Dieting: The right way

“The heaviest man ever recorded weighed in at around 635kg (99 stone) – about the weight of an American Bison.”

As January draws to a close, so too will many new year’s resolutions be wavering. In fact, around 80% of peoples’ resolutions will have failed by the second week of February. One of the most common ones will be to go on a diet and to join the gym. January accounts for around 12% of gym applications but most will have completely stopped after about 24 weeks. Even worse, around 87% of diets will have already failed by the 12th.

While I think the use of new year’s resolutions to kick start such health drives is a positive thing, there is so much information around, particularly online and largely unregulated, that may render those well intentioned efforts fruitless, quite literally.

Dieting is nothing new. At the beginning of the 20th Century, people turned to eating tapeworms to help them with weight loss – that is until they started getting intestinal cysts, meningitis and seizures. For some reason, during the 1930s and again in the 1970s, it became popular to eat half a grapefruit with every meal in the hope that the scales would become more complimentary. In the 1800s, apple-cider vinegar was added to water (apparently popularized by Lord Byron) and in the 1960s, a ‘drinking man’s diet’ emerged which consisted of eating lots of meat and washing it all down with alcohol, even at breakfast. 

The purpose of all of these, you will notice, will have been to lose weight. I suspect now, if you asked most people why they go on a diet or go to the gym, it will be ‘to lose weight’ or ‘to look better’. We have an ideal body shape these days which is endlessly highlighted through online and social media. There is a huge pressure for us to look right.

Arguably, this has been with us for a long time. One only has to look at the statues from ancient Greece and Michelangelo’s famous statue of David in Florence to see the template for the ideal build and shape of a human that has persevered ever since.

Not reaching that ideal puts huge pressure on our mental health. The trouble is, achieving it is getting harder and harder with the choices and options available to us, both in the modern diet and our increasingly sedentary lifestyles.

In the UK, 29% of adults are classed as obese, as are 20% of year 6 children.  It is thought that around 10,660 admissions to hospital each year are directly attributable to obesity. Thus the importance of controlling weight and fitness is not just about looking right.

All too often, people choose to make their lifestyle changes after something has happened – if they are lucky enough to do so – at which point the aims change from honing their body image to things like reducing blood pressure, preventing or controlling diabetes, treating depression, and lowering the risk of heart attacks and strokes. Ultimately, all of this is achievable, but not through the short term fad diets that are so popular in the consumer market of today.

Let’s look for a moment at the physiology of our body and its energy supply. We need energy to live, that much is obvious. That means every cell of the body, in order to function, needs a supply of energy. This comes from our diets which can broadly be split into three categories: fats, carbohydrates and proteins.  The majority of our energy comes from fat and carbohydrates. Fat is too large to be absorbed into the blood stream on its own, so when we eat it, it is broken down in the gut to form fatty acids and glycerol so it can be absorbed.

Fat is mainly stored in the liver and in the subcutaneous (skin) tissue. It can also accumulate around internal organs (visceral fat). When we are not eating and need energy, we draw on these stores to power our bodies, a process kick started by a drop in insulin levels. This will also bring into play the sugars stored around our body, again largely in the liver, in the form of glycogen. A drop in insulin will convert this glycogen into glucose and the fat into fatty acids and glycerol once more, which can then race around the body to power things.

As we eat, insulin levels rise. This encourages cells to take up glucose as a source of energy in the short term, but also promotes a reversal of the process above and stimulates the storage of all of the new energy we are ingesting so we can use it later.

Put simply, our weight is governed by the rate at which we store the energy from the foods we eat against the rate at which we use that energy.

Energy is measured in calories and one calorie is the amount of energy required to raise the temperature of water by 1 degree Celsius or 4.184 joules. 1,000 calories is equivalent to 1 kilocalorie and it is kilocalories that we see on the sides of our food packaging.

Hopefully therefore it should be fairly clear that, in order to maximise our health, there is a need for both healthy intake of food and an active, energy burning lifestyle. If not, then our weight will suffer along with a lot of other things. The heaviest man ever recorded weighed in at around 635kg (99 stone) – about the weight of an American Bison. In the UK, the record stands at 444kg (70 stone) – the weight of the average Moose.

