### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi Doctor, Im 43 years old and I noticed that before my mentruation, I have this heck pain..if not, I experienced headache.  My blood pressure awhile ago is 160/100.  The last few days, the ringing of my left ear is loud than before.  Sometimes, my arm is also aching.  I already take paracetamol awhile ago and massage the back of the neck with ointment.  What do you think., is being 43 already means I need to have doctors checkup at least twice a year?

### output:

Hello! Welcome and thank you for asking on Chat Doctor! Regarding your concern, I would explain that at your age you should start having periodically scheduled check-ups every 6 months. Your headache seems to be related to high blood pressure. You should know that it is one of the most common symptoms of high blood pressure. Regarding back and shoulder pain, it may be related to a cervical disk problem or to chronic degenerative changes to your backbone. I recommend you to closely monitor your blood pressure, different times during the day at home (in sitting position, after 15 minutes of total relax) and refer these values to your GP. It is necessary to perform a complete check-up by your GP including: a careful physical examination, a resting ECG, a chest x-ray study, a service -thoracic spine x-ray study and some blood lab tests (complete blood count, fasting glucose, kidney and liver function tests, blood electrolytes, inflammation tests, etc.). If your blood pressure is above 130/90 mm Hg most of the time (and non-episodic), you should discuss with your doctor the possibility of starting an antihypertensive therapy. Meanwhile, some modifications to your lifestyle would help reduce your blood pressure: - a balanced diet (low salt intake, avoid caffeine)- physical activity (walking, aerobics, recreational activity)- weight loss. Hope to have been helpful! Greetings!