Fatigue

Fatigue is physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease.

Description

Everyone experiences fatigue occasionally. It is the body’s way of signaling its need for rest and sleep. But when fatigue becomes a persistent feeling of tiredness or exhaustion that goes beyond normal sleepiness, it is usually a sign that something more serious is amiss.

Physically, fatigue is characterized by a profound lack of energy, feelings of muscle weakness, and slowed movements or central nervous system reactions. Fatigue can also trigger serious mental exhaustion. Persistent fatigue can cause a lack of mental clarity (or feeling of mental “fuzziness”), difficulty concentrating, and in some cases, memory loss.


Causes & symptoms

Fatigue may be the result of one or more environmental causes such as inadequate rest, improper diet, work and home stressors, or poor physical conditioning, or one symptom of a chronic medical condition or disease process in the body. Heart disease, low blood pressure, diabetes, end-stage renal disease, iron-deficiency anemia, narcolepsy, and cancer can cause long-term, ongoing fatigue symptoms. Acute illnesses such as viral and bacterial infections can also trigger temporary feelings of exhaustion. In addition, mental disorders such as depression can also cause fatigue. A 2002 report suggests that a disorder called hypocalcaemia may be a frequent cause of fatigue.

A number of medications, including antihistamines, antibiotics, and blood pressure medications, may cause drowsiness as a side effect. Individuals already suffering from fatigue who are prescribed one of these medications may wish to check with their healthcare providers about alternative treatments.

Extreme fatigue which persists, unabated, for at least six months, is not the result of a diagnosed disease or illness, and is characterized by flu-like symptoms such as swollen lymph nodes, sore throat, and muscle weakness and/or pain may indicate a diagnosis of chronic fatigue syndrome. Chronic fatigue syndrome (or CFS, sometimes called chronic fatigue immune deficiency syndrome), is a debilitating illness that causes overwhelming exhaustion and a number of neurological and immunological symptoms. Between 1.5 and 2 million Americans are estimated to suffer from the disorder. In late 2001, a panel of experts convened and announced that CFS is definitely associated with the immune system, and likely caused by a virus or bacteria, though no single cause has been identified.

Diagnosis

Because fatigue is a symptom of a number of different disorders, diseases, and lifestyle choices, diagnosis may be difficult. A thorough examination and patient history by a qualified healthcare provider is the first step in determining the cause of the fatigue. A physician can rule out physical conditions and diseases that feature fatigue as a symptom, and can also determine if prescription drugs, poor dietary habits, work environment, or other external stressors could be triggering the exhaustion. Several diagnostic tests may also be required to rule out common physical causes of exhaustion, such as blood tests to check for iron-deficiency anemia.

Diagnosis of chronic fatigue syndrome is significantly more difficult. Because there is no specific biological marker or conclusive blood test to check for the disorder, healthcare providers must rely on the patient’s presentation and severity of symptoms to make a diagnosis. In many cases, individuals with chronic fatigue syndrome go through a battery of invasive diagnostic tests and several years of consultation with medical professionals before receiving a correct diagnosis.

Treatment

The treatment of fatigue depends on its direct cause, but there are several commonly prescribed treatments for non-specific fatigue, including dietary and lifestyle changes, the use of essential oils and herbal therapies, deep breathing exercises, traditional Chinese medicine, and color therapy.

Dietary changes

Inadequate or inappropriate nutritional intake can cause fatigue symptoms. To maintain an adequate energy supply and promote overall physical well-being, individuals should eat a balanced diet and observe the following nutritional guidelines:

• Drinking plenty of water. Individuals should try to drink 9 to 12 glasses of water a day. Dehydration can reduce blood volume, which leads to feelings of fatigue. 
• Eating iron-rich foods (i.e., liver, raisins, spinach, apricots). Iron enables the blood to transport oxygen throughout the tissues, organs, and muscles, and diminished oxygenation of the blood can result in fatigue. 
• Avoiding high-fat meals and snacks. High-fat foods take longer to digest, reducing blood flow to the brain, heart, and rest of the body while blood flow is increased to the stomach. 
• Eating unrefined carbohydrates and proteins together for sustained energy. 
• Balancing proteins. Limiting protein to 15-20 grams per meal and two snacks of 15 grams is recommended. Not getting enough protein adds to fatigue. Pregnant or breastfeeding women should eat more protein. 
• Getting the recommended daily allowance of B complex vitamins (specifically, pantothenic acid, folic acid, thiamine, and vitamin B12). Deficiencies in these vitamins can trigger fatigue.
• Getting the recommended daily allowance of selenium, riboflavin, and niacin. These are all essential nutritional elements in metabolizing food energy.
• A 2002 report suggested that calcium and Vitamin D supplementation can lessen fatigue symptoms in person with hypocalcaemia-caused fatigue.
• Controlling portions. Individuals should only eat when they’re hungry, and stop when they’re full. An overstuffed stomach can cause short-term fatigue, and individuals who are overweight are much more likely to regularly experience fatigue symptoms.

Lifestyle changes

Lifestyle factors such as a high-stress job, erratic work hours, lack of social or family support, or erratic sleep patterns can all cause prolonged fatigue. If stress is an issue, a number of relaxation therapies and techniques are available to help alleviate tension, including massage, yoga, aromatherapy, hydrotherapy, progressive relaxation exercises, meditation, and guided imagery. Some may also benefit from individual or family counseling or psychotherapy sessions to work through stress-related fatigue that is a result of family or social issues.

Maintaining healthy sleep patterns is critical to proper rest. Having a set “bedtime” helps to keep sleep on schedule. A calm and restful sleeping environment is also important to healthy sleep. Above all, the bedroom should be quiet and comfortable, away from loud noises and with adequate window treatments to keep sunlight and streetlights out. Removing distractions from the bedroom such as televisions and telephones can also be helpful.

Essential oils

Aromatherapists, hydrotherapists, and other holistic healthcare providers may recommend the use of essential oils of rosemary (Rosmarinus officinalis), eucalyptus blue gum (Eucalyptus globulus), peppermint, (Mentha x piperata), or scots pine oil (Pinus sylvestris) to stimulate the nervous system and reduce fatigue. These oils can be added to bathwater or massage oil as a topical application. Citrus oils such as lemon, orange, grapefruit, and lime have a similar effect, and can be added to a steam bath or vaporizer for inhalation.

Herbal remedies

Herbal remedies that act as circulatory stimulants can offset the symptoms of fatigue in some individuals. An herbalist may recommend an infusion of ginger (Zingiber officinale) root or treatment with cayenne (Capsicum annuum), balmony (Chelone glabra), damiana (Turnera diffusa), ginseng (Panax ginseng), or rosemary (Rosmarinus officinalis) to treat ongoing fatigue.