Our intake of fats should be around 30% of what we eat. Any more and it can build up in our bodies and cause problems, for example high cholesterol, heart disease and obesity.

In the same way, getting all of our energy from carbohydrates (sugars) is not the answer either, as this can reduce our body’s sensitivity to insulin and cause diabetes. In a cruel twist, excess sugar can also be converted to fat anyway.

We all lament the fact that, in general, the foods that are bad for us are the ones that taste nice. The key, as I suspect you have heard many times over, is balance. This is not repeated for the sake of it but because it is truly important. Many modern diets will hinge on cutting out whole areas of energy – for example the Atkins diet and its dislike for carbohydrates. While this can result in fast initial loss in weight, it falls down in many other areas. If one cuts out an entire food group, one loses the benefits of the foods within that group. If you cut out carbohydrates, you’re cutting out a tremendous source of fibre, vital for gut health and a healthy microbiome. It is also likely you are depriving yourself of the many vitamins and minerals contained within those foods that your body needs. Longer term it falls short and, perhaps most important of all, it is not sustainable.

This brings me to my most important point. If you want to be healthier, reduce your risk of heart disease and diabetes, look better, feel better, lose weight, or whatever your goal, you need to make a permanent and sustainable change to your diet and lifestyle and avoid something that is unrealistic. If you say that you are going to the gym every day but one having not been for the past 5 years, it won’t work. Likewise, if you say you will cut out fat completely from your diet forever, it won’t work.

That’s not to say that making a change won’t be difficult but crucially, if you do it in the right way, it is something your body will eventually assimilate as the norm.

So…

  • Prepare your food for the week ahead and don’t shop while you’re hungry. If that chocolate bar is in the cupboard, you’ll eat it!
  • Join a gym, club or class but make your activity levels fun and sustainable so you aren’t put off it.
  • Watch out for portion size.
  • Use brown rice, brown bread and brown pasta
  • Avoid saturated fats and eat more polyunsaturated fats and cooking oils.
  • Plenty of fruit and vegetables
  • Set goals and guidelines to stay within
  • Eat 3 main meals a day and snack only on nuts and seeds (a tricky one but very important)
  • Drink 6-8 glasses of water a day
  • Reduce your alcohol intake
  • Stop smoking!

Good luck!

Summertime!

 

With all the hot weather recently, I have decided to focus a little on the impacts that a warm summer might have on our health. (Cue thunderstorms and rain). Many associate summer with some of the finer things in life – trips to the coast, beautiful clear skies, Pimms and a high concentration of bank holidays. For others, it means unbearable heat, vicious sunburn, stifling sleepless nights, sun cream all over your clothes and the long agonising wait for the start of the domestic football season to begin again.

In order to enjoy the positive aspects, I have put together some tips on staying healthy through the change in environment during these warmer months.

Let us start first with how our bodies regulate heat. The word homeostasis is used to describe the way the body maintains balance in various processes, including electrolytes in the blood and blood pressure. Part of this homeostatic balance however is related to thermoregulation. In other words, the body’s constant battle to keep its core temperature stable within quite fine margins – around 37.0 degrees on average. Any higher or lower than ideal and this begins to affect many of the normal processes going on in the body at any one time. For example, diabetics tend to absorb more insulin in warmer weather and so a closer eye on insulin doses is required.

Our main tactic in controlling temperature, at least in losing heat, is through the process of sweating. As we sweat, the water from our tissues takes heat from beneath the skin, and the heat energy is lost as the sweat then evaporates. It stands to reason therefore that, in warmer weather we sweat more and so our requirements for fluid go up. Normally we should be drinking 6 to 8 glasses of water each day (about 1.2 litres) but in warmer weather, we should increase this to allow for the extra fluid loss. It is no surprise that summer is kidney stone season, with twice as many presentations when compared to the winter months. This is in part due to greater rates of dehydration but also, as your skin gets more sun exposure, you produce more vitamin D which in turn increases calcium absorption and promotes the build-up of these stones in the kidneys.

