Pain (Chronic Conditions & Treatment)

Menstruation & the Menstrual Cycle ARTICLE ON Menstruation & the Menstrual Cycle HAS ALREADY BEING PUBLISH.

Carpal Tunnel Syndrome

What is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome (CTS) is the name for a group of problems that includes swelling, pain, tingling, and loss of strength in your wrist and hand. Your wrist is made of small bones that form a narrow groove or carpal tunnel. Tendons and a nerve called the median nerve must pass through this tunnel from your forearm into your hand. The median nerve controls the feelings and sensations in the palm side of your thumb and fingers. Sometimes swelling and irritation of the tendons can put pressure on the wrist nerve causing the symptoms of CTS. A person’s dominant hand is the one that is usually affected. However, nearly half of CTS sufferers have symptoms in both hands.

CTS has become more common in the U.S. and is quite costly in terms of time lost from work and expensive medical treatment. The U.S. Department of Labor reported that in 2003 the average number of missed days of work due to CTS was 23 days, costing over $2 billion a year. It is thought that about 3.7 percent of the general public in this country suffer from CTS.

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What are the symptoms of CTS?

Typically, CTS begins slowly with feelings of burning, tingling, and numbness in the wrist and hand. The areas most affected are the thumb, index and middle fingers. At first, symptoms may happen more often at night. Many CTS sufferers do not make the connection between a daytime activity that might be causing the CTS and the delayed symptoms. Also, many people sleep with their wrist bent, which may cause more pain and symptoms at night. As CTS gets worse, the tingling may be felt during the daytime too, along with pain moving from the wrist to your arm or down to your fingers. Pain is usually felt more on the palm side of the hand.

Another symptom of CTS is weakness of the hands that gets worse over time. Some people with CTS find it difficult to grasp an object, make a fist, or hold onto something small. The fingers may even feel like they are swollen even though they are not. Over time, this feeling will usually happen more often.

If left untreated, those with CTS can have a loss of feeling in some fingers and permanent weakness of the thumb. Thumb muscles can actually waste away over time. Eventually, CTS sufferers may have trouble telling the difference between hot and cold temperatures by touch.

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What causes CTS and who is more likely to develop it?

Women are three times more likely to have CTS than men. Although there is limited research on why this is the case, scientists have several ideas. It may be that the wrist bones are naturally smaller in most women, creating a tighter space through which the nerves and tendons must pass. Other researchers are looking at genetic links that make it more likely for women to have musculoskeletal injuries such as CTS. Women also deal with strong hormonal changes during pregnancy and menopause that make them more likely to suffer from CTS. Generally, women are at higher risk of CTS between the ages of 45 and 54. Then, the risk increases for both men and women as they age.

There are other factors that can cause CTS, including certain health problems and, in some cases, the cause is unknown.

These are some of the things that might raise your chances of developing CTS:

• Genetic predisposition. The carpal tunnel is smaller in some people than others.
• Repetitive Movements. People who do the same movements with their wrists and hands over and over may be more likely to develop CTS. People with certain types of jobs are more likely to have CTS, including manufacturing and assembly line workers, grocery store checkers, violinists, and carpenters. Some hobbies and sports that use repetitive hand movements can also cause CTS, such as golfing, knitting, and gardening. Whether or not long-term typing or computer use causes CTS is still being debated. Limited research points to a weak link, but more research is needed.
• Injury or Trauma. A sprain or a fracture of the wrist can cause swelling and pressure on the nerve, increasing the risk of CTS. Forceful and stressful movements of the hand and wrist can also cause trauma, such as strong vibrations caused by heavy machinery or power tools.
• Pregnancy. Hormonal changes during pregnancy and build up of fluid can put pregnant women at greater risk of getting CTS, especially during the last few months. Most doctors treat CTS in pregnant women with wrist splits or rest, rather than surgery, as CTS almost always goes away following childbirth.
• Menopause. Hormonal changes during menopause can put women at greater risk of getting CTS. Also, in some postmenopausal women, the wrist structures become enlarged and can press on the wrist nerve.
• Breast Cancer. Some women who have a mastectomy get lymphedema, the build-up of fluids that go beyond the lymph system's ability to drain it. In mastectomy patients, this causes pain and swelling of the arm. Although rare, some of these women will get CTS due to pressure on the nerve from this swelling.
• Medical Conditions. People who have diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis are more likely to get CTS. In some of these patients, the normal structures in the wrist can become enlarged and lead to CTS.

Also, smokers with CTS usually have worse symptoms and recover more slowly than nonsmokers.

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How is CTS treated?

It is important to be treated by a doctor for CTS in order to avoid permanent damage to the wrist nerve and muscles of the hand and thumb. Underlying causes such as diabetes or a thyroid problem should be addressed first. Left untreated, CTS can cause nerve damage that leads to loss of feeling and less hand strength. Over time, the muscles of the thumb can become weak and damaged. You can even lose the ability to feel hot and cold by touch. Permanent injury occurs in about 1 percent of those with CTS.

