<![CDATA[Chronic Pain - Health.com]]>

<![CDATA[Chronic Pain - Health.com]]> en daily 1 Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationChronic pain can begin with an injury or a problem such as a bulging disk in the spine. It can be associated with complex syndromes such as fibromyalgia. Or you may experience it as headaches, back pain, joint pain, nerve pain, or a myriad of other localized symptoms. Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationChronic pain can begin with an injury or a problem such as a bulging disk in the spine. It can be associated with complex syndromes such as fibromyalgia. Or you may experience it as headaches, back pain, joint pain, nerve pain, or a myriad of other localized symptoms. <![CDATA[Is Chronic Pain Ruining Your Relationship?]]> http://feeds.health.com/~r/health/chronic-pain/~3/8Xqdu5YyLSI/0,,20331273,00.html

fibromyalgia, a chronic condition characterized by widespread pain and tenderness. Her husband hasn't always been 100% sympathetic, however.

“I was in so much pain that I couldn’t bend over to put on my own shoes or socks,” recalls Champneys, who lives in Salt Lake City. “And my husband was like, ‘You've got to be kidding me! Get up and deal!’”

Fibromyalgia affects an estimated 5 million Americans (80% to 90% of them women), but until relatively recently many doctors have pooh-poohed the condition. Women like Champneys have long been told that the pain is “all in their head,” a message that their partners have sometimes taken to heart as well.

Champneys' husband, Adam, acknowledges that he found himself growing skeptical as Athena grew more disabled by her condition. “I started doubting whether it was real,” says the 36-year-old real estate agent. “I even started doubting our relationship, because I was having to do a lot of the same things for her that I have to do for our children. She was in her 30s, but it was like taking care of an 80-year-old grandma.”

The Champneys’ experience isn’t unique. Chronic pain—whether it stems from fibromyalgia, back pain, arthritis, or some other condition—can have a toxic effect on relationships, especially if one partner is skeptical about the source or the severity of the pain, and the other feels that he or she isn’t receiving the proper understanding and support.

“People who have chronic illnesses desire support from their loved ones,” says Annmarie Cano, PhD, an associate professor of psychology at Wayne State University, in Detroit. “We all want to feel loved and cared for, but if the people around us are not supporting us the way we want them to, we might become resentful and feel like we are entitled to support.”

But let’s face it: Hearing about pain can be a drag, and if you’re the one in pain, the strongest potential sources of support—your partner, spouse, or kids—may simply tune you out when you talk about it. The good news is that how you talk about pain matters. There are things you can do that can help you win—not lose—your loved ones’ support.

Why expecting more help can backfire
Cano has studied the unhealthy dynamics that pain can create among couples like the Champneys.

In a study in the December 2009 issue of the journal Pain, Cano and her colleagues followed 106 couples in which one partner had a chronic pain condition, such as arthritis or back pain (the most common condition). The researchers found that people in pain who felt entitled to more support from their partners were more likely to have excessive or exaggerated perceptions and thoughts about the extent of their pain and the disability it caused. (This is known as catastrophizing.)

Next Page: Catastrophizing can be counterproductive

Catastrophizing isn’t a healthy or successful coping strategy; in fact, it’s associated with higher levels of pain, distress, and depression. It's also associated with passive ways of asking for help—a strategy that tends to backfire as well, according to Cano.

“If someone expects other people to provide support but doesn't know how to communicate directly what he or she would like, that person might express their frustration indirectly, by sighing, moaning, or engaging in other behaviors that might seem off-putting to the other person,” she explains. And if the person in pain doesn’t receive the help they want or expect, says Cano, he or she might react with anger or disappointment.

“Meanwhile, the other person had no idea of what was expected,” she says.

Michael E. Geisser, PhD, a professor of physical medicine and rehabilitation at the University of Michigan, in Ann Arbor, says that in such situations, the person who isn't in pain is likely to respond in kind, especially if he or she suspects that the other person is exaggerating or even fabricating the pain.

“If one partner doesn’t believe in the diagnosis, they are more prone to respond in an angry fashion as opposed to be more supportive,” he says.

