Headache, NOS

Headache, NOS is one of the major scourges of the ER physician.  It basically says, "this patient has a headache and I don't know what's causing it".  It infers that there is a sense of doubt that there is a true organic cause to this disease.  It also carries a connotation that this patient will make multiple return trips to the ER like it's their own personal medicine cabinet.  In my four-week rotation in ER at the University, I tried like hell to avoid headache patients.  A new patient with chief complaint of headache popped up on the big board and I suddenly had to empty my bladder.  Crazy how that reflex was established.  But here, in Haiti where there are six of us seeing upwards of 300 patients in a day, I don't have the luxury of a big board announcing the chief complaints, or even bathroom breaks...  Not that I need a big board.  If you're a Haitian and you live in Archaiae, you're going to have headaches.  I never have headaches and I'll be damned if my head wasn't throbbing last night before I went to bed.  Difference between me and the patients?  It's my head...  But beyond that, I have a bottle of 100 tabs of tylenol in my back pack that I purchased for like 4 bucks (I buy generic) at Walgreen's before I left.  So no matter how jaded I am towards patients with a chief complaint of headache (and it is at least 2/3 of the adult patients here) I have to refrain from being dismissive, clear them of the big, bad scary things (our last patient Wednesday that had headache, high fever, photophobia, and neck pain/stiffness ended up getting a few shots of Ceftriaxone) and understand that there is more in play than a quest for narcotics.  Shit, we don't even have narcotics.  And to these patients the idea of narcotics is foreign.  Allergies to ibuprofen haven't been developed yet.  Anxiety has not struck down a single person even though they're living with the constant threat of contaminated water, political instability, and now natural disasters.  Hell, I need a Xanax just realizing I'm going to be here for the next ten weeks.
So I ask my questions.  And guess what, they live in a town crowded with people and diesel engines.  They work under a sun raising the ambient temperature towards triple digits on a daily basis.  The desert habitat has just enough trees and foliage to pepper the landscape, but definitely not enough to keep the dust from flying into your eyes when you are out and about (I'm a victim of this from one car ride to our compound).  And their main source of water is the few aqueducts draining the river.  Oh, that's the same river that was found to kill thousands of people because it was contaminated by the UN with cholera.  Damn.