Although not particularly hairy when compared to most mammals, the small hairs that cover our skin also help in the process. If our body decides it needs to lose heat, signals from the hypothalamus in the brain prompt the hairs to flatten across our skin. Conversely, if we need to warm up, the hairs stand on end (hence goosebumps) thus creating a tiny layer of air trapped in amongst them to warm us up a bit.

If we are getting too hot, our heart rate tends to speed up in order to speed the circulation from the core out to the peripheries where the heat can be transferred from the body through our skin.

As you can see, we have some inbuilt mechanisms to prevent ourselves from becoming overheated, but sometimes that is not enough. Heat stroke can be nasty and causes headaches, dizziness, confusion, cramps, and pale clammy skin. If this happens on a warm day, lie down in a cool shaded place, try to cool the skin with water and a fan, and drink lots of water or rehydration solutions (you can get these over the counter at any pharmacy or supermarket and are good to have handy, particularly on holidays in the sun). If this is not improving things within half an hour, or if you are concerned, you must seek urgent medical attention.

To keep cool in general, avoid prolonged exposure in the sun (fairly obvious), wear a hat to provide some shade, make sure you are well hydrated and avoid drinking too much alcohol which can dehydrate you.

At night, warm temperatures can really disrupt sleep, leaving you tired and unrested the next day. If flipping the pillow to the cool side isn’t quite cutting it, you could try the following measures.

  • Start when you get up… close the blinds and keep windows closed during the day if it is hot outside to prevent heat building up inside.
  • Avoid a heavy meal, especially with spicy food before bedtime.
  • Drink cold water, but not ice cold as sometimes this can confuse the body’s normal heat losing measures.
  • Take a tepid shower before bed.
  • Use light, cotton bedding
  • Encourage air flow with a fan
  • You can even put your bedding in a bag and then in the freezer for a bit so it is extra cool at bedtime.

Summer’s drawbacks are not always directly related to heat though. The other big drawback is hay fever. This is a real menace for many people and ranges from the very mild to the debilitating. The most severe cases require specialist input with immunotherapy. It is not a new problem and even as far back as the 9th Century, numerous remedies were put forward, some more successful than others. Inhaling tobacco, chloride of ammonia, chlorophorm or using cocaine spray never really caught on.

Classically, hay fever causes sneezing, coughing, runny nose and itchy eyes but it can manifest itself in other ways too. Loss of smell, headaches around the temples and forehead and tiredness can also be signs.

Over the counter remedies are often your best option to treat these, such as anti-histamines and eye drops but you can alleviate some of the symptoms even more by following these steps:

  • Use vaseline under the nose
  • Don’t dry your clothes outside (so they don’t pick up all the pollen)
  • Keep the windows shut and stay indoors when you can on days with a high pollen count
  • Use wrap around sunglasses
  • Vacuum and dust regularly
  • You can even get fit pollen filters for your car air conditioning

Hopefully for the most part, all of the negatives of summer are outweighed by the positives but if you follow the above steps, it will make things even easier on your body. And in some cases, the sun can even improve things. Those with skin conditions like eczema and psoriasis will see an improvement in their symptoms due to the increase UV exposure (UV phototherapy is a recognised treatment for psoriasis). Having said that, for most cases you should protect your skin from the sun as much as possible. Sun cream is essential and, if you neglect it, in later life you will be far more prone to damaged and unhealthy skin, not to mention a far greater risk of skin cancer. You have been warned.   

The Pancreas

While the pancreas may not be one of the A-listers or showstoppers of the organ world (if there is such a thing), it is as important as any other cog in the system. For a long time, perhaps owing to its position behind the stomach, its true function was completely unknown. It is curious in appearance, shaped a bit like a leaf and rubbery in texture (apparently). This gave rise to a certain vagueness in its naming – it means ‘all flesh’ in Greek. Until the late nineteenth century, many thought its only function was as a shock absorber in the upper abdomen just below the ribs and the sternum.