This cycle of resentment, aversion, and unmet expectations can infect every aspect of a relationship. If spouses in pain consistently feel that they deserve more special care and attention than they are receiving, says Cano, “this mismatch of attitudes can certainly cause problems in couples and can spill over into other areas of disagreement, like financial decisions and decisions about how to spend leisure time.”

The potential for pain-related discord to spread into the rest of the relationship has been well documented, according to Geisser. "It has been shown that relationships in which one partner has chronic pain tend to be more strained, have more marital distress, more conflict, and a greater likelihood for divorce,” he says.

How to halt the cycle
If you sense that chronic pain is tearing your relationship apart, it's important to act before things get out of hand.

The first step is education, Cano suggests. “Consider treatment as a joint effort,” she says. “Both partners should try to learn as much as they can about the pain condition and should attend doctors' appointments together to learn about options for treatment.”

It’s helpful for both partners to hear a professional opinion on how much exercise and movement is healthy for the person with pain, for instance, and to what extent the partner in pain should help with housework and physical tasks. (Moderate physical activity can actually lessen the pain associated with some conditions, such as fibromyalgia and arthritis.)

Next Page: Therapy can help

Couples therapy is another option. “It allows couples to talk openly and without defensiveness about how the pain has changed their lives,” Cano says.

In Cano's new study, the spouse who was in pain sometimes simply wanted emotional support. “They weren't necessarily looking for the spouse to do more chores, they just wanted their emotional distress to be accepted by their partner and they wanted to feel like their partners understood and listened to them,” she says.

Even in these cases, the study suggests, it’s better to be clear about your needs—for example, “I just need to talk, honey”—rather than sighing or moaning.

Communication between partners is essential to prevent pain from interfering in a relationship, says Mildred Farmer, MD, an internist and fibromyalgia specialist at Meridien Research, in St. Petersburg, Fla. And it goes both ways: People who are in pain also need to listen to their partners and make an effort to understand how they're feeling, Dr. Farmer says.

“Keep lines of communication open with your partner and understand that both partners may have issues with fairness,” she says. “While it doesn't seem fair to have to struggle with pain, watching a loved one struggle with pain is another kind of burden."

Communication doesn't just mean speaking, Dr. Farmer says. People in pain should realize that they might be signaling anger or distress "even when [they] think [they] are doing a good job hiding the pain,” she says. “Be aware that you can manifest pain purposefully by talking about your pain, or manifest pain indirectly through facial expression, or body language."

After some fraught years, the Champneys' relationship is back on solid ground as a result of effective treatment for Athena’s fibromyalgia, some basic education about the condition, better communication, and a healthy—though unforeseen—dose of empathy.

In 2007, Adam Champneys developed an excruciating kidney stone, which, he says, helped him understand and empathize with his wife’s pain.

]]> Getty Images http://www.health.com/health/condition-article/0,,20331273,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/JiCIT9hNBHM/0,,20331273,00.html <![CDATA[Study: Signs of Fibromyalgia Show Up on Neurological Exam]]> http://feeds.health.com/~r/health/chronic-pain/~3/rmZzqK4iM50/0,,20308309,00.html

The new research may shed light on fibromyalgia, a condition that is characterized by chronic widespread pain.

However, lead author Nathaniel Watson, MD, emphasizes that the findings are preliminary and should be used more as a hypothesis to be explored in future research, rather than as proof of a distinct neurological cause for fibromyalgia.

“I don’t think these findings are significant enough to suggest we should change the way fibromyalgia should be evaluated or managed,” says Dr. Watson, who performed the blinded neurological exams in the study. “But it’s a starting point.”

In addition to chronic pain, people with fibromyalgia may have symptoms such as fatigue, insomnia, depression or anxiety, and numbness and tingling of the limbs. About 2% of Americans have the condition, which is often debilitating and more common in women than in men.

Dr. Watson and his colleagues at the University of Washington Medicine Sleep Institute, in Seattle, compared a group of 166 adults with fibromyalgia with 66 people who did not have any pain problems. Compared to their pain-free counterparts, the people with fibromyalgia were more likely to have neurological abnormalities, including greater cranial nerve dysfunction and more sensory, motor, and gait problems, according to the study in the September 2009 issue of Arthritis and Rheumatism. The doctors performing the exams were not aware if the patients had fibromyalgia or not.