An infusion is prepared by mixing the herb with boiling water, steeping it for several minutes, and then removing the herb from the infusion before drinking. A strainer, tea ball, or infuser can be used to immerse loose herb in the boiling water before steeping and separating it. A second method of infusion is to mix the loose herbal preparation with cold water first, bringing the mixture to a boil in a pan or teapot, and then separating the tea from the infusion with a strainer before drinking.

Caffeine-containing central nervous system stimulants such as tea (Camellia senensis) and cola (Cola nitida) can provide temporary, short-term relief of fatigue symptoms. However, long-term use of caffeine can cause restlessness, irritability, and other unwanted side effects, and in some cases may actually work to increase fatigue after the stimulating effects of the caffeine wear off. To avoid these problems, caffeine intake should be limited to 300 mg or less a day (the equivalent of 4-8 cups of brewed, hot tea).

Traditional Chinese medicine

Chinese medicine regards fatigue as a blockage or misalignment of qi, or energy flow, inside the human body. The practitioner of Chinese medicine chooses acupuncture and/or herbal therapy to rebalance the entire system. The Chinese formula Minot Bupleurum soup (or Xiao Chia Hu Tang) has been used for nearly 2,000 years for the type of chronic fatigue that comes after the flu.

In this condition, the person has low-grade fever, nausea, and fatigue. There are other formulas that are helpful in other cases. Acupuncture involves the placement of a series of thin needles into the skin at targeted locations on the body known as acupoints in order to harmonize the energy flow within the human body.

Deep breathing exercises

Individuals under stress often experience fast, shallow breathing. This type of breathing, known as chest breathing, can lead to shortness of breath, increased muscle tension, inadequate oxygenation of blood, and fatigue. Breathing exercises can both improve respiratory function and relieve stress and fatigue.

Deep breathing exercises are best performed while lying flat on the back on a hard surface, usually the floor. The knees are bent, and the body (particularly the mouth, nose, and face) is relaxed. One hand should be placed on the chest and one on the abdomen to monitor breathing technique. With proper breathing techniques, the abdomen will rise further than the chest.

The individual takes a series of long, deep breaths through the nose, attempting to raise the abdomen instead of the chest. Air is exhaled through the relaxed mouth. Deep breathing can be continued for up to 20 minutes. After the exercise is complete, the individual checks again for body tension and relaxation. Once deep breathing techniques have been mastered, an individual can use deep breathing at any time or place as a quick method of relieving tension and preventing fatigue.

Color therapy

Color therapy, also known as chromatherapy, is based on the premise that certain colors are infused with healing energies. The therapy uses the seven colors of the rainbow to promote balance and healing in the mind and body. Red promotes energy, empowerment, and stimulation. Physically, it is thought to improve circulation and stimulate red blood cell production. Red is associated with the seventh chakra, located at the root, or base of the spine. In yoga, the chakras are specific spiritual energy centers of the body.

Therapeutic color can be administered in a number of ways. Practitioners of Ayurvedic, or traditional Indian medicine, wrap their patients in colored cloth chosen for its therapeutic hue. Individuals suffering from fatigue would be wrapped in reds and oranges chosen for their uplifting and energizing properties. Patients may also be bathed in light from a color filtered light source to enhance the healing effects of the treatment.

Individuals may also be treated with color-infused water. This is achieved by placing translucent red colored paper or colored plastic wrap over and around a glass of water and placing the glass in direct sunlight so the water can soak up the healing properties and vibrations of the color. Environmental color sources may also be used to promote feelings of stimulation and energy. Red wall and window treatments, furniture, clothing, and even food may be recommended for their energizing healing properties.

Color therapy can be used in conjunction with both hydrotherapy and aromatherapy to heighten the therapeutic effect. Spas and holistic healthcare providers may recommend red color baths or soaks, which combine the benefits of a warm or hot water soak with energizing essential oils and the fatigue-fighting effects of bright red hues used in color therapy.

Allopathic treatment

Conventional medicine recommends the dietary and lifestyle changes outlined above as a first line of defense against fatigue. Individuals who experience occasional fatigue symptoms may benefit from short-term use of caffeine-containing central nervous stimulants, which make people more alert, less drowsy, and improve coordination. However, these should be prescribed with extreme caution, as overuse of the drug can lead to serious sleep disorders, like insomnia.

Another reason to avoid extended use of caffeine is its associated withdrawal symptoms. People who use large amounts of caffeine over long periods build up a tolerance to it. When that happens, they have to use more and more caffeine to get the same effects.

Heavy caffeine use can also lead to dependence. If an individual stops using caffeine abruptly, withdrawal symptoms may occur, including headache, fatigue, drowsiness, yawning, irritability, restlessness, vomiting, or runny nose. These symptoms can go on for as long as a week.

Expected results

Fatigue related to a chronic disease or condition may last indefinitely, but can be alleviated to a degree through some of the treatment options outlined here. Exhaustion that can be linked to environmental stressors is usually easily alleviated when those stressors are dealt with properly.

There is no known cure for chronic fatigue syndrome, but steps can be taken to lessen symptoms and improve quality of life for these individuals while researchers continue to seek a cure.

Prevention

Many of the treatments outlined above are also recommended to prevent the onset of fatigue. Getting adequate rest and maintaining a consistent bedtime schedule are the most effective ways to combat fatigue. A balanced diet and moderate exercise program are also important to maintaining a consistent energy level.

Fever

A fever is a rise in body temperature to greater than 100°F (37.8°C).

Description

A healthy person’s body temperature fluctuates between 97°F (36.1°C) and 100°F (37.8°C), with the average being 98.6°F (37°C). The body maintains stability within this range by balancing the heat produced by the metabolism with the heat lost to the environment.

The “thermostat” that controls this process is located in the hypothalamus, a small structure located deep within the brain. The nervous system constantly relays information about the body’s temperature to the thermostat. In turn, the thermostat activates different physical responses designed to cool or warm the body, depending on the circumstances.


These responses include:

• decreasing or increasing the flow of blood from the body’s core, where it is warmed, to the surface, where it is cooled
• slowing down or speeding up the rate at which the body turns food into energy (metabolic rate)
• inducing shivering, which generates heat through muscle contraction
• inducing sweating, which cools the body through evaporation

A fever occurs when the body’s thermostat resets at a higher temperature, which primarily happens in response to an infection. To reach the higher temperature, the body moves blood to the warmer interior, increases the metabolic rate, and induces shivering. The chills that often accompany a fever are caused by the movement of blood to the body’s core, which leaves the surface and extremities cold.

