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OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Although, common migraine is very easy to diagnose because of its paroxysmal nature, rest of all the headaches are more or less due to tension (muscle contraction headache) seen in private practice. The commonest cause of dizziness is also anxiety and tension.

I want to mention a few conditions some of which may even be dangerous diseases, but still can be picked up by routine blood count, which in my opinion must be done as a part of full clinical examination.

During 40 years of my practice, I have picked up the following conditions in my clinic because of these reports.

1.Anaemia - This is a very common condition to cause dizziness and easy to treat. Mild anaemia can be missed on clinical examination.

2.Secondary polycythaemia is often seen in alcoholics and smokers, where Hb is 17 or 18 gms. These patients often complain of headache and dizziness. Omission of alcohol and smoking and increased hydration relieves them of these complaints, but if the Hb is more than 18 gms, venesection will have to be advised.

3.Polycythaemia vera is cancer of the red blood cells and has a very bad prognosis. It can be picked up easily because the white blood cells are also raised in this condition. Fortunately, it is a very rare condition and calls for haematological guidance for treatment.

4.A patient having multiple myeloma (cancer of the plasma cells) can come with the above 2 symptoms in addition to bone pains, etc. Presence of anaemia (specially in a male patient) and albumin (really speaking Bence Jones Protein) and/or a markedly raised ESR (around 100 mm at 1 hr) should remind you about this condition.

5.A patient having sickle cell anaemia can often complain of headache and dizziness.

6.A patient of lymphoma (cancer of the lymph glands) who has mediastinal glands pressing on superior vena cava often complains of headache, dizziness, along with swelling of the face and neck, which is maximum early in the morning, in addition to other symptoms like fever, loss of weight and anaemia.

7.Presence of anaemia in a patient having epileptic fits, should remind you of tuberculoma of the brain.

8.Finally, a patient of hypertension who develops an "accelerated phase", can develop headache and dizziness. Routine blood count may show mild anaemia which is due to a mechanical cause like having a prosthetic valve in the heart.

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