In addition, the fibromyalgia patients’ self-reported neurologic symptoms often correlated with the results of the physical exam. In fact, they had more symptoms in 27 of the 29 categories. In particular, light sensitivity (70% versus 6%) was more common in those with fibromyalgia, as were poor balance, weakness, and tingling in the arms and legs.

The results support the possibility that fibromyalgia might be related to a neurological or anatomical problem in the head or neck. Some possibilities include the narrowing of the spinal canal or Arnold-Chiari type I malformation, a genetic defect that affects the brain.

Dr. Watson also says that some of the neurological results could be caused by pain sensations themselves and not other neurological or anatomical issues.

Cleveland Clinic pain management specialist Phil Berenger, MD, does not believe that the neurological exam itself can yield purely objective findings, as the responses patients give during the exam are still subjective. “The exam depends upon what the patient tells you he or she is experiencing, like ‘I can’t feel that pin prick,’ so it’s really hard to say that these findings are totally objective,” says Dr. Berenger, who was not involved in the study.

Dr. Berenger also notes that fibromyalgia patients could be experiencing symptoms from other undiagnosed conditions—such as rheumatoid arthritis, lupus, hypothyroidism, or Parkinsonism—highlighting the difficulty doctors face in accurately diagnosing fibromyalgia. Since its symptoms often overlap with those of various ailments, people may be diagnosed with fibromyalgia if they have widespread pain and symptoms that are not explained by other diseases. People with chronic pain lasting more than three months should see a doctor and undergo a thorough neurological exam, Dr. Berenger says.

Although the precise cause of fibromyalgia remains at large, recent research points to possible central-nervous-system functioning problems that might amplify normal pain signals. Several hormonal abnormalities have been associated with the condition, including unusual levels of a chemical known as substance P, circulating growth hormone, and serotonin. Still, none of the potential explanations have gained widespread acceptance or been proven conclusively.

Fibromyalgia can be treated in a number of ways. The U.S. Food and Drug Administration has approved the anti-epileptic Lyrica as the first drug to treat the condition. Some other types of drugs, such as antidepressants, tricyclic compounds, and dual reuptake inhibitors, can also be effective, along with alternative therapies such as massage. Regular exercise, relaxation techniques, and a regular sleeping pattern can be beneficial for patients as well.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases funded the study.

]]> Istockphoto http://www.health.com/health/condition-article/0,,20308309,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/CApgRottM0A/0,,20308309,00.html <![CDATA[Prescription Medications for Fibromyalgia: Lyrica, Cymbalta, Savella, and Off-Label Remedies]]> http://feeds.health.com/~r/health/chronic-pain/~3/Cqu1r-eIa-U/0,,20305347,00.html

But because so much is still unknown about what causes fibromyalgia, there is no go-to treatment. In fact, typically only “35% to 40% of patients will respond well to any one of these three drugs,” says Daniel Clauw, MD, the director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.

Research suggests that people with fibromyalgia may have extremely sensitive central nervous systems that perceive pain much more acutely than those with normal pain responses. There is also some evidence that people who suffer from fibromyalgia experience a range of sleep disturbances that may leave them more prone to pain. An even newer theory is that fibromyalgia may be related to compression of the cervical spinal cord, which can lead to sleep disruptions as well as widespread pain.

The three drugs currently approved for fibromyalgia are thought to ease the pain by acting on either the nerves or brain chemicals called neurotransmitters. Since these drugs do not have a high success rate, patients often use more than one or try several before finding one that works well with the least side effects.

“People should be encouraged to find someone who is willing to work with them to find that combination or single treatment that works well,” says Charles E. Argoff, MD, a professor of neurology at Albany Medical College in New York.

You may find that over-the-counter medications help to alleviate some of the pain flare-ups associated with fibromyalgia. But if you’ve been diagnosed with the condition and are looking for long-term treatment, talk to a doctor about prescription drugs. Here’s a brief breakdown of different medications used to treat fibro pain, both on- and off-label.

Lyrica
How it works: The first drug approved to treat fibromyalgia, Lyrica (pregabalin) is an anticonvulsant that the U.S. Food and Drug Administration (FDA) previously approved in late 2004 to treat pain associated with diabetic neuropathy and shingles. The medicine is believed to calm overactive neurons as well as possibly influence the release of neurotransmitters.