Once the body reaches the higher temperature, the shivering and chills stop. When the infection has been overcome or drugs such as aspirin or acetaminophen (Tylenol) have been taken, the thermostat resets to normal. When this happens, the body’s cooling mechanisms switch on. The blood moves to the surface and sweating occurs.

Fever is an important component of the immune response, though its role is not completely understood. Physicians believe that an elevated body temperature has several effects. Certain chemicals in the immune system react with the fever-inducing agent and trigger the resetting of the thermostat.

These immune system chemicals also increase the production of cells that fight off the invading bacteria or viruses. Higher temperatures also inhibit the growth of some bacteria and speed up the chemical reactions that help the body’s cells repair themselves. Changes in blood circulation may cause the heart rate to increase, which speeds the arrival of white blood cells to the sites of infection.

Causes & symptoms

Fevers are primarily caused by viral or bacterial infections, such as pneumonia or influenza. However, other conditions can induce a fever, including these:

• allergic reactions
• autoimmune diseases
• trauma, such as breaking a bone
• cancer
• excessive exposure to the sun
• intense exercise
• hormonal imbalances
• certain drugs
• damage to the hypothalamus

When an infection occurs, fever-inducing agents called pyrogens are released, either by the body’s immune system or by the invading cells themselves. These pyrogens trigger the resetting of the thermostat. In other circumstances, an uncontrolled release of pyrogens may occur when the immune system overreacts due to an allergic reaction or becomes damaged due to an autoimmune disease.

A stroke or tumor can damage the hypothalamus, causing the body’s thermostat to malfunction. Excessive exposure to the sun or intense exercise in hot weather can result in heat stroke, a condition in which the body’s cooling mechanisms fail. Malignant hyperthermia is a rare, inherited condition in which a person develops a very high fever when given certain anesthetics or muscle relaxants in preparation for surgery.

A recent study showed that most parents have misconceptions about fever and view it as a disease rather than a symptom. How long a fever lasts and how high it may go depend on several factors, including its cause and the patient’s age and overall health. Most fevers caused by infections are acute, appearing suddenly and then dissipating as the immune system defeats the infectious agent.

An infectious fever may also rise and fall throughout the day, reaching its peak in the late afternoon or early evening. A low-grade fever that lasts for several weeks is associated with autoimmune diseases such as lupus or with some cancers, particularly leukemia and lymphoma.

Diagnosis

A fever is usually diagnosed using a thermometer. A variety of different thermometers are available, including traditional oral and rectal thermometers made of glass and mercury, and more sophisticated electronic ones that can be inserted in the ear. For adults and older children, temperature readings are usually taken orally. Younger children who cannot or will not hold a thermometer in their mouths can have their temperatures taken by placing an oral thermometer under their armpits. Infants generally have their temperature taken rectally using a rectal thermometer.

As important as registering a patient’s temperature is determining the underlying cause of the fever. The physician can make a diagnosis by checking for accompanying symptoms and by reviewing the patient’s medical history, any recent trips he or she has taken, what he or she may have ingested, or any illnesses he or she has been exposed to. Blood tests hold additional clues.

Antibodies in the blood point to the presence of an infectious agent, which can be verified by growing the organism in a culture. Blood tests can also provide the doctor with white blood cell counts. Ultrasound tests, magnetic resonance imaging (MRI) tests, or computed tomography (CT) scans may be ordered if the doctor cannot readily determine the cause of a fever.

Treatment

Often, doctors must remind patients, especially parents, not to “overtreat” low fevers but to remember that they are symptoms of an underlying disease or condition. Alternative therapies for treatment of fever focus not only on reducing fever but also on boosting the immune function to help the body fight infections more effectively. They include nutritional therapy, herbal therapy and traditional Chinese medicine.

Nutritional therapy

Naturopaths often recommend that patients take high doses of vitamin C to ward off diseases and prevent fever. In addition to vitamin C, other antioxidants such as vitamin A and zinc also boost the immune function. Naturopaths may also suggest reducing sugar intake (even fruit juices) because sugar depresses the immune system. To replace fluid that is lost during fever, patients are advised to drink vegetable juices and eat soups.

Herbal therapy

Western herbalists use tea preparations containing herbs such as bupleurum root or boneset to reduce fever. Mild herbs such as peppermint, elderflower, or yarrow can provide comfort to the child who has a mild fever. Others believe in sweating a fever out, literally. They often recommend that patients take hot baths to induce sweating. This helps induce or increase fever, which is believed to help the body get rid of infections.

Chinese medicine (TCM) offers many herbs and formulas for fevers. There are many distinct kinds of fevers, also called heat syndromes. For example, an excess- heat syndrome is characterized by a high fever, great thirst, and lots of sweating. Deficiency heat syndrome is characterized by a low-grade fever with afternoon fevers or night sweats. For excess heat, herbs that are dispersing and cold in nature are used.

For chronic and low-grade fevers, herbs that tonify the yin (cooling aspect) are used as well as herbs that get rid of heat. There are even herbs such as bupleurum root (called Chai Hu in TCM) that are used for intermittent fevers or conditions alternating between fever and chills. Alternating fevers and chills occur in malaria, conditions connected to AIDS, chronic fatigue syndrome, and Epstein- Barr virus. The individual pattern should be diagnosed by a trained practitioner.

Aromatherapy

Patients can reduce feverish symptoms by inhaling essential oils of camphor, eucalyptus, lemon, and hyssop. These oils can also be mixed with an unscented body lotion or a vegetable oil for aromatherapy massage.

Homeopathy

Homeopathic doctors may prescribe herbal remedies based on the patient’s overall personality profile as well as specific symptoms.

Allopathic treatment

Physicians agree that the most effective treatment for a fever is to address its underlying cause. Also, because a fever helps the immune system fight infection, some clinicians suggest it be allowed to run its course. Drugs to lower fever (antipyretics) can be given if a patient (particularly a child) is uncomfortable.

These include aspirin, acetaminophen, and ibuprofen. Aspirin, however, should not be given to a child or adolescent with a fever since this drug has been linked to an increased risk of Reye’s syndrome. Sponging a child or infant with tepid (lukewarm) water can also help reduce mild fevers.

