SUNDAY STAR, 19 JULY 2020
BRAIN HEALTH
More than a random bout of pain
“THE brain itself does not contain
pain fibres. Instead, the pain
originates from the tissues and
structures that surround the brain,”
says Dr Cheah Pooi Pooi, debunking
a common misconception
regarding headaches.
Dr Cheah, who is a consultant
neurosurgeon at ParkCity Medical
Centre, elaborates that the
periosteum (the thin layer of tissue
that surrounds bones and muscles
encasing the skull, sinuses, eyes and
ears), as well as thin tissues that
cover the surface of the brain and
spinal cord (otherwise known as
the dura, meninges, arteries, veins
and nerves), can become inflamed
or irritated, causing headaches.
According to the classification
developed in 2013 by the
International Headache Society,
there are three types of headaches:
l Primary headache
l Secondary headache
l Cranial neuralgias, facial pain
and other headaches
Dr Cheah says, “Primary
headaches are headaches that are
not the result of other medical
conditions. Common primary
headaches include tension
headaches, migraines and cluster
headaches. On the other hand,
secondary headaches are usually
the result of an injury, underlying
medical illness or an infection.”
Alternatively, cranial neuralgias
may present as a localised head or
facial pain or coexist with other
headache syndromes, such as
migraine. They can be an important
factor in patients with chronic
refractory headaches.
Knowing the difference
Headaches are a hindrance and
intense episodes can affect one’s
social schedules and ability to
perform at work. Dr Cheah
elaborates that most primary
headaches are benign in nature and
self-limiting in terms of timeframe.
Underlying causes of headaches
According to Dr Cheah Pooi
Pooi, consultant neurosurgeon at
ParkCity Medical Centre, a
secondary headache is one that
occurs due to underlying health
conditions. Secondary headaches
are more worrying as they can
lead to serious complications.
It is important to be aware of
the common causes and spot the
vital signs. Patients must seek
medical treatment as their
headache could possibly fall
under this category. Causes of
secondary headaches include:
l Trauma to the head and
neck
– Injuries to the head may
cause bleeding in the spaces
between the meninges and
layers of tissue that surround
the brain
– Swelling within the brain
following a trauma (not
associated with bleeding) that
may cause pain and change in
mental function
– Concussions, where head
Distinguishing between a primary and secondary headache is the first step to ascertain if you live with underlying
health conditions.
Her advice to people experiencing
these types of headaches is rest,
gentle massaging at the temples
or scalp or over-the-counter
medication such as paracetamol
(which, she adds, is very safe
to consume).
“However, secondary headaches
could be a sign of an underlying
serious illness or infection and you
should consult your doctor as soon
as you can,” advises Dr Cheah.
Often, patients question: how
can headaches be differentiated
from one another?
“Headaches can be difficult to
injuries occur without bleeding
– Whiplash and neck injury
l Blood vessel problems in
the head and neck
– Stroke or transient ischaemic
attacks (TIA)
– Arteriovenous
malformations (AVMs) when
they rupture, leak or bleed
– Cerebral aneurysm and
subarachnoid haemorrhages –
An aneurysm or weakened area
in the blood vessel wall can
expand and leak a small amount
of blood, causing what is called a
sentinel headache, which may be
a warning sign for a future
catastrophic bleed into the brain
– Temporal arteritis
(inflammation of the temporal
artery)
l Non-blood-vessel problems
of the brain
– Brain tumours – Either
primary, originating in the brain
or metastatic from a cancer that
originates from other organs
diagnose as they are subjective. In
most cases, the information we get
depends on what the patient
discloses during a consultation.
From the history given by a patient,
a doctor can get some indication
about the type of headache the
patient probably has,” says Dr
Cheah. Laboratory blood tests,
lumbar punctures (or spinal taps)
and some imaging studies are also
helpful when confirming the
diagnosis. Note that spinal taps are
not routinely performed in every
patient with headaches. Only
patients with high index of
– Seizures
– Idiopathic benign
intracranial hypertension –
where pressure within the
cranium or spinal canal
increases. While it can occur in
all ages, the cause is unknown
and often affects young, obese
women. It can cause severe
headaches and if left untreated,
may often lead to blindness
l Medications and drugs
(including withdrawal from
those drugs)
– A reaction to medication
such as oral contraceptives,
medications used to treat
erectile disfunction or other
heart medications.