Recommended dosage: Begin at 150 mg daily, and can be increased to a maximum of 450 mg per day

When it may be prescribed: “Most of us think that if people have a prominent sleep disturbance, we should use Lyrica or Neurontin first,” says Dr. Clauw. Neurontin (gabapentin) is an anticonvulsant that has not been approved for, but is often used to treat, fibromyalgia.

What to consider: The most common side effects are dizziness, weight gain, fatigue, difficulty concentrating, and swelling in the hands and feet. In April 2009, the FDA also began requiring Lyrica to carry a warning that the drug increases the increase the risk of suicidal thoughts or behavior.

Next Page: Cymbalta

Cymbalta
How it works: Approved in 2008 for use in fibromyalgia (and previously approved for diabetic retinopathy and depression), Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI)—a type of antidepressant that raises the levels of the neurotransmitters serotonin and norepinephrine in the brain and body. These highly sensitive brain chemicals seem to play a role in the perception of pain and keeping them at consistent levels appears to help alleviate it.

Recommended dosage: 60 mg once a day

When it may be prescribed: Since depression often accompanies fibromyalgia, experts say that SNRIs such as Cymbalta may be a good choice for someone who experiences depression or fatigue in conjunction with his or her pain.

What to consider: Common side effects of SNRIs include nausea, vomiting, dry mouth, constipation, loss of appetite, and dizziness, but those side effects may improve over time. All SNRIs can cause or exasperate hypertension, so patients should have their blood pressure checked regularly.

A more significant concern is the interaction these drugs can have with other medications that affect serotonin, especially migraine medications and the painkiller tramadol. Since 70% of people with fibromyalgia are on more than one medication, drug interactions are an important consideration, says Andrew J Holman MD, clinical rheumatologist and associate clinical professor of medicine at the University of Washington. Like all antidepressants, Cymbalta is required to carry a black box warning about an increased risk of suicidal thinking and behavior in people under the age of 25.

Savella
How it works: Approved in January 2009, Savella (milnacipran) is also an SNRI.

Recommended dosage: 100 mg daily, begun at a much lower dosage and increased over a week

When it may be prescribed: Like Cymbalta, clinicians may choose Savella when someone with fibromyalgia also suffers from depression or has significant fatigue.

What to consider: The side effects of Savella are similar to those of Cymbalta. Savella also carries a warning about the risk of cardiovascular side effects, most notably hypertension, increased heart rate, and heart palpitations. Patients taking the drug should have their blood pressure monitored periodically. Like all antidepressants, Savella is required to carry a black box warning about an increased risk of suicidal thinking and behavior in people under the age of 25.

Next Page: Off-label: Other antidepressants

Off-label: Other antidepressants
Doctors often prescribe drugs off-label to treat medical conditions; this means they prescribe a drug to treat a condition for which it has not been approved by the FDA but has shown promise in practice. For fibromyalgia, the most common medications prescribed off-label are tricyclic antidepressants such as amitriptyline, or a chemically similar muscle relaxant, cyclobenzaprine (Flexeril).

How it works: Tricyclic antidepressants (TCAs) were among the first antidepressants developed. Like SNRIs, they control the level of serotonin and norepinephrine in the brain, but also affect the neurotransmitter dopamine.

Recommended dosage: Because they are not approved for fibromyalgia, doctors must work with a patient to figure out the right dosage; some may not be willing to prescribe the drugs off-label.

When it may be prescribed: Because they have been around for so long and are available as generics, TCAs are often the cheapest medication option and can be used when cost is a concern. In addition, says Dr. Clauw, TCAs have been shown to alleviate other symptoms of fibromyalgia besides joint and muscle pain, such as interstitial cystitis (which causes pain the in bladder) and irritable bowel syndrome. One of the side effects of TCAs, drowsiness, means it may be a good choice for people who have trouble falling asleep, says Dr. Clauw. (Savella and Cymbalta can be stimulating.)

What to consider: Because TCAs affect so many receptors in the brain, more people experience side effects—such as dry mouth and fatigue—than with the other medications. All TCAs carry a black box warning about an increased risk of suicidal thinking and behavior in people under the age of 25.