A fever requires emergency treatment under the following circumstances:

• Newborn (three months or younger) with a fever above 100.5°F (38°C).
• Infant or child with a fever above 103°F (39.4°C). A very high fever in a small child can trigger seizures (febrile seizures) and therefore should be treated immediately.
• Fever accompanied by severe headache, neck stiffness, mental confusion, or severe swelling of the throat. A fever accompanied by these symptoms can indicate the presence of a serious infection, such as meningitis, and should be brought to the immediate attention of a physician.

Expected results

Most fevers caused by infection end as soon as the immune system rids the body of the pathogen. Most fevers do not produce any lasting effects. The prognosis for fevers associated with more chronic conditions, such as autoimmune disease, depends upon the overall outcome of the disorder.

Gangrene

Gangrene is a term used to describe the decay or death of an organ, tissue, or bone caused by a lack of oxygen and nutrients. It is a complication resulting from tissue injuries (such as frostbite), the obstruction of blood flow, or the processes of chronic diseases such as diabetes mellitus. Externally, the hands and feet are the areas most often affected by gangrene; internally, it is most likely to affect the gallbladder and the intestines. Gangrene is referred to as wet, or moist, if a bacterial infection is involved. In dry gangrene, there is no infection.

Description

Gangrene is often characterized by pain followed by numbness. The infection may first go unnoticed, especially in the elderly or those individuals with a loss of sensation. The area affected by gangrene may be cold and pale, especially early in the disease. Blisters may be apparent and the patient may experience an increased heart rate and profuse sweating. As the tissue dies, the skin begins to darken. The dead tissue gradually separates and falls away from the healthy tissue.

Dry gangrene is often seen in advanced cases of diabetes and arteriosclerosis. The tissue doesn’t become infected, rather it dries out and shrivels over a period of weeks or months. Wet gangrene progresses much more rapidly. The affected area becomes swollen and gives off a foul smelling discharge. Death may occur within a matter of hours or days. Fever, rapid heart rate, rapid breathing, altered mental state, loss of appetite, diarrhea, vomiting, and vascular collapse may occur as the infection progresses.


Causes & symptoms

The primary cause of gangrene is often an injury to the blood vessels, causing either an interruption of blood flow, the introduction of a bacterial infection, or both. Such injuries may include burns, infected bedsores, boils, frostbite, compound fractures, deep cuts, or gunshot wounds.

Gangrene can also develop due to the poor circulation and obstructions in the blood vessels associated with abnormal blood clots, torsion of organs, and diseases such as diabetes, heart disease, and Raynaud’s disease. Gangrene of the internal organs may be attributed to a ruptured appendix, internal wounds, or the complications of surgery.

The bloodstream is the body’s main transport system. When blood flow is diminished, the flow of the oxygen and nutrients needed to keep tissues healthy is greatly decreased. The white blood cells needed to fight infection are not readily available. In such an environment, invading bacteria thrive and multiply quickly. Streptococcus spp. and Staphylococcus spp. are the most common agents of external skin infection.

Gas gangrene, also called progressive or clostridial myonecrosis, is a type of moist gangrene most commonly caused by an infection of Clostridium perfringens, or other species that are capable of thriving under conditions where there is little oxygen. These bacteria produce gases and poisonous toxins as they grow in the tissues.

Gas gangrene causes the death of tissue, the destruction of red blood cells, and the damaging of the walls of the blood vessels and parts of the kidneys. Early symptoms include sweating, fear, and anxiety. Gas gangrene is a life-threatening condition and should receive prompt medical attention.

Diagnosis

A diagnosis of gangrene will be based on a combination of patient history, a physical examination, blood test results, and other laboratory findings. A physician will look for a history of recent trauma, surgery, cancer, or chronic disease. Blood tests will be used to determine whether infection is present and to determine how much the infection has spread.

A sample of drainage from a wound or obtained through surgery may be tested to identify the bacteria causing the infection and to aid in determining treatment. In the case of gas gangrene, the gas produced by the bacteria may be detected beneath the skin by pressing into the swollen areas. The crackling sounds of gas bubbles may also be heard in the affected area and the surrounding tissues.

X-ray studies and other imaging techniques, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), may be helpful in making a diagnosis by showing evidence of gas accumulation or muscle tissue death. These techniques, however, are not sufficient alone to provide an accurate diagnosis of gangrene. Precise diagnosis often requires surgical exploration of the wound.

Treatment

Chelation therapy is a treatment that uses an intravenous solution containing the drug ethylenediamine tetra-acetic acid (EDTA), among other substances. In the bloodstream, EDTA binds and removes toxins and plaque formation on arterial walls. It promotes circula-

Hair loss

Hair loss, or alopecia, is total or partial baldness caused by hormonal changes or physical or mental stress.

Hair loss occurs for many reasons. Some causes, such as hormonal changes, are considered natural, while others signal serious health problems. Some conditions are confined to the scalp, while others reflect disease processes throughout the body.

Causes & symptoms

Androgenetic alopecia occurs in both men and women, and is considered normal in adult males. Also known as male pattern baldness, it is easily recognized by the distribution of hair loss over the top and front of the head (leaving a horseshoe pattern of hair) and by the healthy condition of the scalp.


Women with androgenetic alopecia experience hair thinning, particularly over the top of the scalp. The disorder is thought to be caused by a genetic predisposition that triggers the production of certain enzymes that convert testosterone into the hormone dihydrotestosterone (DHT). DHT is known to shrink hair follicles, and can cause partial or complete hair loss.

Alopecia areata and alopecia circumscripta refer to hair loss conditions that can be patchy or extend to complete baldness. The exact cause of alopecia areata is unknown, but it is thought to be triggered by an immune system disorder.

Oftentimes, conditions affecting the skin of the scalp will result in hair loss. The first clue to the specific cause is the pattern of hair loss, whether it be complete baldness (alopecia capitis totalis), patchy bald spots, thinning, or hair loss confined to certain areas. Also a factor is the condition of the hair and the scalp beneath it. Sometimes only the hair is affected; sometimes the skin is visibly diseased as well.

Fungal infections of the scalp usually cause patchy hair loss. The fungus, similar to the ones that cause athlete’s foot and ringworm, often glows under ultraviolet light.

Complete hair loss is a common result of cancer chemotherapy, due to the toxicity of the drugs used. Placing a tourniquet around the skull just above the ears during the intravenous infusion of the drugs may reduce or eliminate hair loss by preventing the drugs from reaching the scalp. However, this technique may not be recommended in the treatment of certain types of cancer. An investigational topical gel that may prevent chemotherapy-related hair loss, known as GW 8510, was in clinical trials as of April 2000.

