Meningococcal disease

Meningococcal disease is caused by bacteria (germs) called meningococci, also known as Neisseria meningitidis. Although meningococcal disease is uncommon, it is a very serious disease. The infection can develop quickly and can cause serious illness or death. Children under five years of age and young adults aged 15 to 24 years are most at risk. Early diagnosis and treatment with antibiotics are vital.

Meningococci bacteria commonly cause:
Meningitis – infection of the membranes covering the brain and spinal cord
Septicaemia – infection in the bloodstream.

Both these infections are medical emergencies. If you think a person has symptoms that suggest meningitis or septicaemia, contact your doctor immediately, call triple zero (000) for an ambulance or go to the nearest hospital emergency department.

Most common in winter and spring
Meningococcal disease can occur all year round and in all age groups. However, it is more common during winter and early spring. In Victoria, the highest risk is in children under five years of age and young adults aged 15 to 24 years. About one-third of cases are in people 25 years of age or older.

Signs and symptoms – infants and young children
Signs and symptoms of meningococcal disease in infants and young children can include:

• Fever
• Refusing to take feeds
• Irritability, fretfulness
• Grunting or moaning
• Extreme tiredness or floppiness
• Dislike of being handled
• Nausea and/or vomiting
• Diarrhoea
• Turning away from light (photophobia)
• Drowsiness
• Convulsions or twitching
• Rash of red–purple pinprick spots or larger bruises.

Signs and symptoms – older children and adults
The signs and symptoms of meningococcal disease in older children and adults can include:

• Fever
• Headache
• Loss of appetite
• Neck stiffness
• Discomfort when looking at bright lights (photophobia)
• Nausea and/or vomiting
• Diarrhoea
• Aching or sore muscles
• Painful or swollen joints
• Difficulty walking
• General malaise
• Moaning, unintelligible speech
• Drowsiness
• Confusion
• Collapse
• Rash of red–purple pinprick spots or larger bruises.

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MRSA

MRSA stands for methicillin-resistant Staphylococcus aureus. It causes an infection that is resistant to several common antibiotics. There are two types of infection. Hospital-associated MRSA happens to people in healthcare settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling.

Infection control is key to stopping MRSA in hospitals. To prevent community-associated MRSA

* Practice good hygiene
* Keep cuts and scrapes clean and covered with a bandage until healed
* Avoid contact with other people’s wounds or bandages
* Avoid sharing personal items, such as towels, washcloths, razors, or clothes
* Wash soiled sheets, towels and clothes in hot water with bleach and dry in a hot dryer

If a wound appears to be infected, see a healthcare provider. Treatment may include draining the infection and antibiotics.

Headache and eye problems

There are a variety of eye problems that can cause headache. In some cases, the headache is caused by the person squinting and overworking the eye muscles in an attempt to better focus their vision. In other cases, problems of internal pressure and swelling within the structures of the eye can ‘refer’ pain into other areas of the head. Difficulties with vision, such as blurring caused by long-sightedness, can be corrected with prescription glasses or contact lenses. Other disorders, such as glaucoma, need to be medically investigated and treated promptly. Once the cause of eyestrain is corrected, the associated headaches should ease.

The structure of the eye

The eye is our organ of vision. An image passes through its many layers and is focused on the back of the eye, called the retina. The retina contains light sensitive cells, called rods and cones. Information on shape, colour and pattern is picked up by the retina and carried to the brain via the optic nerve. The eye focuses images with two structures, the lens and the cornea. The lens is fine focus, while the cornea is fixed focus. The cornea is plumped up by a small chamber containing fluid called aqueous humour, while vitreous humour is the thick, jelly-like fluid that fills the main body of the eyeball and keeps it firm.

Refractive errors

The cornea and the lens work together to focus images on the retina at the back of the eye. Sometimes, this delicate interplay fails and the small muscles of the eye are forced to work harder. The result is tired, aching eyes, blurred vision and headache. Most conditions can be corrected with prescription glasses or contact lenses.

