the chickens, and the staff. My husband wasn’t so thrilled about his new position and traffic in Dallas either.

However, I could not imagine my children living without a mother. They were too young and needed me. So, I started to bargain with God just to give me enough time to raise my children to an age where they would be independent. I knew my husband needed me as well.

4. Depression

This stage was brief for me. My children, my husband, and my family members had given me a good reason to live. Their love and care renewed my hope for the future. I had refused to have my other aneurysm that is still intact to be monitored, but I decided to keep up with it.

5. Acceptance

Finally, I learnt to accept that God chose me for a reason and I decided to start looking at my life in a completely different angle. I had to move on. I had to find things that make me happy and do them. I started living by a check box rather than spend an eternity in the planning face. I spend more time in the implementation phase now because I want to check all of my boxes. Above all, I have learnt to rely not only on my own understanding but from the Almighty God who is responsible for all of us and whose powers surpasses all human comprehension.

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