CTS is much easier to treat early on. Most CTS patients get better after first-step treatments and the following tips for protecting the wrist. Treatments for CTS include the following:

• Wrist Splint. A splint can be worn to support and brace your wrist in a neutral position so that the nerves and tendons can recover. A splint can be worn 24 hours a day or only at night. Sometimes, wearing a splint at night helps to reduce the pain. Splinting can work the best when done within three months of having any symptoms of CTS.
• Rest. For people with mild CTS, stopping or doing less of a repetitive movement may be all that is needed. Your doctor will likely talk to you about steps that you should take to prevent CTS from coming back.
• Medication. The short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful to control CTS pain. NSAIDs include aspirin, ibuprofen, and other non-prescription pain relievers. In severe cases, an injection of cortisone may help to reduce swelling. Your doctor may also give you corticosteroids in a pill form. But, these treatments only relieve symptoms temporarily. If CTS is caused by another health problem, your doctor will probably treat that problem first. If you have diabetes, it is important to know that long-term corticosteroid use can make it hard to control insulin levels.
• Physical Therapy. A physical therapist can help you do special exercises to make your wrist and hand stronger. There are also many different kinds of treatments that can make CTS better and help relieve symptoms. Massage, yoga, ultrasound, chiropractic manipulation, and acupuncture are just a few such options that have been found to be helpful. You should talk with your doctor before trying these alternative treatments.
• Surgery. CTS surgery is one of the most common surgeries done in the U.S. Generally, surgery is only an option for severe cases of CTS and/or after other treatments have failed for a period of at least six months. Open release surgery is a common approach to CTS surgery and involves making a small incision in the wrist or palm and cutting the ligament to enlarge the carpal tunnel. This surgery is done under a local anesthetic to numb the wrist and hand area and is an outpatient procedure.

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What is the best way to prevent CTS?

Current research is focused on figuring out what causes CTS and how to prevent it. The National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) support research on work-related factors that may cause CTS. Scientists are also researching better ways to detect and treat CTS, including alternative treatments such as acupuncture.

Fibromyalgia

What is fibromyalgia?

Fibromyalgia (fye-bro-mye-AL-ja) is a disorder that causes aches and pain all over the body. People with fibromyalgia also have "tender points" throughout their bodies. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs that hurt when pressure is put on them.

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What are the symptoms of fibromyalgia?

In addition to pain, people with fibromyalgia could also have:

• Cognitive and memory problems (sometimes called “fibro fog”)
• Trouble sleeping
• Morning stiffness
• Headaches
• Irritable bowel syndrome
• Painful menstrual periods
• Numbness or tingling of hands and feet
• Restless legs syndrome
• Temperature sensitivity
• Sensitivity to loud noises or bright lights

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How common is fibromyalgia? Who is mainly affected?

Fibromyalgia affects as many as 5 million Americans ages 18 and older. Most people with fibromyalgia are women (about 80 - 90 percent). However, men and children also can have the disorder. Most people are diagnosed during middle age.

Fibromyalgia can occur by itself, but people with certain other diseases, such as rheumatoid arthritis,lupus, and other types of arthritis, may be more likely to have it. Individuals who have a close relative with fibromyalgia are more likely to develop it themselves.

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What causes fibromyalgia?

The causes of fibromyalgia are not known. Researchers think a number of factors might be involved. Fibromyalgia can occur on its own, but has also been linked to:

• Having a family history of fibromyalgia
• Being exposed to stressful or traumatic events, such as
  
  • Car accidents
  • Injuries to the body caused by performing the same action over and over again (called “repetitive” injuries)
  • Infections or illnesses
  • Being sent to war

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How is fibromyalgia diagnosed?

People with fibromyalgia often see many doctors before being diagnosed. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, also are symptoms of many other conditions. Therefore, doctors often must rule out other possible causes of these symptoms before diagnosing fibromyalgia. Fibromyalgia cannot be found by a lab test.

A doctor who knows about fibromyalgia, however, can make a diagnosis based upon 2 criteria:

1. A history of widespread pain lasting more than 3 months. Pain must be present in both the right and left sides of the body as well as above and below the waist.
2. Presence of tender points. The body has 18 sites that are possible tender points. For fibromyalgia diagnosis a person must have 11 or more tender points. For a point to be “tender,” the patient must feel pain when pressure is put on the site. People who have fibromyalgia may feel pain at other sites, too, but those 18 sites on the body are used for diagnosis.

Your doctor may try to rule out other causes of your pain and fatigue. Testing for some of these things may make sense to you. For instance, you may find it reasonable that your doctor wants to rule out rheumatoid arthritis, since that disease also causes pain. Testing for other conditions — such as lupus, multiple sclerosis, or sleep apnea — may make less sense to you. But fibromyalgia can mimic or even overlap many other conditions. Talk with your doctor. He or she can help you understand what each test is for and how each test is part of making a final diagnosis.

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How is fibromyalgia treated?