Selective serotonin reuptake inhibitors (SSRIs), another kind of antidepressant, are also sometimes used to treat fibromyalgia, either alone or in combination with a TCA. These medications include fluoxetine (Prozac) and sertraline (Zoloft) and are prescribed when symptoms include severe mood problems. Atypical antidepressants such as bupropion (Wellbutrin) may also be prescribed off-label.

What’s next
In early 2009, a Stanford University study found that low doses of the drug naltrexone helped reduce pain and fatigue in women with fibromyalgia. Naltrexone is relatively inexpensive and has been used for years to treat drug addiction, but it has only been used off-label to ease fibromyalgia symptoms. Researchers say the study was too small for them to make any new recommendations, but that the results were promising.

The importance of other therapies
Since medication is not universally successful and because the causes of fibromyalgia are so poorly understood, Dr. Argoff cautions that “medication alone is not the solution” and recommends that it be combined with lifestyle changes such as good sleep hygiene and moderate aerobic exercise as well as complementary therapies, such as cognitive behavioral training, to manage pain.

]]> Cymbalta is an antidepressant that may help control fibromyalgia pain and fatigue. http://www.health.com/health/condition-article/0,,20305347,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/iRsUsSk3zI4/0,,20305347,00.html <![CDATA[Chronic Pain and Fibromyalgia: What Is Normal What Is Not?]]> http://feeds.health.com/~r/health/chronic-pain/~3/oL9n3TnyEpg/0,,20288409,00.html

Now that the FDA has approved three drugs to treat fibromyalgia, you may be hearing a lot about this condition. And if you’ve experienced unexplained pain recently, it’s easy to wonder whether you might even suffer from it. (Between 80% and 90% of those diagnosed with fibromyalgia are women.) Diagnosis can be tricky, but experts say that with the right information, it is possible to find the true cause of your pain—whether it’s fibro or something else—and get the treatment you need.

So where do your aches, pains, and everyday health woes fit in? Here’s our guide to what’s normal and what’s not, and when you should see your doctor.

View the slideshow.

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]]> http://www.health.com/health/condition-article/0,,20288409,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/ZgfFoM2_VsE/0,,20288409,00.html <![CDATA[No More Headaches: 10 Surprising Headache Triggers]]> http://feeds.health.com/~r/health/chronic-pain/~3/QPjGnMhc-YE/0,,20272753,00.html

1. Your weight
In a recent study, researchers found that women with mild obesity (a body mass index of 30) had a 35 percent greater risk of headaches than those with a lower BMI. Severe obesity (BMI of 40) upped the chances to 80 percent.

2. Your personality
Certain traits, including rigidity, reserve, and obsessivity may make you headache-prone. If that sounds like you, it could be time to sign up for relaxation training.

3. The big O
In one survey, 46 percent of headache sufferers said sex had triggered a headache. Usually, this is an overexertion headache (like joggers and weightlifters sometimes get); you may feel a dull pain that builds during foreplay or get a sudden headache around orgasm (more likely in men). In rare cases, such an intense headache could be caused by a tumor or aneurysm. For most folks, though, sex headaches are harmless.

4. That three-day vacay
Weekend or “let-down” headaches can happen when you take a break from your routine, says Alexander Mauskop, MD, founder and director of the New York Headache Center and co-author of What Your Doctor May Not Tell You About Migraines. Ease into the change by keeping your sleep time as normal as possible—you’ll end up feeling more rested than if you stay in bed until noon.

5. Your bathroom paint job
It’s not just arguing over paint colors that can give you a headache; fumes from traditional paints can trigger pain. Many companies now make nearly odorless, low-VOC (volatile organic compound) formulas, like Benjamin Moore’s Natura line or Devoe’s Wonder Pure.

6. Dehydration
You don’t have to drink gallons of water to stay hydrated, says John La Puma, MD, author of ChefMD’s Big Book of Culinary Medicine, “I’d love it if people got more water from eating fruits and vegetables because then they’d get all the other good things that come with them.”

7. Skipping meals
We know you’re busy, but hunger is a common headache trigger.

Take the Migraine Quiz: Find out what really triggers that debilitating pain in your head.

