How can I be stressed when I lead a very health life?

Dr Flo,
I have had consistent headaches for close to a year now. I have seen neurologists and neurosurgeons and done various tests such as MRI and CT scans, and brain angiogram. The tests reveal nothing. One neurologist suggested I could be stressed. I have a very happy life, without problems. I am very involved socially and religiously. I do not understand why the neurologist said I could be stressed. I got some anti-depressants, which only worked when I was taking them. What does this mean? Should I be on constant medication? I am quite fit as I exercise daily and have a great physical and spiritual life. Which other doctor should I see since brain specialists have not found anything wrong?
Brenda

Dear Brenda,
Almost everybody gets headaches at some point, and the causes are very diverse. In many cases, headaches are a symptom of an underlying issue. Sometimes the cause of the headache is not something that can be physically detected, so when you do the tests for the brain, the results are normal. For example, with the most common types of recurrent headaches (tension, cluster and migraine headaches), the brain scans will be normal. This does not mean nothing is wrong, it just means that whatever is triggering the headache cannot be seen physically.
The most common type of headache is a tension headache. Usually, the pain is on both sides of the head and it may feel as though there is a tight band around the head. It occurs due to tightening of the muscles around the neck and the scalp. It may be triggered by fatigue, dehydration, hunger, light exposure (too little or too much), noise, congestion, stress, too little or too much sleep, or even poor posture. Tension headaches are usually not very severe, and resolve within an hour or so, with or without painkillers. To prevent them, then you need to figure out what your triggers are and address them for example rest, take enough water, eat regularly, get adequate sleep, avoid noisy or congested surroundings, wear ear muffs if you work in a noisy place, reduce screen time (computers, tablets and phones), make sure you work in well-lit areas, practise good posture and stress management. Sometimes taking a warm bath may also reduce the headache.
Cluster headaches occur for several weeks at a time, and are very severe and do not respond very well to painkillers. The pain is usually concentrated around one eye, and there may be redness and tearing from the eye or a blocked or running nose.
Migraine headaches are severe, usually affect one side of the head, and may be accompanied by increased sensitivity to light and sound, nausea and vomiting.
Headaches may also be caused by hormonal changes, medications, too much alcohol, exposure to carbon monoxide, flu, sinusitis, and almost every illness, especially those affecting the head and neck region. If a specific cause for the symptoms is identified, then it is treated.
Some medication helps to prevent recurrent headaches and painkillers can help with the headache. If regular painkillers do not clear the headaches, there are much stronger medications that are prescribed by neurologists. Most likely the anti-depressant medication you took is a type that can relieve headaches. When the headaches are constant, it is advisable to take medication continuously for a specified period. There are also some medications that are taken to prevent the headaches such as flunarizine and propranolol, which should be taken under the direction of a doctor. The best person to follow up on you is one neurologist. You may also benefit from evaluation by a psychologist.
You also need to identify triggers (such as hunger, dehydration, heat, congestion, noise and motion) that may start the headache and the easiest way to avoid the symptoms is by avoiding the triggers.

Dr Flo,
My five-year-old son was recently treated for an ear infection, and yesterday he had pus oozing from his left ear. The pain has reduced. But, I am worried he will develop a hearing problem. Is there a way to prevent the ear infection from recurring?
Concerned parent

Dear concerned parent,
Infections of the ears are quite common in children. When the middle ear is affected, that is the part behind the eardrum, then the infection is called otitis media.
It may be due to a bacterial or viral infection, and most of the time, they occur during or after an upper respiratory tract infection (running nose, throat pain, tonsillitis and cough). The infections are also common in those with allergies, exposed to tobacco smoke,  use pacifiers a lot and not breastfed for long. Some people also get ear infections after going swimming. There is a tube that connects the back of the throat to the middle ear, called the eustachian tube. The infection usually travels to the inner ear through this tube. In children, this tube is a bit wider, making it easier for the infection to move. Children also have a lower immunity than adults.
The child may have a fever, may complain of ear pain, you may notice that they do not hear well with the affected ear, and at some point, there may be a pus-like discharge from the ear if the ear drum ruptures. In the younger children who may not be able to talk, you may notice that they are pulling the ear repeatedly or hitting their hands against it.
Once the problem has been diagnosed, treatment will include antibiotics and pain medicine. Ear drops may also be useful. Dry the discharge by dry wicking - use pieces of cotton wool, roll the length of the cotton wool with your fingers and insert it gently into the ear canal. Allow it to absorb the discharge, then remove and repeat with another piece of cotton, until dry. You can repeat this three or four times a day. If otitis media is treated well when it first occurs, then it can heal without any complications, and the ruptured ear drum also heals. Unfortunately, for some people, the problem persists and keeps recurring. In such an instance, then you need to see an ENT (ear, nose and throat) specialist for further treatment, to prevent permanent hearing loss, and other complications.

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