The main problems that cause eyestrain and associated headache include:

• Astigmatism - the cornea is not a regular shape, which means that objects look blurry from certain angles. A person with astigmatism tends to squint in order to better focus their vision, which can contribute to headache.
• Hyperopia - or long-sightedness. Instead of focusing the image squarely on the retina at the back of the eye, the image is focused to a point behind the eye.
• Presbyopia - the lens becomes hard and inflexible with age. The symptoms include difficulties in focusing closely, sore eyes, sluggish changes in focus when looking from one distance to another, and headache.

Glaucoma is a build-up of fluid

The eye disease glaucoma can cause severe headache in some cases. Intraocular pressure refers to the amount of pressure inside the eye exerted by the aqueous humour. Glaucoma is characterised by a build-up of aqueous humour, caused by insufficient drainage. The result is damage to the optic nerve. It is not possible to prevent glaucoma from developing, but early detection may help to curb its progression. The two main types of glaucoma include:

• Open angle glaucoma - the slow build-up of intraocular pressure over time; this type usually presents no symptoms.
• Angle closure glaucoma - the sharp increase in intraocular pressure results in severe pain, blurred vision, watering of the eyes, nausea and vomiting. This type of glaucoma attack needs prompt medical intervention.

How are cluster headaches treated?

The Cluster headaches can be very complicated to treat and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and additional headaches need to be prevented.

Initial treatment options may include the following:

* Inhalation of high concentrations of oxygen (though this will not work if the headache is well established);

* injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well;

* injection of lidocaine, a local anesthetic, into the nostril;

* dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;

* caffeine

Preventative cluster headache treatment options may include the following:

* calcium channel blockers [for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS), diltiazem (Cardizem, Dilacor, Tiazac)]

* prednisone (Deltasone, Liquid Pred)

* antidepressant medications

* lithium (Eskalith, Lithobid)

* valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax) (often used for seizure control)

Symptoms of headaches

The symptoms of tension headache are:

• A pain that begins in the back of the head and upper neck as a band-like tightness or pressure.
  


• Described as a band of pressure encircling the head with the most intense pain over the eyebrows.
  


• The pain is usually mild (not disabling) and bilateral (affecting both sides of the head).
  


• Not associated with an aura (see below) and are not associated with nausea, vomiting, or sensitivity to light and sound.
  


• Usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.
  


• Most people are able to function despite their tension headaches.
  

Symptoms of cluster headaches:

Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years.

• During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.
  


• Each episode of pain lasts from 30 minutes to an hour and a half.
  


• Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
  


• The pain typically is excruciating and located around or behind one eye.
  


• Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.
  


• The nose on the affected side may become congested and runny.
  

Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in males than females.

Headache Medication Guide

The accurate biological changes that arise with migraine, cluster, and tension headaches are not absolutely known. Medical research studies have shown that slightest one of the following factors is usually complicated:

1. Fluctuations in the amount of “neurotransmitters,” especially serotonin, circulating in the body. Neurotransmitters such as serotonin, nor epinephrine and dopamine are chemicals that special cells release to produce changes in your body. Inappropriate amounts of neurotransmitters can contribute to headaches, particularly chronic headache.

2. Inflammation around nerves and blood vessels in your head can result in pain.

3. In the past, medical experts thought that migraine was caused by blood vessel changes. When blood vessels enlarge (dilate), they can release irritating chemicals and physically stimulate surrounding nerves, both of which may lead to pain. We now know that blood vessel changes, though they do occur, are not the primary biological cause of migraine and other headaches.

4. Muscle tension previously was also viewed as the main cause of headaches. Today, we know that muscle tension can contribute to headaches but is not typically the main cause.

Most medications used in headache treatment are intended to help with at least one of the following:

1. Mimic serotonin effects
2. Maintain appropriate levels of your body’s own serotonin (or other neurotransmitters)
3. Limit inflammation
4. Stabilize blood vessels
5. Reduce muscle tension

Treatment of chronic headaches is often a challenging, long-term process. Though medications can provide benefits by themselves, they are usually more effective when combined with other therapies. These may include proper diet, stress management, adequate sleep, counseling and exercise.