 

 

The discovery of a sneaky duct that connects it with the first part of the small intestine was the first clue that it might have a deeper role. It was then discovered that the pancreas secretes a rich cocktail of juice and enzymes through this duct and into the intestine in order to help with our digestion. Specifically it helps in breaking down fats (with an enzyme called lipase), starches (with amylase) and proteins (with various different proteases). Basically, anything with ‘ase’ at the end generally means it is an enzyme of some form or other.

This is important because, without the ability to break these dietary components into smaller building blocks, we would not be able to absorb them from the intestines into our bloodstream. In addition, the pancreas produces lots of bicarbonate (an alkali) to neutralise all of the acids secreted in the stomach so that once your food gets into your intestine, it is at optimal pH for absorption.

That role alone is extremely useful you might say, but the pancreas is not finished there. While its function in digestion relates to what is known as the exocrine system (essentially ‘exo’ means outside and the digestive system is classed as ‘outside’ because it begins and ends outside!) the pancreas has a vital endocrine role. Endocrine relates to the travels of hormones throughout the closed circulatory system, i.e. the blood.

In those years where scientists considered the pancreas to be nothing more than a glorified cushion, hormones controlling the body’s sugar levels were thought to be pumped into the circulation from the brain. This idea persisted until a chap called Langerhans identified in 1869 an area of tissues in the pancreas different from the rest. When these areas were (rather cruelly) removed under anaesthetic from dogs, the animals went on to develop features of diabetes.

Through various means subsequent to this, it was proved that these ‘islets of Langerhans’ (useful to know for pub quizzes) secreted hormones, the first of which discovered was named insulin after the Latin term for ‘islands’. We now know that the pancreas also produces a second hormone called glucagon as well. As part of the endocrine system, these hormones are secreted from the pancreas into the bloodstream and it is here that they perform their vital work.

Insulin helps the cells around the body to take up sugar from the blood stream to use as fuel and also helps to store it in the liver. Glucagon performs the opposite role, mobilising energy stores in the liver and fatty tissue for those days when we’ve not had time for lunch or have decided to run a marathon.

In this way, to use a rather crude comparison, the pancreas is a bit like the national grid. When it receives certain signals that more energy than usual might be required, like going for a long run (just as TV coverage of a royal wedding, for example, might cause a surge in electricity uptake, to keep the national grid analogy alive), it prepares by secreting more glucagon to draw from the reserve of energy we keep stored in our livers and fatty tissue. If, on the other hand, we are providing more energy than we need by eating lots of sugar, the body switches to insulin to use up the sugar being eaten and store any spare energy left over. 

So evidently the pancreas when it is working well is extremely important. When it is not, diabetes can result. But what else might go wrong?

Sometimes, the pancreas can become inflamed and this is known as pancreatitis. Every medical student will most likely know (or at least have heard of) the pneumonic GET SMASHED. Each letter represents a potential cause for pancreatitis, the two most common being Gallstones and ETOH or Excessive Alcohol. ‘S’ stands for Scorpion venom and, as there are not many scorpions running around Henley, I’ll not dwell on that too much.

Pancreatitis can range from the mild to the severe and can even be life threatening. Symptoms include severe upper abdominal pain going through to the back, nausea and vomiting. You may also sometimes get a fever and also diarrhoea. It often results in a stay in hospital where you can receive pain relief, fluids and oxygen if needed.

The other main condition affecting the pancreas is cancer. Pancreatic cancer is the UK’s 11th most common cancer and tends to affect those in older age groups more. Around 9,600 people in the UK develop pancreatic cancer each year.

The big issue with pancreatic cancer that gives it a high mortality rate is the difficulty in its detection. This means that it is often picked up only at later stages. Researchers are always looking for effective tests that might be used as a good screening tool, but as yet none has been found. The symptoms are often very vague but include…

-Weight loss

-Dull, boring pain or fullness in the upper abdomen which can go through to the back as well

-Jaundice, often without pain or any other symptoms (this occurs because of the pancreas’s proximity to the bile duct which, if pressed on, causes a back-up of the pigment bilirubin in the blood.)