Systemic diseases often affect hair growth either selectively or by altering the skin of the scalp. One example is thyroid disorders. Hyperthyroidism (too much thyroid hormone) causes hair to become thin and fine. Hypothyroidism (too little thyroid hormone) thickens both hair and skin. Several autoimmune diseases also affect the skin and potentially the hair, notably lupus erythematosus.

Hair loss can also be caused by trichotillomania, a mental disorder or compulsion that causes a person to pull out his/her own hair. In some individuals severe mental or physical stress can cause hair loss, including major surgery or illness, significant life changes (i.e., divorce, death of a loved one), and drastic dietary changes. This type of hair loss is called Telogen effluvium, and is the second most common type of hair loss.


Diagnosis

Dermatologists are skilled in diagnosis by sight alone. For more obscure diseases, they may have to resort to a skin biopsy, removing a tiny bit of skin using a local anesthetic so that it can be examined under a microscope. Systemic diseases will require a complete evaluation by a physician, including specific tests to identify and characterize the problem.

Treatment

Traditional Chinese medicine (TCM) has a particular understanding of baldness that is different from the allopathic view. TCM recommends foods to eat and others to avoid, herbs to treat hair loss, and special hair massage. One Chinese approach is to first understand where there is weak energy in the body and to strengthen the qi (chi) of those organ systems. Treatment is not a one-shot approach but a well-rounded response.

Vitamins B6 and biotin are thought to advocate healthy hair growth, as are the minerals zinc, copper, and silica. Fifty milligrams of silica a day is thought to encourage hair growth in young men with alopecia. The herb horsetail (Equisetum arvense) contains silica, and can be taken as an infusion, or tea. Copper and zinc have been shown to inhibit growth of the enzyme that causes DHT production. Iron supplements may be useful in individuals whose hair loss is caused by anemia or an inadequate intake of dietary iron.

The herbal remedies saw palmetto (Serenoa repens) and pygeum (Pygeum africanum) may be prescribed by an herbalist, naturopath, or holistic healthcare professional to stop or slow hair loss. Saw palmetto is thought to stop DHT production, and pygeum influences testosterone production. Both can be taken orally as a dietary supplement. The Chinese herb He Shou Wun (Polygonum multiflorum) can be taken orally or applied as a topical formula.

For hair loss caused by trichotillomania (hair pulling), behavioral therapy may be a useful treatment program. If the hair pulling or hair loss itself is triggered by stress, there are a number of stress reduction therapies that can promote relaxation, including aromatherapy, muscle relaxation exercises, yoga, guided imagery, and biofeedback.

Allopathic treatment

Successful treatment of underlying causes is most likely to restore hair growth, be it the completion of chemotherapy, effective cure of a scalp fungus, or control of a systemic disease. Drugs such as minoxidil (Rogaine) and finasteride (Propecia, Proscar) promote hair growth in a significant minority of patients, especially those with male pattern baldness and alopecia areata.

When used continuously for long periods of time, minoxidil produces satisfactory results in about one-quarter of patients with androgenic alopecia and as many as half the patients with alopecia areata. Both drugs have so far proved to be quite safe when used for this purpose. Side effects of Rogaine include some dryness and irritation of the scalp. Reported side effects of Propecia include infrequent cases of diminished sexual drive and impotence. Propecia is not approved for women because it can cause birth defects.

In 2001, a study was made of immunotherapy with diphencyprone to treat alopecia areata. A lag of three months from start of therapy to development of noticeable hair growth occurred. Researchers noted that the extent of the disease prior to therapy and age at time hair loss began affected treatment success. Patients who were older at onset of baldness had a better success rate than those who were younger. The study concluded that longterm therapy was required for effectiveness.

Over the past few decades there have appeared a multitude of hair replacement methods performed by both physicians and non-physicians. They range from simply weaving someone else’s hair in with the remains of an individual’s own hair to surgically transplanting thousands of hair follicles one at a time.

Expected results

The prognosis for individuals with hair loss varies with the cause. It is generally much easier to lose hair than to regrow it. Even when it returns, it is often thin and less attractive than the original crop.

Hangover

Hangover is the collection of physical and mental symptoms that occur after a person drinks excessive amounts of alcohol.

Hangovers have probably been experienced since prehistoric time when alcohol was first discovered. A survey found that about 75% of the persons who drank enough to be intoxicated (drunk) sometimes experienced hangover. Although very prevalent, hangovers have not been extensively studied. It is known that ethanol is the primary chemical component of alcohol to produce the effects associated with drinking.

Whether hangover affects complex mental tasks and the performance of simple tasks is unclear. Studies on these areas have yielded conflicting results, presumably due to differences in methods. Clearly, alcohol consumption can affect sleep, and sleep deprivation is known to affect performance.


Causes & symptoms

The cause of hangover is believed to be multifactorial. Hangover is likely caused by a combination of direct effects of ethanol, effects of ethanol removal, effects of ethanol breakdown products, effects of other components of the alcoholic beverage, personal characteristics, and behaviors associated with alcohol use.

Direct effects of ethanol

Ethanol can directly affect the body by causing dehydration (loss of fluids), electrolyte (body chemicals) imbalance, stomach and intestinal irritation, low blood sugar, and sleep disruption. In addition, alcohol directly affects the circadian rhythm (internal 24-hour clock) causing a feeling similar to jet lag. Ethanol causes vasodilation (enlarged blood vessels) and affects bodily chemicals, like serotonin and histamine, which may contribute to the headache associated with hangover.

Effects of ethanol removal

Because hangover symptoms peak at around the same time that the blood alcohol concentration falls to zero, some researchers propose that hangover is actually a mild form of withdrawal. Excessive drinking causes changes in the chemical messenger system of the brain and, when the alcohol is removed, the system becomes unbalanced.

Many of the symptoms of hangover are similar to those associated with mild withdrawal. Some differences exist, however, between hangover and withdrawal; specifically, hangover symptoms do not include the hallucinations, seizures, and the lengthy impairment of withdrawal.

Effects of ethanol breakdown products

In the body, ethanol is first broken down to acetaldehyde and then to acetate. Acetaldehyde is a reactive chemical that, at high concentrations, can cause sweating, rapid pulse, skin flushing, nausea, and vomiting. Some researchers believe that acetaldehyde causes hangover. Although there is no acetaldehyde in the blood when the blood alcohol concentration reaches zero, the toxic effects of acetaldehyde on the body may still persist.

Other factors

Most alcoholic beverages contain small amounts of other active compounds besides ethanol. These compounds add to the smell, taste, and appearance of the beverage. Gin or vodka, which contain almost pure ethanol, produce fewer hangover symptoms than alcoholic beverages that contain other alcohol compounds (such as red wine, brandy, or whiskey). For example, methanol is implicated in contributing to hangover. Red wine, whiskey, and brandy all contain high levels of methanol.