– Overuse of medication –
Occurs when pain medications
are taken too frequently. Can be
caused by acetaminophen,
aspirin, ibuprofen, over-the-
counter analgesics containing
caffeine, narcotic painkillers
and other prescription pain
relief medication.
suspicion of having a brain
infection, or in cases where
benign intracranial hypertension
is suspected, will spinal taps be
helpful. Brain imaging (such as
CT scan or MRI) is also commonly
performed to rule out secondary
headaches, in order to treat the
headaches accordingly
and effectively.
In treating secondary headaches,
the first step is to treat the cause of
a patient’s headache. This often
relieves pain. Nevertheless, your
doctor may also address the
headache with over-the-counter or
Seeking medical care
Headaches are a common
health problem that most people
experience at some time or other.
Factors that may lead to
headaches can be emotional,
medical or physical. Most
headaches can be treated
effectively with medication,
however in certain instances,
headaches may be an indicator or
symptom of a more severe
underlying issue.
According to consultant
neurosurgeon Dr Cheah Pooi Pooi
at ParkCity Medical Centre, you
should seek medical attention
when you have the following
symptoms for a headache:
l When you describe your
headache as the “worst headache
of your life” – This is the wording
often used in textbooks as a cue
for medical practitioners to
consider the diagnosis of a
subarachnoid haemorrhage due
to a ruptured cerebral aneurysm
l When your headache is
different than your usual
headaches
Dr Cheah Pooi Pooi.
Common primary
headaches include
tension headaches,
migraines and cluster
headaches. On the
other hand, secondary
headaches are usually
the result of an injury,
underlying medical
illness or an
infection.
prescription drugs.
Many people experience more
than one type of headaches. In
most cases, these are primary
headaches and can be resolved
easily. However, Dr Cheah
cautions, “Anyone experiencing
severe or recurring headaches
must consult a doctor and receive
professional care.”
n For more information, call
03-5639 1212.
l If your headache starts
suddenly or is aggravated by
exertion, coughing, sneezing or
bending over
l Not responding to treatment
or getting worse
l Requires more than the
recommended dose of over-the-
counter medication for pain
l Associated with persistent
nausea and vomiting
l Associated with fever or
stiff neck – A stiff neck may be
due to meningitis or blood from a
ruptured aneurysm, but most
patients who complain about a
stiff neck have muscle spasms
and inflammation as the cause
l Accompanied by seizures
l Associated with a recent
head trauma or fall
l Associated with changes in
vision, speech or behaviour
l Associated with weakness
or change in sensation on one
side of the body that may be a
sign of stroke
l Disabling pain that interferes
with work and quality of life
2 Brain Health
Keeping your mind sharp as you age
WITH life expectancy on the rise, the quality
of our life in our later years is becoming
increasingly important. Keeping our minds
sharp and healthy has become a priority. So
what can you do?
You are what you eat
The core of our Malaysian culture is
food, and with so many delicious varieties
available, it is easy to overindulge
in something that may not have the
right nutrients.
What most people do not know is that
80% of your fitness is attributed to what
you put in your body and the other 20% is
actually doing the physical work. Just like
your body, your brain also thrives on a well-
balanced diet. A healthy diet can contribute
to preventing conditions such as diabetes
and high blood pressure that may impair
your mental functions.
In the Neuroprotective Diets Are
Associated with Better Cognitive Function:
The Health and Retirement Study,
researchers found that eating
Mediterranean and MIND-style diets is
linked to better overall cognitive function
in older adults. Older adults who follow
these healthy diets are also at lower risk
of cognitive impairment in later life.
Keep physically active
A study published in the Journal of
Alzheimer’s Disease in 2017 found that older
adults with better cardiorespiratory fitness
had less deterioration of the white-matter
fibres in their brains, which is responsible
for pathway communication within the
brain. The healthier the white-matter fibres,
the better people’s scores were on tests for
critical thinking and planning skills.