Next Page: 8. Too much caffeine

8. Too much caffeine
A little can help headaches, but too much can trigger them, New York City neurologist Audrey Halpern, MD, says. If caffeine is causing your pain, gradually cut back until you have caffeine no more than two days a week.

9. Inactivity
A recent Swedish study showed that those who were inactive were more likely to get headaches than those who worked out. Aim for 20 to 30 minutes of cardio a day, five days a week, to relieve stress, send blood to the brain, and get feel-good endorphins flowing. Exercise may be a trigger for some people, so consult your doc first.

10. Sleep deprivation
One large study says those who slept an average of six hours a night tended to have significantly more severe and more frequent headaches than those who got more zzz’s.

Don’t feed your headache
Everyone reacts differently, but some foods are known to trigger headaches for many people—and others (especially those rich in magnesium) seem to help prevent them.

Take the Migraine Quiz: Find out what really triggers that debilitating pain in your head.

THIS	NOT THIS
Spinach	Red Wine
Tofu	Beer
Oat Bran	MSG
Barley	Chocolate
Fish Oil	Aged Cheese
Olive Oil	Saurkraut
White Beans, Sunflower and Pumpkins Seeds	Processed Meats (Pepperoni, Ham, Salami, etc.)

This article was first published in Health magazine, May 2009.

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Alternative remedies:
Biofeedback: This form of relaxation training teaches you to read your body’s responses to stress. As you become more aware of your own signals—a clenched jaw, shallow breathing, a tight neck—you learn to control them, and this results in fewer and less-severe headaches. This nondrug treatment may teach you a useful lifelong skill, but it can be a bit pricey. Formal training, which is offered at many headache clinics, can run as much as $850 for 10 sessions; some insurance programs will cover a portion of the cost. Home systems are available for as little as $100.

Acupuncture: In a huge German study, researchers looked at more than 15,000 people with migraine and tension-type headaches. Results showed that those treated with both acupuncture and regular medical care improved significantly more than those who had regular medical care alone.

Botox: Widely known as a beauty procedure, Botox is also used off-label to treat migraines. Injections are given in the forehead, around the eyes, at the temples, or on the back of the neck. Treatment costs $700 to $1,200, and studies show that it can relieve headaches for up to three months.

Supplements: Magnesium, co-enzyme Q10, vitamin B2, feverfew, and butterbur all have been shown in studies to help ease headaches. Talk to your doctor before taking them. Upside: These treatments are all-natural and relatively inexpensive. Downside: It may take a few months to see results.

The new meds:
Treximet: This Rx, which became available last year, combines the existing migraine medicine Imitrex with naproxen to treat migraines. Studies show the two-drug combo can be more effective than taking either medication alone, and a single dose has a longer effect.

Migralex: Just out this spring, this over-the-counter pain reliever combines aspirin and magnesium. The magnesium relieves headaches on its own and may also help the stomach absorb and tolerate aspirin. On the downside, aspirin may upset some people’s stomachs, and magnesium can sometimes cause diarrhea, says Merle Diamond, MD, a headache specialist at the Diamond Headache Clinic in Chicago.

Coming soon:
Telecagepant: This drug blocks the receptor of calcitonin gene-related peptide (CGRP), a substance that’s released during migraines. Doctors often prescribe triptans to deal with CGRP, but some people can’t take them. Telecagepant is about a year away from receiving approval.

Transcranial Magnetic Stimulation (TMS): Used as a depression treatment, this technique may work on headaches, too. A device would deliver a powerful—but painless—electromagnetic pulse to zap headache-related electrical activity in your head.

This article was first published in Health magazine, May 2009.

]]> http://www.health.com/health/condition-article/0,,20272718,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/5Tn6Y8ARPk0/0,,20272718,00.html <![CDATA[No More Headaches: Ask the Headache Doctor]]> http://feeds.health.com/~r/health/chronic-pain/~3/BA2fav6IDOk/0,,20272872,00.html

This article was first published in Health magazine, May 2009.

From eyestrain-induced headaches to memory loss, our resident headache expert, Christina Peterson, MD, author, The Women’s Migraine Survival Guide, and founder of the Oregon Headache Clinic, weighs in.

Q: I get a killer migraine every time I have my period. It must be hormones, right?