Some inherent personal traits place persons at risk of experiencing hangover. In some persons, high levels of acetaldehyde accumulate (because of a deficient enzyme) which causes them to experience more severe hangovers. Persons who are neurotic, angry, or defensive, feel guilty about drinking, experience negative life events, or have a family history of alcoholism have increased hangover symptoms.

Certain behaviors associated with drinking increase the chance of experiencing hangover. These include drug use, disruption of normal sleep patterns, restricted food intake, and cigarette use.

Hangover symptoms begin within several hours after a person has stopped drinking and may last up to 24 hours. The specific symptoms experienced may vary depending upon the individual, the occasion, and the type and amount of alcohol consumed. The physical symptoms of hangover include headache, fatigue, light and sound sensitivity, muscle aches, eye redness, thirst, nausea, vomiting, and stomach pain.

Hangover can cause rapid heartbeat, tremor, increased blood pressure, and sweating. Mental symptoms associated with hangover are decreased sleep, changes in sleep stages, decreased attention, decreased concentration, depression, dizziness, anxiety, irritability, and a sense that the room is spinning (vertigo).

Treatment

Eating balanced meals, drinking extra water, and limiting total alcohol help to reduce or avoid hangover. There are also many alternative treatments to prevent or reduce hangover symptoms. Drinking additional alcohol to relieve hangover, although it reduces short-term symptoms, is not recommended.

Some experts believe that drinking alcohol to relieve hangover is a sign of impending alcoholism. The primary measure to fight hangover is to drink plenty of water while drinking alcoholic beverages, before going to bed, and the day after. Sweating from exertion, exercise, sauna, or massage may also help.

Food therapy

Hangover symptoms may be reduced by taking in lots of extra water and fluids and by eating foods that are high in vitamin C and the B vitamins, which are believed to speed the removal of alcohol from the body. Oranges, guava, grapefruit, and strawberries are rich in vitamin C and beans, fish, and whole grains are rich in the B vitamins.

A cocktail prepared from orange juice (1 cup), pineapple juice (1 cup), kiwi fruit (one), vitamin- B-enriched nutritional yeast (1 tablespoon), and honey (1 tablespoon) provides important nutrients which the body needs to recover from hangover. Juice therapists recommend drinking a mixture of carrot juice (8 oz), beet juice (1 oz), celery juice (4 oz), and parsley juice (1 oz) twice during hangover. The Chinese drink fresh tangerine juice and eat 10 strawberries to treat hangover.

Eating bland complex carbohydrates, such as crackers or toast, is easy on the stomach and helps to raise blood sugar levels. Drinking tea or coffee can relieve fatigue and possibly the headache. Throughout the world, traditional food remedies for hangover have certain things in common. These include eggs, tripe, hot spices, hearty soups, and fruit and vegetable juices. These foods all serve to replenish vitamins, minerals, and other nutrients lost by the body as it detoxifies alcohol.

Ayurveda

Ayurvedic practitioners believe that hangover reflects the symptoms of excess pitta. Immediate relief may be found after drinking water containing lime juice (1 teaspoon), sugar (one half teaspoon), salt (pinch), and baking soda (one half teaspoon). Orange juice containing cumin (pinch) and lime juice (1 teaspoon) helps hangover. Drinking cool lassi, water containing yogurt (1 tablespoon) and cumin powder (pinch), three or four times daily may relieve nausea, headache, and drowsiness.

Herbals

The following herbal remedies are useful in treating hangover symptoms:

• An Ayurvedic remedy is to take one half teaspoon of a mixture of shatavari (5 parts), shanka bhasma (one eighth part), kama dudha (one eighth part), and jatamamsi (3 parts) with water 2–3 times daily.
• An Ayurvedic antidote for alcohol toxicity is one half teaspoon of tikta (or myrrh, aloe vera, or sudharshan) with warm water three times during the day.
• Barberry (Barberis vulgaris) tea reduces hangover symptoms.
• Dandelion (Taraxacum officinale) and burdock (Arctium lappa) tea (with gentian extract, powdered ginger, and honey) can ease the nausea.
• Evening primrose (Oenothera biennis) oil helps to replenish lost gamma-linoleic acid.
• Milk thistle (Silybum marinum) reduces alcohol toxicity on the liver.
• Nux vomica (Strychnos nux vomica) is a homeopathic antidote for alcohol overconsumption.
• Siberian ginseng (Eleutherococcus senticosus) helps the body adjust to the stress of alcohol toxicity.
• Wintergreen (Gaultheria procumbens) tea with hot pepper (Capsicum) sauce relieves the headache.

Other hangover remedies

Various other remedies for hangover include:

• Acupressure. Point LI 4 (between the thumb and index finger) relieves headache and stomach ailments and the B2 points (upper edge of the eye socket) relieves headache accompanied by light sensitivity.
• Aromatherapy. The nausea of hangover may be relieved by drinking an aromatic cocktail of water, lemon juice, and a drop of fennel essential oil before breakfast.
• Imagery. The hangover sufferer may visualize being on a ship in a stormy ocean. The ocean gradually becomes calm until the ship is gently bobbing in the water
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• Probiotics. The bacteria Bifidobacterium bifidus is able to remove alcohol breakdown products. To fight hangover, naturopaths recommend taking B. bifidus before going to bed and again the following day.
• Supplements. Taking 50 mg of vitamin B3 before going to bed may relieve hangover.
• Hydrotherapy. Drinking a glass of water containing activated charcoal powder before going to bed may absorb alcohol in the stomach and reduce hangover symptoms.

Allopathic treatment

Hangover symptoms may be relieved by taking antacids for nausea and stomach pain and aspirin or a nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) for headache and muscle pains. Acetaminophen (Tylenol) should be avoided while drinking or during hangover because alcohol enhances acetaminophen’s toxic effects on the liver. Caffeine, usually taken as coffee, is historically used to treat hangover, although this has not been studied.

Expected results

There is no cure for hangover. Left untreated, hangover will resolve within several hours. Treatments may reduce the severity of certain symptoms.

Prevention

Hangover may be prevented by limiting the intake of alcohol, or drinking alcoholic beverages with a lesser incidence of causing hangover such as gin, vodka, or pure ethanol. Getting adequate sleep may reduce the fatigue associated with hangover. Drinking nonalcoholic beverages, both during and after drinking alcohol, may reduce dehydration and reduce hangover symptoms. Taking 120 mg of milk thistle before drinking can help the liver detoxify the alcohol.

