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Case study: headache and allergic reaction CASE STUDY: HEADACHE AND ALLERGIC REACTION
Joan Kowan was one of my earliest and most difficult headache patients. She had been a student nurse until she was expelled from the nurses' training program for poor attendance. Her constant, severe headaches had prevented her from being able to keep up with her classmates. So severe were these attacks that, in desperation, she had consented to two brain operations. They were complete failures, and the surgeons could find nothing organically wrong.
In my office, she was found to be highly sensitive to milk. By avoiding milk and dairy products in all of their forms, she was able to control her headache problem and return to school. As time went by, however, it became increasingly difficult for her to avoid all forms of milk. She lived in a college dormitory and ate institutional food. While the regular cook had cooperated with her requests, he was not always there. For example, her vegetables were cooked and set aside before butter was added. A substitute cook, however, did not do this, and Joan unknowingly ate the buttered vegetables. Within an hour, she suddenly fell to the floor in the nurse's station, overcome by violent head pains. The cause of this reaction was traced, in retrospect, to the seemingly insignificant amount of butter on her vegetables. Such inadvertent exposures to milk were fairly common and most troublesome.
To alleviate the pain, she began to take codeine tablets, until she became addicted to them. She also became dependent on other pain-killers to which milk sugar was added as a filler. Thus, while these drugs appeared to give relief, they were actually perpetuating her basic problem.
Miss Kowan was so amazingly susceptible to milk that I thought it would be worth recording some of the features of her case for the medical record. She agreed to take an EEG (electroencephalogram) test, which records brain waves, while drinking a minute amount of milk.
To make the test "blind," she was given two drops of milk in a glass of water. This, at least, is what she was told she was receiving. Actually, the first sample she chose contained several drops of an inert antacid, aluminum hydroxide (Amphojel), in a glass of water. The water became slightly cloudy, just as if it had had milk added. She drank this with fear and trembling, since she anticipated one of her characteristic headaches. Nothing happened. She was then given two drops of actual milk in a glass of water, but she was told she was receiving more of the previous substance. This time she rapidly went into agonizing pain. In her writhing, she pulled herself free of the EEG machine, ruining that part of the experiment.
Her case made clear, however, the ability of even small amounts of an incriminated substance to cause severe and chronic headaches.
Miss Kowan eventually managed to get her allergy under control and to graduate. Years later I received a letter from her. She had obtained an excellent position with a large manufacturing concern and had a good work record, with few absences. "Since you saw me last," she wrote, "I have not faltered in my quest for a new future."
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