Bones

In Paget's disease of bone, the bones of the head enlarge and grow abnormally, the abnormal growth being associated with headache and, incidentally, an increase in hat size. The eyes themselves might show optic atrophy, and close inspection of the fundi can reveal the curious appearance of wavy lines known as angioid streaks. Oxycephaly is a congenital defect of the skull caused by premature closure of the sutures; patients sometimes complain of headache, as well as visual loss because of optic nerve compression. Multiple myeloma is the name given to a malignant proliferation of plasma cells within the bone marrow. There is also an excessive production of immunoglobu-lins. Osteolytic bone lesions occur especially in the skull, and headache can be an accompaniment. The disease is more common in the elderly and is accompanied by a high ESR. Diagnosis is made by examining the urine for Bence-Jones proteins and the serum for abnormal immunoglobulins. Disease of the cervical vertebrae is another cause of headache, because of the effect of spasm of the neck muscles. Relief of the pain by neck manipulation has been claimed, but the exact diagnosis must be made before embarking on such treatment.

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