Headache

A headache is a pain in the head and neck region that may be either a disorder in its own right or a symptom of an underlying medical condition or disease. The medical term for headache is cephalalgia.

Headaches are divided into two large categories, primary and secondary, according to guidelines established by the International Headache Society (IHS) in 1988 and revised for republication in 2004. Primary headaches—accounting for more than 90% of all headaches— are not caused by an underlying medical condition. There are three major types of primary headaches: migraine, cluster, and tension. Secondary headaches are caused by another disease or medical condition, and account for fewer than 10% of headaches.

Rebound headaches, also known as analgesic abuse headaches, are a subtype of primary headache caused by overuse of headache drugs. They may be associated with medications taken for tension or migraine headaches.


Secondary headaches are classified as either traction or inflammatory headaches. Traction headaches result from the pulling, pushing, or stretching of pain-sensitive structures, such as a brain tumor pressing upon the outer layer of tissue that covers the brain. Inflammatory headaches are caused by infectious diseases of the ears, teeth, sinuses, or other parts of the head.

Headaches are very common in the North American adult population. The American Council for Headache Education (ACHE) estimates that 95% of women and 90% of men in the United States and Canada have had at least one headache in the past 12 months. Most of these are tension headaches. Migraine headaches are less common, affecting about 11% of the population in the United States and 15% in Canada.

Several studies indicate that doctors tend to underdiagnose migraine headaches; thus the true number of patients with migraines may be considerably higher than the reported statistics. Cluster headaches are the least common type of primary headaches, affecting about 0.4% of adult males in the United States and 0.08% of adult females. Cluster headaches occur most commonly in adults between the ages of 20 and 40.

It is possible for patients to suffer from more than one type of headache. For example, patients with chronic tension headaches often have migraine headaches as well.

Causes & symptoms

Causes

A person feels headache pain when specialized nerve endings, known as nociceptors, are stimulated by pressure on or injury to any of the pain-sensitive structures of the head. Most nociceptors in humans are located in the skin or on the walls of blood vessels and internal organs. The bones of the skull and the brain itself do not contain these specialized pain receptors.

The parts of the head that are sensitive to pain include the skin that covers the skull and upper spine; the 5th, 9th, and 10th cranial nerves, and the nerves that supply the upper part of the neck; and the large arteries located at the base of the brain, as well as those that supply the membranes covering the brain and spinal cord.

Tension headaches typically result from tightening of the face, neck, and scalp muscles as a result of emotional stress; physical postures that cause the head and neck muscles to tense (e.g., holding a phone against the ear with one’s shoulder); emotional depression or anxiety; temporomandibular joint (TMJ) dysfunction; or arthritis of the neck. The tense muscles put pressure on the walls of the blood vessels that supply the neck and head, which stimulates the nociceptors in the tissues that line the blood vessels.

The causes of migraine headaches have been debated since the 1940s. Some researchers think that migraines are the end result of a magnesium deficiency in the brain, or of hypersensitivity to a neurotransmitter (brain chemical) known as dopamine.

Another theory is that certain nerve cells in the brain become unusually excitable, setting off a chain reaction that leads to changes in the amount of blood flowing through the blood vessels and stimulation of their nociceptors. Specific genes associated with migraines were recently discovered. This finding suggests that genetic mutations may be responsible for the abnormal excitability of the nerve cells in the brains of patients with migraine headaches.


As of 2004, little is known about the causes of cluster headaches or changes in the central nervous system that produce them. Patients with cluster headaches are advised to quit smoking and minimize their use of alcohol because nicotine and alcohol appear to trigger these headaches. The precise connection between these chemicals and cluster attacks is not yet completely understood.

Symptoms

Tension headaches are less severe than other types of primary headache. They rarely last more than a few hours; 82% resolve in less than a day. Patients usually describe the pain of a tension headache as mild to moderate. The doctor will not find anything abnormal in the course of a general physical examination, although he or she may detect sore or tense areas (trigger points) in the muscles of the patient’s forehead, neck, or upper shoulder area.

Migraine headaches are characterized by throbbing or pulsating pain of moderate or severe intensity lasting from four hours to as long as three days. The pain is typically felt on one side of the head; in fact, the English word “migraine” is a combination of two Greek words that mean “half” and “head.” Migraine headaches worsen with physical activity, and are often accompanied by nausea and vomiting. Patients with migraine headaches are hypersensitive to lights, sounds, and odors.

Cluster headaches are recurrent brief attacks of sudden and severe pain on one side of the head. The pain is usually most intense in the area around the eye. Cluster headaches may last between five minutes and three hours, and may occur once every other day or as often as eight times per day. Some patients describe it as severe enough to make them consider suicide.

Patients may pace the floor, weep, rock back and forth, or bang their heads against a wall in desperate attempts to stop the pain. In addition to severe pain, patients often have a runny or congested nose, watery or inflamed eyes, drooping eyelids, swelling in the area of the eyebrows, and heavy facial perspiration. Because of the nasal symptoms and the relative rarity of cluster headaches, they are sometimes misdiagnosed as sinusitis.

Diagnosis

Patient history

The differential diagnosis of headaches begins with a careful patient history that includes information about head injuries or surgery on the head; eye problems or disorders; sinus infections; dental problems or extensive oral surgery; and medications that the patient takes regularly.

Some primary care physicians give the patient a printed questionnaire that consists of 50–55 brief questions covering such matters as the timing and frequency of the headaches; family history of the same type of headache; signs of depression; correlation between headaches and weather changes; and so on. The doctor may also ask the patient to keep a headache diary to help identify foods, stress, lack of sleep, weather, and other factors that may trigger the pain.

Physical examination

A physical examination helps the doctor identify signs and symptoms that may be relevant to the diagnosis such as fever; difficulty breathing; nausea or vomiting; stiff neck; changes in vision or hearing; watering or inflammation of the nose and eyes; evidence of head trauma; skin rashes or other indications of an infectious disease; and abnormalities in the structure or alignment of the spinal column, teeth or jaw. In some cases, the doctor may refer the patient to a dentist or oral surgeon for a more detailed evaluation of the mouth and jaw.

Special tests and imaging studies

Laboratory tests are useful in identifying headaches caused by infections, anemia, or thyroid disease. These tests include a complete blood count (CBC); erythrocyte sedimentation rate (ESR); and blood serum chemistry profile. Patients who report visual disturbances and other neurologic symptoms may be given visual field tests and screened for glaucoma (a condition involving high fluid pressure inside the eye).