One in ten cases may have a genetic element so, if a family member has had pancreatic cancer younger members may sometimes be screened.

If you are at all concerned about this, it is of course always worth coming to see your GP for a check.

As always, there is always more to learn. Even now, research is being done into other hormones produced by the pancreas which may perform roles as yet unknown, thereby, in the future, potentially opening up different possibilities for the treatment and understanding of various diseases, including diabetes. For that reason alone, I think the pancreas deserves a little more time in the limelight.

 

 

 

 

 

Dry January: Probably a good idea

‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems.

I saw a programme on television a while back (I think Chris Packham was involved) in which there was a gentleman who, seemingly unprovoked, would quite regularly lose co-ordination, become disorientated and somewhat ‘lary’. Despite his protestations, his wife began to suspect that he was sneaking off to the pub at every available opportunity without telling her. Understandably this placed rather a strain on their relationship until finally it transpired that he was innocent after all. It turns out he was suffering from something called Auto-brewery Syndrome.

This thankfully rare condition is thought to occur when there is an overgrowth of yeasts in the intestines that produce a natural fermenting process in the gut, resulting in high alcohol levels that make the sufferer quite literally drunk without having consumed any alcohol.

Fermentation (the science of which is known as zymology for the purposes of pub quiz trivia) is key to producing alcohol and there is evidence to show that we, as a species, have been using it to make alcoholic drinks for thousands of years, as far back as 7000 BC. In the middle ages we were brewing beer as an everyday drink, often protecting against various water-borne diseases. It was also quite handy for sailors to take along with them on long voyages. Essentially, alcohol – specifically in alcoholic drinks ethyl alcohol or ethanol – is produced when yeasts and bacteria break down natural sugars found in fruits and grains in the absence of oxygen. Lactic acid that causes cramp in muscles during exercise is formed through a similar process.

Of course, as much as we like it, drinking the stuff does not always result in the best of outcomes. Some research has estimated that, at any one time, up to 0.7% of the world’s population (equivalent to around 50 million people) are drunk. Unfortunately in the UK in 2016 7,327 people died from alcohol specific causes and around 40% of all violent crime involves alcohol in some way. It accounts for more than a million hospital admissions each year.

As you can imagine, this creates rather a strain on the health service as well as on a person’s general health. When we drink alcohol, it creates a numbing effect on the brain, resulting from inhibition of certain neurotransmitters. Most likely it is this sensation that has us coming back for more each time. While in the moment it could be described as pleasant, it has some far more negative effects.

Your body reacts to ethanol as a toxin and this causes a reduction in insulin effectiveness in the long term if we drink a lot. Conversely, in the hours after drinking lots of ethanol, there will be an upturn in insulin production, lowering our blood sugar and causing tiredness and fatigue. As it is broken down, it produces acetaldehyde, which is heavily implicated in hangovers. It is also something which has been implicated in ethanol’s role in causing cancer, in this case by damaging DNA.

There are seven proven types of cancer (probably more yet to be proved) in which alcohol has a causative role: bowel, breast (possibly due to increased oestrogen levels), laryngeal, pharyngeal, mouth, oesophageal and liver. The liver becomes more and more damaged with persistent alcohol use and the scarring produced from this (cirrhosis) can cause irreparable and unpleasant consequences which may ultimately be fatal.

If that is not enough, excessive alcohol will drive up blood pressure and predispose a drinker to diabetes, all of which increase the risks of heart attacks and strokes. Alcoholic drinks account for around 11% of the UK population’s sugar intake further compounding this risk. It will inevitably cause weight gain and likely some tooth decay along the way.

Sleep can be greatly affected by alcohol. While many people drink as an aid to sleep, although that initial numbing effect may help them drift off, the sleep achieved will be restless and inefficient. Time spent in REM (rapid eye movement) sleep will be increased, resulting in less time spent in deep and restful slumber. This only causes fatigue and makes things worse rather than better. 