Adults should get at least 150 minutes of
physical activity each week. You should aim
Older adults with better cardiorespiratory fitness had less deterioration of the white-matter
fibres in their brains leading to better critical thinking and planning skills compared to their peers.
to move for about 30 minutes on most days.
Brisk walking is a good exercise that is
beneficial to cognitive health. Some other
ideas to stay active on a day to day basis are
to take the stairs rather than the lift; start a
hobby that keeps you physically active; park
your car further away than you would
normally and walk the extra distance; or if
you have a dog, take it for longer and more
regular walks.
Exercise your brain
Like your body, your brain also benefits
from being challenged. Through research,
scientist have found that mentally
stimulating activities encourage new
connections between nerve cells and may
even help the brain generate new cells,
develop neurological “plasticity” and build
up a functional reserve that provides a
hedge against future cell loss.
Lots of activities can keep your mind
active, including reading, playing games or
even volunteer work. People who engage in
meaningful activities are also said to feel
happier and healthier.
Learning a new skill may also improve
SUNDAY STAR, 19 JULY 2020
If you are not maintaining
social interactions on an
everyday basis, you may
be putting yourself at risk
of depression or dementia.
Interactions with peers lead
to a sharper mind and keeps
you connected to the world
around you.
your thinking. A study titled The Impact of
Sustained Engagement on Cognitive Function
in Older Adults: The Synapse Project, found
that older adults who learned quilting or
digital photography had more memory
improvement than those who only socialised
or did less cognitively demanding activities.
Be sociable
Social contact can be just as effective at
improving your mood and your quality of
life. If you are not maintaining social
interactions on an everyday basis, you may
be putting yourself at risk of depression or
dementia. Interactions with peers lead to a
sharper mind and keeps you connected to
the world around you. Visit family and
friends, take a class or join a club or group
to stay socially active. Social activity is vital
to seniors for their health and mental
well-being.
Cognitive health, motor and sensory
functions as well as emotional happiness are
all part of brain health. Regardless of your
age, be proactive and take the necessary
steps to keep your brain active and healthy.
SUNDAY STAR, 19 JULY 2020 3
4 Brain Health
Better blood flow for a healthy you
OVER the past few months, the world has
been grappling with the effects of the Covid-
19 pandemic, with more than 12 million
people infected and a death toll of 552,000,
according to the World Health Organization.
The most common symptoms of Covid-19
include fever, cough and shortness of
breath. There is also emerging data showing
that Covid-19 not only causes respiratory
illness, but is also associated with
neurologic complications such as stroke.
What do all these symptoms have in
common? Impaired blood circulation. In
fact, several retrospective clinical studies
have shown that the Covid-19 virus is prone
to attacking the lining of blood vessels all
over the body, deteriorating the body
defence system and forming blood clots in
the blood vessels, which can ultimately lead
to poor blood circulation.
Poor blood circulation is reflected in
restricted or blocked blood flow to various
parts of the body and vital organs such as
brain, which is usually due to blockage of
the blood vessels caused by blood clots
resulted from platelet clumping (platelet
aggregation). Subsequently, the lack of
oxygen and nutrient supply to the organs
may lead to:
l Fatigue
l Numbness and tingling sensations in
the hands and feet
l Cold hands and feet
l Chronic or life-threatening diseases
Maintaining healthy blood circulation is
important for a healthy life as it warrants
the smooth flow of blood that carries
oxygen and nutrients throughout the body,
allowing vital organs such as the brain to
function properly, as well as ensuring the
efficient transport of immune cells around
MIGRAINES are severe, recurring headaches
that can last for hours or even days. They
can sometimes be crippling in that they can
hamper daily activities of those who suffer
from them.
While there are headaches caused by
other underlying medical issues, most
migraine headaches are distinctive.
Characterised by a throbbing and stabbing
pain that usually affects one side of the
head, migraines are sometimes
accompanied by nausea, vomiting,
numbness and a tingling sensation in the
limbs. Many people also become sensitive to
light (photophobia) and sound
(phonophobia) during migraine attacks.
There are different kinds of migraines, the
most common ones are:
l Migraine with aura – Some people
experience optical disturbances such as
Many people who suffer from migraines can also become sensitive to light and sound during their attacks.