Imaging studies may include x rays of the sinuses to check for infections; and CT or MRI scans, which can rule out brain tumors and cerebral aneurysms. Patients whose symptoms cannot be fully explained by the results of physical examinations and tests may be referred to a psychiatrist for evaluation of psychological factors related to their headaches.

Warning symptoms

There are warning signs associated with headache that indicate the need for prompt medical attention. Patients with any of the following symptoms should see a physician at once:

• Three or more headaches per week.
• Need for a headache pain reliever every day or almost every day.
• Need for greater than recommended doses of over-thecounter (OTC) headache medications.
• Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. 
• Headache that becomes worse over a period of six months, especially if most prominent in the morning or if accompanied by neurological symptoms.
• Sudden onset of headache accompanied by fever and stiff neck.
• Change in the character of the headaches—for example, persistent severe headaches in a person who has previously had only mild headaches of brief duration.
• Recurrent headaches in a child.
• Recurrent severe headaches beginning after age 50.

Treatment

Alternative remedies can lessen the frequency and severity of headaches. Common treatments include:

• Acupressure. The stomach 3 and large intestine 4 points relieve sinus headaches.
• Acupuncture. A National Institutes of Health (NIH) panel concluded that acupuncture may be a useful treatment for headache.
• Aerobic exercise. Regular aerobic exercise reduces the frequency and intensity of headaches.
• Aromatherapy. Massage using the essential oils of lavender, rosemary, or peppermint relieves headache.
• Autogenic therapy. Headache may be relieved by learning to put oneself in a semi-hypnotic state.
• Chiropractic. Cervical manipulation may relieve tension headaches.
• Heat and/or cold. A hot shower or bath can ease tension headaches. Vascular headache may be relieved by placing an ice pack on the forehead, or the feet in hot water and a cold pack on the forehead (hydrotherapy treatment).
• Herbals. Feverfew (Chrysanthemum parthenium) can be used for migraine; goldenseal (Hydrastis canadensis) for sinus headache; valerian (Valeriana officinalis), skullcap (Scutellaria lateriflora), or passionflower (Passiflora incarnata) for tension headache; and cayenne (in nostrils) for cluster headache. A German remedy made from butterbur root (Petasites hybridus) is now available in the United States under the brand name Petadolex. The herb, Brahmi (Bacopa monnieri), is used in Ayurvedic medicine to treat headaches related to anxiety.
• Holistic medicine. Headaches may be caused by constipation and liver malfunction. Apple-spinach juice relieves constipation, and a blend of carrot, beet, celery, and parsley juices treats the liver.
• Homeopathy. Remedies are chosen for each patient and may include Belladonna (throbbing headache), Bryonia (splitting headache), Kali bichromicum (sinus headache), and Nux vomica (tension headache with nausea and vomiting).
• Massage. Firm massage of the forehead, neck, and scalp may relieve headache.
• Osteopathy. Headache is treated with neuromuscular manipulation and massage of the head, neck, and upper back.
• Pressure. A headband tied tightly around the head may relieve migraines in some patients.
• Reflexology. Headache is treated using the solar plexus, ear, eye, and head points.
• Relaxation techniques. Meditation, biofeedback, and yoga may relieve headache.
• Supplements. Vitamins B2 and B12, niacin, and magnesium (a mineral) may help treat or prevent headache.
• Transcutaneous electrical nerve stimulation (TENS). This effective headache treatment electrically stimulates nerves and blocks pain transmission.
• Visualization. This relaxation technique controls the images in the mind, replacing negative thoughts and images with positive ones that enhance relaxation. Allopathic treatment

Medical

Tension headaches are usually relieved fairly rapidly by such over-the-counter analgesics as aspirin (300–600 mg every four hours), acetaminophen (650 mg every four hours), or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (brands include Advil or Motrin) or naproxen (brands such as Naprosyn or Aleve).

For patients with chronic tension headaches, the doctor may prescribe a tricyclic antidepressant or benzodiazepine tranquilizer in addition to a pain reliever. A newer treatment for chronic tension headaches is botulinum toxin (Botox type A), which appears to work quite well for some patients.

Nonsteroidal anti-inflammatory drugs, including acetaminophen (e.g. Tylenol), ibuprofen, and naproxen are helpful for early or mild migraines. More severe attacks may be treated with dihydroergotamine; a group of drugs known as triptans; beta-blockers and calcium channelblockers; antiseizure drugs; antidepressants (SSRIs); meperidine (Demerol); or metoclopramide (Reglan). Some of these medications are also available as nasal sprays, intramuscular injections, or rectal suppositories for patients with severe vomiting.

Sumatriptan (known as the brand Imitrex) or indomethacin (Indameth or Indocin) may be prescribed to suppress a cluster headache.

Surgical

Headaches that are caused by brain tumors, head trauma, dental problems, or disorders affecting the spinal discs usually require surgical treatment. In addition, some plastic surgeons have reported success in treating chronic migraine patients by removing some muscle tissue near the eyebrows, cutting a branch of the trigeminal nerve, and repositioning the soft tissue around the temples (sides of the head).

Psychotherapy

Psychotherapy may be helpful to patients with chronic headaches by interrupting the “feedback loop” between emotional upset and the physical symptoms of headaches.

Expected results

The prognosis for primary headaches varies. Episodic tension headaches usually resolve completely in less than a day without affecting the patient’s overall health. The long-term outlook for patients with migraines depends on whether they have one or more of the other disorders associated with migraine. These disorders include Tourette’s syndrome, epilepsy, ischemic stroke, hereditary essential tremor, depression, anxiety, and others. For example, migraine with aura increases a person’s risk of ischemic stroke by a factor of six.

The prognosis for secondary headaches depends on the seriousness and severity of the cause.

Prevention

Lifestyle modification is one measure that people can take to lower their risk of tension headaches. They should get enough sleep and eat nutritious meals at regular times. Skipping meals, using unbalanced fad diets to lose weight, and insufficient or poor-quality sleep can bring on tension headaches.

Some headaches may be prevented by avoiding substances and situations that trigger them, or by employing alternative therapies, such as yoga and regular exercise. Proper lighting may prevent headaches caused by eyestrain. Because food allergies are often linked with headaches, especially cluster strain headaches and migraines, identification and elimination of the allergycausing food(s) from the diet can be an important preventive measure.

Women with migraines often benefit by switching from oral contraceptives to another method of birth control, or by discontinuing estrogen replacement therapy. Prophylactic treatments for migraine include prednisone, calcium channel blockers, and methysergide.