What then, is a ‘safe’ level of alcohol? The chief medical officer’s official recommendation is that we do not exceed 14 units of alcohol each week (one unit is 10ml of alcohol). This is a reduction from the old recommendations and represents roughly 6 pints of beer, or 6 glasses of average strength wine.
Often people underestimate how many units there are in their drinks – it is more than you might think!

If you do drink 14 units a week, spreading them out is the way to go rather than all at one time. If you are drinking any more than this, you are really not doing your health any favours, not to mention your bank account. Incidentally, the most expensive vodka in the world will set you back a cool 3.7 million dollars. ‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems. Served in a diamond encrusted crystal bottle, it is some fairly serious stuff. While not all alcohol is priced that high, it does highlight the glamour that often surrounds it. Therein lies much of its danger.

Dependence on alcohol can creep up on you and, if unchecked, can quite literally kill you. It is thought that only 6% of alcohol dependant people will access treatment every year, so if you are unsure it is worth coming to see your GP or accessing any of the online resources listed at the bottom of this article.

You may have heard every now and again about the benefits of alcohol. In the past, before the advent of anaesthesia, surgeons would ply their patients with alcohol before procedures and physicians would recommend a ‘hot toddy’ to stave off a cold. In fact, while giving an initial boost (due to the effects of alcohol on the mind) a dash of whisky in your hot drink probably only serves to slow down the natural process of fighting off the infection.

Certainly there have been studies reported in the papers about regular red wine being good for your heart. The truth is, certainly in my mind, that there is simply not enough evidence to back this up. While some studies have shown benefits, the context in which they have been carried out is far from conclusive. Things like red wine do contain ingredients known as flavonoids, thought to be rich in anti-oxidants which, among other things prevent clotting disorders. However, current evidence only points towards an overall benefit in a very small amount of alcohol (5 units a week) for women over 55 years old. Before you all go rushing down to the pub, remember that is a mere 5 units a week!

So I would recommend that the next time you feel a spot of cenosillicaphobia coming on – a pathological fear of an empty glass – consider filling it with something other than alcohol instead. I’m not saying we should stop drinking altogether but moderation is the overwhelming key. And if there are any generous billionaires out there, I would much prefer a nice house or three rather than a bottle of vodka. Thanks. 

The Dreaded Headache

“…there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment”

I was speaking to a friend recently who claimed that he had never had a headache. On further enquiry, it appeared he simply had no concept of what one might feel like, even the dreaded hangover headache.  Now I don’t have any statistics on this, but I suspect that this situation is very rare. Let’s face it, most of us get headaches and, unfortunately, there are lots of things that can lead to one.

Throughout history people have suffered and there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment. Drastic though that may seem, some have shown signs of bone growth around these holes, suggesting the patients survived this process. Altogether more civilised were the ancient Greeks and Romans who tried either peppermint tea or rubbing raw potato into their heads.

Overwhelmingly the most common cause is the tension headache and most of us will have experienced one of these. They occur due to muscular tension that can develop from the shoulders and neck or from around the muscles of the forehead if, for instance, one’s posture in front of the computer is not optimised. They can also develop through stress or if the eyes have been straining to read a screen for too long. It’s always worth popping to your optician to get your eyes tested if you feel you are straining a lot, especially if you’re getting headaches.

Although tension headache is most common, it is perhaps over-diagnosed at the expense of another common cause of headache – the migraine. Thought to have a global prevalence of 14.7%, it is estimated that the UK population loses 25 million work or school days from the condition each year. That equates to roughly £2.25 billion loss to the economy and produces a £150 million cost to the NHS through prescriptions and GP appointments.

Migraines are typically one sided (although not always), hence the derivation of their name from the Greek word ‘hemikrania’ meaning ‘half the skull’. Despite their impact and prevalence, the process behind what causes them is still unknown. Rather than relating to blood vessels in the brain constricting and then dilating as once thought, it is now suspected to be more related to particular neurological systems. There is ongoing research into various facets of this, including particular gene associations (there is a definite hereditary element to migraines), specific brain regions activated in the earliest stages and the roles of various neuropeptides. It’s all pretty complex stuff.