A: For most women, hormone-related migraines occur a day or two before their periods, and may continue or occur again during their period. If you track your periods, you can try taking a mini-prevention medicine such as ibuprofen, Aleve, or aspirin before menstruation starts. Once the headache begins, your regular migraine medicine may help.

Migraines can flare up or even appear for the first time during perimenopause, when hormones are fluctuating like crazy. The good news is that headaches may diminish or go away once you fully enter menopause.

Q: Why do I wake up every morning with a headache?

A: You might have sleep apnea, a potentially serious condition in which your breathing stops and starts during sleep. Or you could be clenching or grinding your teeth while you sleep. If everything checks out OK with your doctor, you may want to consider investing in a new mattress or pillow. A lack of support can also lead to headaches.

Q: I get a headache from working on a computer all day. Help?

A: You’re probably suffering from eyestrain, in addition to stress from poor posture. Have an ergonomic evaluation done to make sure your workstation is set up correctly. (Some companies offer this service for employees, or you can request a physical therapy referral from your doctor.)

If you use a laptop, connect it to a larger monitor, which will be easier to read. During any computer work, take a two-minute stretch break every hour; set an e-mail alert if you need a reminder. If you wear glasses or contacts, make sure your eye doctor knows that you work at a computer; you may need a different correction for computer work and book work.

Q: My friend says headaches can cause memory loss. True?

A: Unless your headaches are frequent and severe, it’s unlikely that they’ll cause any permanent problems. Recent evidence suggests that in some forms of migraine brain-cell loss can occur during the earliest beginning phases of the attack—and that’s why preventive treatment is so important if you have frequent migraines.

]]> http://www.health.com/health/condition-article/0,,20272872,00.htmlhttp://feeds.health.com/~r/health/chronic-pain/~3/j1SzffK0iJs/0,,20272872,00.html <![CDATA[No More Headaches: What Kind of Headache is It?]]> http://feeds.health.com/~r/health/chronic-pain/~3/hC70LNrxswc/0,,20272862,00.html

Sadly, we can’t do much about Wall Street. We can help with that headache, though—whether it’s a throbbing in your temples after skipping lunch, a pain behind your eyes from staring at your computer, or a dull ache the morning after you’ve had a little too much to drink.

Use our handy guides on the following pages to learn about the most common headache types—then talk to your doctor.

TENSION
Who gets them The most common form of headache, tension-type headaches strike 100 million Americans a year. Some sufferers get them every day.

What happens in your head Stress makes muscles (neck, scalp, jaw) spasm, stimulating pain receptors in the brain. Some experts now believe changes in brain chemicals may be another culprit.

Where it hurts Top or both sides of the head

How it feels Steady, bandlike pressure around the head that doesn’t get worse with normal physical activity

Other symptoms May feel pain in the neck and shoulders or become sensitive to light or sound

Common triggers Lack of sleep, eyestrain, poor posture, irregular meals, stress, worry

Treatment OTC meds with acetaminophen (Tylenol, Excedrin) usually lessen pain. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) with ibuprofen (Motrin, Advil) or naproxen (Aleve) can zap pain and reduce inflammation. Overuse can cause rebound headaches, though, so see your doc if you’re popping pills more than two days a week.

Good to know Tension-type headaches typically last 30 minutes or even a few days.

Next Page: Sinus headaches

SINUS
Who gets them The number of sinus-headache sufferers is unclear, partly because a sinus headache is so often misdiagnosed. (It’s often a migraine.)

What happens in your head During a sinus infection, which is the primary cause of a sinus headache, the sinuses and nasal passages become inflamed, creating pain and pressure.

Where it hurts Cheekbones, forehead, or across the nose

How it feels Deep, constant pain

Other symptoms Fever, runny nose, stuffy ears, facial swelling, bad breath, cough

Common triggers Anyone can have a sinus infection and/or headache; people prone to colds and allergies seem to have them more often

Treatment See your doctor for antibiotics to fight the infection. Advil or another NSAID with ibuprofen can help relieve inflammation, but decongestants and allergy drugs may make sinus headaches worse (they can dry you out); talk to your doctor before taking any meds.

Good to know Greenish-yellow nasal discharge is an obvious symptom of a sinus infection.

