Overpowered Resident Doctor

Migraines are clinically the most common type of primary headache.

The main symptom is episodic, moderate-to-severe, throbbing headaches. This includes pulsating pain in the forehead and temples, usually on one side, but sometimes on both.

The pain can last from tens of minutes to several hours, or even dozens of hours.

Furthermore, this pain is recurrent and difficult to cure.

It is often accompanied by nausea and vomiting.

Exposure to light and sound, or even daily activities, can worsen the headache.

A quiet environment and rest can alleviate the headache.

During an attack, it is often impossible to study or work normally.

Migraines often begin at a very young age, usually starting in childhood or adolescence, and reaching peak incidence in young to middle-aged adults.

Migraines also show a preference for women, with a male-to-female patient ratio of approximately 1:2 or 1:3. The prevalence in the general population is 5% to 10%.

Migraines have a hereditary component. About 60% of migraine sufferers have a family history, and their relatives have a three to six times higher risk of developing migraines than the general population.

Some data suggests that migraines are also common among white-collar workers.

Certain external factors can trigger migraines. For example, hormonal changes, such as during a woman’s menstrual period, can make attacks more likely.

Lack of sleep, or suddenly sleeping too much, can also be a trigger.

Other potential triggers include mental stress, emotional fluctuations, excessive strenuous exercise, irregular meals, or not eating enough.

Certain foods or medications, such as chocolate and alcohol, may also induce migraines.

Additionally, changes in weather, exposure to heat or cold, stuffy environments, climate shifts, low atmospheric pressure, exposure to flashing lights, strong odors, or noisy surroundings can all potentially trigger a migraine.

The factors listed above are all external triggers.

However, the specific pathological mechanism of migraines is still not clearly understood.

This is the greatest source of suffering for migraine patients. They often undergo various examinations, only for all the results to come back normal.

Yet the headaches keep returning to torment them, and they are left with no way to deal with it.

Yan Feifan had once read some research materials stating that for a certain group of people, the root cause of their migraines is the heart.

The source of their migraines is likely a small hole in the heart.

This hole is called a patent foramen ovale, or PFO.

The foramen ovale is a physiological channel in the atrial septum of the heart during the embryonic stage.

After birth, this foramen ovale closes in most people.

In some individuals, it fails to close, resulting in a patent foramen ovale.

Studies have found that the incidence of PFO in migraine patients is 30-40%.

Statistical data shows that among PFO patients who also suffer from migraines, one year after a PFO closure procedure, 60% experience complete relief from their migraines, while the remaining 40% achieve partial relief.

However, the pathogenic mechanism linking PFO to migraines is still inconclusive.

Some scholars speculate that it might be due to venous microemboli, or chemical substances (like serotonin) that are not cleared by pulmonary circulation, thereby triggering migraines.

Because a definitive pathological mechanism cannot be found, doctors currently approach migraine treatment from two main angles.

The first is avoidance, and the second is alleviation.

Avoidance involves identifying and avoiding migraine triggers as much as possible.

Alleviation involves using medication, physical therapy, or other methods to reduce the severity of the headache to a tolerable level.

「1:20 PM, examination room of the plastic surgery center.」

Yan Feifan quickly glanced over the examination reports from another hospital, handed to him by a middle-aged couple, and sized up the youth before him.

He was about 1.72 meters tall, with a slender build. Wearing a pair of glasses, he looked gentle and frail, with somewhat delicate features.

"When do the headaches usually occur? How many times a week?"

The youth replied softly, "About once or twice a week."

"It’s mainly in the afternoon. The right side of my head starts with a dull, throbbing pain, which gradually gets worse. It hurts a lot and seriously affects my studies."

"I’ll go to the athletic field to walk or jog, and usually, after about half an hour, the headache starts to ease up."

Yan Feifan nodded and asked, "Can you remember what you ate before each headache attack?"

"And what classes you had? What you were doing?"

The youth was taken aback for a moment, then recalled, "Doctor, I only remember what happened before the most recent headache, which was yesterday afternoon."

"For lunch, I had pork chop noodles and a banana."

"In the afternoon, I had physics and chemistry. During the study hall that followed, I was working on a physics test paper, and the headache started while I was doing it."

Yan Feifan instructed, "From now on, get a notebook or use your phone. Every time you have a headache, write down a detailed record of what you ate that day, what you did, the weather conditions, and so on."

"Migraines can be triggered by many different factors."

"Once you’ve recorded enough attacks, you might be able to find a pattern, discover the triggers, and then take steps to avoid them."