One third of migraines will start with an aura (a visual phenomenon a little like the image below although it can differ from person to person) and may progress to a throbbing ache, typically lasting for between 4 to 72 hours. Women are more prone than men, and tend to suffer more often during or just before their periods.

Just one way you might visualize an aura

If you have a migraine, it is best treated as early as possible with paracetamol or ibuprofen. If these don’t work, regular sufferers may benefit from trying one of the triptan medications available on prescription. Once established however, a migraine can be debilitating and so lying down in a dark room and resting is often the best course of action.

It’s worth considering that there can be certain triggers. Coffee, chocolate, sugar-free food sweetened with aspartame or sucralose and any foods containing tyramine such as citrus fruits, bananas, processed meats, onions and nuts are all potential offending items.

What of other causes of headaches? I mentioned hangovers earlier and these must be up there alongside tension and migraine headaches in terms of prevalence. Essentially, when we drink lots of alcohol, our bodies dehydrate and this reduces our circulating volume of blood. This causes a shrinkage of the brain that then pulls upon the membranes holding it in place, thus causing an ‘ache’. Like the migraine however, the full process is not wholly understood and there is a theory that suggests a significant contributing factor may be the build-up in the brain, in place of glucose, of a chemical known as acetaldehyde (which is a breakdown product of alcohol).  Either way, the best way to avoid it is obviously to limit alcohol intake and, if you are going to drink a lot, ensure you drink plenty of water before bed and in between alcoholic drinks.

There are several more severe and mercifully less common headaches worth mentioning.

Trigeminal neuralgia (the trigeminal nerve is a major nerve that supplies various areas of the head and neck; neuralgia is ‘nerve pain’) is characterised by short episodes of sharp, intense, electric shock pain in the eyes, nose, scalp, forehead, jaw or even lips. Even the slightest touch can trigger it, including a light breeze, and it can be life-changing for sufferers of severe forms.

Similarly, cluster headaches can be so severe that they are sometimes referred to as the suicide headache. The pain from these is often described as a penetrating and excruciating pain around the eye and can last anything from 15 to 180 minutes. Some have labelled it the worst pain a human can experience. If you are suffering from these, the chances are you won’t need prompting to come and see a doctor.

If you suddenly experience a sudden severe (often described as thunderclap) headache, one that you might describe as the worst headache you have ever had (assuming you have never had a cluster headache!) or as if you have been hit on the back of the head, it might be a sign of a different cause – a subarachnoid haemorrhage (subarachnoid means below the outer layer of the brain, haemorrhage = bleed). This can be accompanied by sensitivity to light and neck stiffness, much like those suffering from meningitis. This needs a trip to A&E to get tested.

More subtly, but still serious, is a headache that manifests in tenderness over your scalp. If you have pain when you press over your temples (typically, in contrast, rubbing here with a tension headache helps) then it may represent an inflammation of the blood vessels in the scalp known as temporal or giant cell arteritis. This is a rheumatological condition and may require blood tests and maybe even biopsy of the offending areas. It can also cause blurred vision so if you think this is happening (typically you will be a woman around your 70th year) then it is worth coming to see us.

Finally, if you are waking up every morning with a headache over the course of several weeks, this is probably something you should also get checked out. It could well be tension, a stiff neck or blocked sinuses but this pattern can sometimes point towards pressure within the brain itself caused by a tumour. No harm in coming to get it checked by us.

Far from wanting to worry you, the chances are that, if you have a headache, it is caused by tension or a migraine. So my advice is similar to what it would be for many other health conditions. Maintain a healthy and balanced diet, with plenty of exercise, and ensure you drink enough water through the day. Get your eyes checked regularly and make sure you consider your posture both at work and at home on the sofa. Manage stress (as much as that is possible!) and if you are worried that the headache has any worrying features, feel free to come and see your GP. As for hangover headaches though, I’m afraid you’re on your own. “