The most common
symptoms of Covid-19
include fever, cough and
shortness of breath. There is
also emerging data showing
that Covid-19 not only
causes respiratory illness,
but is also associated with
neurologic complications
such as stroke.
the body. Below are some tips to improve
blood circulation:
l Regular exercise
l Massages
l Staying hydrated
A natural health supplement
Fruitflow, a natural water-soluble tomato
extract, is the first natural, scientifically
proven ingredient that promotes healthy
blood circulation. It consists of a number of
bioactive compounds with anti-platelet
properties such as nucleosides, polyphenols
and flavonoids, which have been clinically
proven to improve blood circulation.
A daily dose of just 150mg of Fruitflow
natural water-soluble tomato extract can
help to improve blood circulation by
maintaining normal platelet aggregation,
according to a 2010 article titled Scientific
Opinion on the modification of the
Not just a headache
spots, zigzag lines, tunnel vision and flashing
lights just before or during the onset of a
migraine attack. These visual disturbances
are commonly known as auras and can last
from five to 30 minutes. People who
experience them often confirm that these
are the warning signs of an impending
severe headache.
l Migraine without aura – This is the
most common form, affecting almost 70% to
90% of people experiencing migraine. The
headache can last for hours if left untreated
or if it is unsuccessfully treated, and can
hamper daily activities. The frequency of
attacks differs from one person to another
and can vary in duration from several times
Improving your blood circulation not only helps to strengthen your immunity but also reduces
your risk of developing chronic diseases in the future.
authorisation of a health claim related to
water-soluble tomato concentrate and helps
to maintain a healthy blood flow and benefits
circulation pursuant to Article 13(5) of
Regulation (EC) No 1924/2006 following a
request in accordance with Article 19 of the
Regulation (EC) No 1924/2006 published in
EFSA Journal.
While strengthening your immunity to
fight against Covid-19 is important now,
a week to a few times a year.
l Chronic migraine – When someone
experiences a migraine for more than 15
days, they are diagnosed as having chronic
migraine. Healthcare professionals have yet
to pinpoint the cause of chronic migraine,
but people who experience such migraines
identify stress, sleep deprivation, caffeine,
hormonal changes and particular food items
as triggers. The impact of chronic migraine
can be far reaching, even causing depression
among those suffering from them because
they feel helpless.
l Menstrual migraine – Although there is
no proper diagnosis for menstrual migraine,
many women confirm that they experience
the attacks only during their periods, hence
the name. It has been observed that the
migraine usually begins a couple days prior
to the start or within three days of the onset
of menstruation. The best way to identify
this type of migraine is to keep an account of
attacks for at least three months to see if
there is a trend.
SUNDAY STAR, 19 JULY 2020
maintaining healthy blood circulation is vital
to reduce your risk of developing serious
illnesses in the future.
This article is brought to you by Biogrow.
n For more information, call 03-7956 2220
(Monday to Friday, 9am to 5pm), visit www.
biogrow.com.my and like the Facebook page
at www.facebook.com/BiogrowMY
While there are headaches
caused by other underlying
medical issues, most migraine
headaches are distinctive.
Characterised by a throbbing
and stabbing pain that
usually affects one side of
the head, migraines are
sometimes accompanied by
nausea, vomiting, numbness
and a tingling sensation in
the limbs.
l Hemiplegic migraine – This is a rare
form of migraine that can feel more like a
stroke. It doesn’t always include severe head
pain and those who have experienced this
type of migraine develop weakness on one
side of the body, often with visual aura
symptoms and a numb sensation, or loss of
sensation on one side of the body.
Hemiplegic migraine can last from a few
hours to several days.
l Migraine without head pain (typical
aura without headache) – Also known as a
silent or Acephalgic migraine, this type of
migraine can be alarming as you experience
dizzying aura and other visual disturbances,
nausea and other phases of migraine, but
without any head pain.
Unfortunately, there is no permanent cure
for migraine; it can only be controlled with
the help of painkillers and other kinds of
medication. It is advisable to consult a
healthcare professional, especially when you
suffer from chronic migraine attacks,
because taking too much over-the-counter
pain medications can have long-term
negative repercussions on your health,
including liver failure.