Dear Doctor;

A friend of mine suffers from debilitating headaches and he cannot work anymore. All possible tests are turning out negative - heart, Brain CT scan, etc. Worse still, one physician says ‘do this’, another says ‘don’t do it’. What could be the problem? What should we try to underpin and focus on during diagnosis? Jareth. 

Dear Jareth, 

You have not specified the age of your friend, his job, where is the headache, localised to some part or generalised over entire head, when did the headache start, the frequency and duration, time of the day or night of the headache, so much of information is missing which could help in making a clear diagnosis. But if all tests done are negative and no abnormality has been found, a physical cause is unlikely underlying the headache. Most likely it is due to mental stress. Stress generated headaches such as migraine, tension headache, etc can also be very severe and disabling. Apart from all other tests, has he got the eyes tested? Because problems in the eyes such as severely reduced vision, glaucoma, among others, can also induce severe headache. 

Taking off for some days from work or change in the workplace or schedule can possibly help this person. He also needs to learn to relax completely both physically and mentally. He should learn to accept things as they come instead of getting stressed up. 

If the headache is severe, paracetamol with  a strong opiod pain killer drug like tramadol or codeine can help in obtaining relief. If the headache continues in spite of adopting other measures, it is advisable to repeat the tests, including CT scan of the head after about six months. If there is some underlying pathology which would have been dormant at that time may grow and become manifest later.