The youth nodded and said, "Doctor, I understand. I’ll create a headache log on my phone when I get back."

Yan Feifan pointed to the examination bed beside them and instructed, "Lie down on it. I’m going to give you an examination first."

As the youth lay down on the examination bed, Yan Feifan began to examine him with his hands, starting from his head and moving down inch by inch.

Yan Feifan’s thought was that checking for a patent foramen ovale in the heart would require a right-heart contrast echocardiogram.

This is an invasive procedure with certain risks, and it also costs a fair amount.

Relying on his detailed understanding of human anatomy, he decided to first check if the youth’s body had any other potential causes for the headaches.

Migraines aren’t an emergency. He didn’t want to casually suggest a risky and expensive procedure without being thorough.

And with this examination, Yan Feifan actually found something.

After examining the youth’s front, he had him turn over to examine his back. As he did, Yan Feifan felt that the left facet joint of the youth’s third and fourth cervical vertebrae showed significant wear.

’A migraine induced by cervical spine compression?’

With this suspicion in mind, Yan Feifan finished examining the youth’s back. Finding no other physical issues, he finally asked, "Do you have a habit of tilting your head to the left?"

Before the youth could even speak, his mother cut in anxiously, "Yes, yes! Mr. Yan, now that you mention it, I realize this child always tilts his head to the left when he’s doing his homework at home."

"Mr. Yan, are his headaches caused by tilting his head to the left?"

Yan Feifan replied seriously, "It’s just a possibility."

"However, this habit of tilting his head left needs to be corrected. The left facet joint of his third and fourth cervical vertebrae already shows clear signs of wear."

"There’s a definite possibility that this is causing nerve compression in the cervical spine, which in turn is triggering the migraines."

"How about this: take him to a licensed massage therapist for some cervical spine massage and Tui Na. Gua Sha could also work."

"Also, have him wear a neck brace to correct the habit of tilting his head left."

After a short pause, Yan Feifan continued, "Let’s treat the cervical spine first. At the same time, keep up with the migraine diary."

"After a while, if the migraines haven’t improved, come back and see me..."

Hearing this, the youth’s parents exchanged a look.

It was the mother who spoke up, asking, "Um... Mr. Yan, what about the migraine specialist?"

Yan Feifan smiled and said, "The tests you had done at the other hospital are already quite comprehensive. Since they didn’t find anything, a migraine specialist here at our hospital isn’t likely to come up with a new diagnosis."

"The most he would do is also tell your son to keep a headache diary and come back for a follow-up after some time."

He gave a clear signal to end the consultation, saying, "Let’s leave it at that for today."

"After a while, if the migraines haven’t improved, and you’ve got some entries in the headache diary, then come back and see me..."

After seeing the family of three out, Yan Feifan learned from a phone call that Yu Suye was still in surgery, so he went to the director’s office.

Feeling a bit tired, he lay down to rest on the sofa in the reception area, but he felt agitated and couldn’t seem to quiet his mind.

Just then, his phone rang.

Yan Feifan picked it up and saw that it was a call from Xv Shuang, a young nurse at the plastic surgery center.

"What is it?"

"Mr. Yan, that family of three is arguing."

"I snuck a listen... the husband is blaming his wife, saying they should have followed his advice and brought a gift."

"Now look, the promise to introduce them to a specialist is off the table."

Yan Feifan couldn’t help but chuckle. He suppressed it and said in a critical tone, "Instead of focusing on your work, you have the spare time to eavesdrop."

"Be careful, or I’ll dock your bonus..."

After hanging up, Yan Feifan felt partly amused and partly exasperated.

He hoped the family would follow his medical advice...

This small interlude unexpectedly calmed Yan Feifan’s mood considerably, and before he knew it, he had drifted off to sleep...

An unknown amount of time passed. In a daze, Yan Feifan felt someone watching him.

He opened his eyes and saw Yu Suye sitting beside him.

Yan Feifan quickly sat up and asked, "Are the results in?"

Yu Suye nodded. "Negative!"

Yan Feifan felt a huge weight lift from his shoulders. A wave of relief washed over his entire body.

"Good news! Great news..."

At this point, Yan Feifan realized his relief was too obvious. He quickly tried to explain, "Su Ye, it’s not that I don’t want to have a child with you..."

Yu Suye raised a hand to stop him. "No need to explain."

"When I saw the blood test results, I felt a wave of relief, too."

"This really is good news..."