Headaches are some of the most common causes of chronic pain and there are several types of headaches, making diagnosis difficult in some people.

Migraine is the best-known chronic headache, and it causes a severe, pulsating (throbbing) headache that is usually on one side of the head. Persons who suffer migraine attacks frequently see visual hallucinations, are hyper-sensitive to light and noise, are nauseous and frequently vomit. The attack can go on for hours or days and is frequently incapacitating. There may be warning symptoms before the attack, and these are called auras. This can include visual hallucinations, pins and needles and even difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.

Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease. Your immune system mistakenly attack your own body cells and this cases inflammation in certain body parts. It specifically attacks joints of the hands, wrists and knees. The process of joint damage is caused by inflammation of the lining of the joint. Some persons with RA develop deformed joints. RA can also attack the lungs, heart and eyes.

Because it is a disease of inflammation there are cycles of flares (when the inflammation becomes worse) and remissions (when the inflammation lowers) and the symptoms include pain and stiffness of joints, swelling of the joints. It is usually the same on both sides of the body and persons with this disease can show effects of a chronic illness with weakness, fatigue, weight-loss and sometimes fevers.

It is not clear what causes RA, but the following are risk factors: genetic predisposition, cigarette smoking, obesity, advancing age and female sex.

RA is diagnosed with clinical history taking, physical examination, blood tests and imaging studies like X-rays.

The treatment of RA should be driven by your rheumatologist working from within an interdisciplinary team that will focus on both the lifestyle adaptations and self-help strategies that you require to manage your condition.

The corner stones of the management are:

Dietary and nutritional strategies – ensuring that you diet ensure optimal joint health is paramount, read about the anti-inflammatory diet here.

Physical activity – physical activity and movement actively combats the disease and the symptoms of the disease. See more about movement programs here.

Obesity – being overweight causes systemic disease, inflammation and puts strain on your joints. See more about healthy eating here.

Self-management programs – all chronic diseases require active participation of the people who
suffer from the disease, and you require a tailor-made self-management program. Read more about self-management here.

Group therapy – for patient who live in chronic pain, group therapy is an excellent tool to help with coping strategies and it complements self management programs. Read more about it here.

Medication - Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, and these are called disease-modifying antirheumatic drugs. Biological response modifiers are medications that are an effective second-line treatment.

Gout is a common form of arthritis that predominantly affects men and is usually present in one joint only and most frequently the big toe. Just as rheumatoid arthritis and osteoarthritis , there are periods that the symptoms worsen and these are called flares and periods here the symptoms die down, called remission. Repeated episodes of gout can lead to a progressive kind of arthritis.

Gout cannot be cured and must be treated as part of an interdisciplinary team with multimodal therapy.

Patients with gout usually present with a severely painful, inflamed and warm joint and the condition is caused too much uric acid in your body. The uric acids is formed from the breakdown of purines which are found in the food we eat.

The following are risk factors for the development of gout: Being male, overweight, systemic disease like high blood pressure, heart failure, diabetes, poor kidney function contribute and eating foods rich in purines like red meat and certain types of seafood. Drinking alcohol has a direct correlation with the development of gout and the more you drink the  higher the chance is of developing gout.

A physical examination, blood tests and X-rays are used to diagnose gout.

Gout must be managed with a multi-modal approach through an interdisciplinary team and the following are important:

Dietary and nutritional strategies -  obesity and a diet rich in inflammatory foods and purines contribute significantly to disease progression and pain. Understanding how to eat for your condition is important as this is the pillar of the management of this condition. Read more about it here

Movement – during a flare up movement can become difficult and rest is often sensible, however during periods of remission movement programs and walking significantly aid general health and joint mobility. Read more about it here.

Medication -  during the remission phase drugs that lower the uric acid levels in the blood is used, like allopurinol. In the flare phase, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, steroids, and the anti-inflammatory drug colchicine, are used.

Self – Management – each person with must gather an interdisciplinary team around them to advise them on a personal maintenance program designed specifically with them in mind. Aspects would include nutrition, movement, adaptations in the activities of daily living (ADL), and pain neuroscience education. Read more about self-management here.