CLUSTER
Who gets them More men than women, with onset typically in the 20s to 40s. (Most frequent onset age for women: 60s.) May be underdiagnosed in African-American women.

What happens in your head Something may go awry in the hypothalamus, the part of the brain that houses your biological clock. During attacks, the brain may stimulate responses in the nose and eyes.

Where it hurts One side of the head, often around one eye

How it feels Sudden sharp or burning pain that lasts 15 minutes to more than two hours

Other symptoms Stuffy nose, a watery eye, flushed face, restlessness; attacks can occur several times a day; cycles can last for weeks or months, or stop for years

Common triggers Smoking, alcohol, certain foods, bright lights, sleep problems, stress

Treatment Your doctor may prescribe oxygen treatments or a steroid such as prednisone to stop the attacks. Imitrex injections—fairly painless, compared with the actual headache—or triptan nasal sprays can speed relief. Verapamil, a blood pressure med, has been known to prevent cluster headaches, although doctors aren’t exactly sure how.

Good to know Cluster headaches are rare and not life-threatening. But any first-time sudden-onset headache requires a trip to the doc or ER.

Next Page: Rebound headaches

REBOUND
Who gets them More women than men. Up to one-fourth of all chronic headaches are believed to be caused by taking too much pain medicine.

What happens in your head Overuse of painkillers may trick your brain into thinking you need them all the time; once the meds wear off (or lose their effectiveness), the headache comes back.

Where it hurts Varies

How it feels Constant ache, often starting early in the day

Other symptoms Nausea, anxiety, restlessness, insomnia, depression

Common triggers Caffeine is used to treat headaches but can also prompt them (especially if you’re a heavy user and you suddenly skip or quit your morning Joe)

Treatment Retraining the brain takes time. Depending on the severity of your symptoms and the types of drugs you’re taking, your doctor may want you to taper off your pain meds over several months. Always consult a doc before stopping any prescription drugs.

Good to know To be safe, experts recommend that you take painkillers no more than two days per week.

MIGRAINE
Who gets them About 29.5 million Americans. Women are three times more likely to suffer than men.

What happens in your head Long thought to be caused by abnormal blood vessels, but many experts now point to a central nervous system disorder.

Where it hurts On one side of the head, often around eye, temples, jaw, or neck

How it feels Intense throbbing or pounding that gets worse with physical activity; usually lasts 4 to 72 hours

Other symptoms May be preceded by an aura, weakness in arm or leg, or tingling in face; some sufferers experience nausea, vomiting, and light and/or sound sensitivity

Treatment Migraines are easier to treat if caught early. If yours are mild, try an OTC pain reliever with ibuprofen. For severe attacks, see a doctor to deterimine triggers and meds. Triptans (Imitrex, Maxalt) are often prescribed and usually relieve pain in two hours or less. They shouldn’t be used by people with current or past history of stroke or heart disease.

Good to know A recent study suggested that postmenopausal women who suffer migraines with aura are less likely to develop breast cancer.

This article was first published in Health magazine, May 2009.

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She tried over-the-counter painkillers with no relief. And no wonder: When she finally went to an urgent-care center, a CAT scan revealed swelling in her brain and an MRI showed a brain tumor pressing against the top of her skull.

Days later doctors removed a growth the size of a tennis ball. Fortunately, the tumor—a kind known as meningioma, which develops in the brain’s surrounding membrane—was benign, and Koelker, now 49, is pain-free and in good health. “I was lucky I got a doctor in urgent care who said we should check into this further and do a scan,” she says.

A severe headache should never be ignored, says Alan Carver, MD, assistant professor of neurology and director of headache and pain management at Mt. Sinai School of Medicine in New York City.

“It can be a warning sign of something more ominous: a brain tumor, stroke, or aneurysm.” Patients worry about stirring up drama for nothing, but it’s not worth taking chances. “You don’t have to apologize,” Carver says. “Headaches aren’t always just headaches.”

Call 911 if …

You feel like it’s the worst headache you’ve ever had in your life.
The headache is accompanied by a loss of vision, seeing double, weakness or numbness in your body, difficulty speaking or hearing, or trouble with balance or walking.
You’re afraid you may pass out.

This article was first published in Health magazine, May 2009.

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