Fibromyalgia can be hard to treat. It's important to find a doctor who has treated others with fibromyalgia. Many family doctors, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who treat arthritis and other conditions that affect the joints and soft tissues.

Treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Treatment for fibromyalgia may include the following:

• Pain management. Three medicines have been approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. These are pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). Other medications are being developed and may also receive FDA approval in the future. Your doctor may also suggest non-narcotic pain relievers, low-dose antidepressants, or other classes of medications that might help improve certain symptoms.
• Sleep management. Getting the right amount of sleep at night may help improve your symptoms. Here are tips for good sleep:
  
  • Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day — even on weekends and vacations.
  • Avoid caffeine and alcohol in the late afternoon and evening.
  • Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which can be stimulating, keeping you awake.
  • Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
  • Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
  • Keep your bedroom dark, quiet, and cool.
  • Avoid liquids and spicy meals before bed. Heartburn and late-night trips to the bathroom do not lead to good sleep.
  • Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (A warm bath also may soothe aching muscles.)

• Psychological support. Living with a chronic condition can be hard on you. If you have fibromyalgia, find a support group. Counseling sessions with a trained counselor may improve your understanding of your illness.
• Other treatments. Complementary therapies may help you. Talk to your physician before trying any alternative treatments. These include:
  
  • Physical therapy
  • Massage
  • Myofascial release therapy
  • Water therapy
  • Light aerobics
  • Acupressure
  • Applying heat or cold
  • Acupuncture
  • Yoga
  • Relaxation exercises
  • Breathing techniques
  • Aromatherapy
  • Cognitive therapy
  • Biofeedback
  • Herbs
  • Nutritional supplements
  • Osteopathic or chiropractic manipulation

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What can I do to try to feel better?

Besides taking medicine prescribed by your doctor, there are many things you can do to lessen the impact of fibromyalgia on your life. These include:

• Getting enough sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Most adults need seven to eight hours of “restorative” sleep per night. Restorative sleep leaves you feeling well-rested and ready for your day to start when you wake up. It is hard for people with fibromyalgia to get a good night’s sleep. It is important to discuss any sleep problems with your doctor, who can recommend treatment for them.
• Exercising. Although pain and fatigue may make exercise and daily activities difficult, it is crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do hard exercise should just begin to move more and become more active in routine daily activities. Then they can begin with walking (or other gentle exercise) and build their endurance and intensity slowly.
• Making changes at work. Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make changes that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift. A number of federal laws protect the rights of people with disabilities.
• Eating well. Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.

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Will fibromyalgia get better with time?

Fibromyalgia is a chronic condition, meaning it lasts a long time — possibly a lifetime. However, it may be comforting to know that fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time.

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What is the difference between fibromyalgia and chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) and fibromyalgia are alike in many ways. In fact, it is not uncommon for a person to have both fibromyalgia and CFS. Some experts believe that fibromyalgia and CFS are in fact the same disorder, but expressed in slightly different ways. Both CFS and fibromyalgia have pain and fatigue as symptoms.

The main symptom of CFS is extreme tiredness. CFS often begins after having flu-like symptoms. But people with CFS do not have the tender points that people with fibromyalgia have. To be diagnosed with CFS, a person must have:

1. Extreme fatigue for at least 6 months that cannot be explained by medical tests and
2. At least 4 or more of the following symptoms:
   
   • Forgetting things or having a hard time focusing
   • Feeling tired even after sleeping
   • Muscle pain or aches
   • Pain or aches in joints without swelling or redness
   • Feeling discomfort or "out-of-sorts" for more than 24 hours after being active
   • Headaches of a new type, pattern, or strength
   • Tender lymph nodes in the neck or under the arm
   • Sore throat

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What if I can’t work because of fibromyalgia?

Many experts in fibromyalgia do not suggest patients go on disability. These experts have found that if patients stop working, they:

• Stop moving as much during the day
• Lose contact with co-workers
• Lose a “sense of purpose” in life

All of these things can make a patient feel more alone and depressed. These 3 things tend to make fibromyalgia symptoms worse. Deciding to go on disability is a hard choice that you should talk about with your doctor or nurse.

However, if you cannot work because of your fibromyalgia, contact the ONGEORGE MEDICAL SERVICES, IDIMU-IKOTUN ROAD, LAGOS OR CALL 08038084759

Interstitial Cystitis/Bladder Pain Syndrome

What is interstitial cystitis/bladder pain syndrome (IC/BPS)?

Interstitial cystitis (int-uhr-STISH-uhl siss-TYT-uhss) (IC), is a chronic pain condition that affects the bladder. Many experts now call it bladder pain syndrome (BPS). Symptoms of IC/BPS include:

• Pain or discomfort believed to be related to the bladder, which often gets worse as the bladder fills.
• Feeling like you need to urinate right away (urgency), often (frequency), or both. Most people urinate between 4 and 7 times a day. Yet with IC/BPS, the bladder may hold less urine. People with severe IC/BPS urinate as often as 30 times a day.
• Pain, pressure, or tenderness in the pelvic area and/or genitals.
• Pain during sexual intercourse, or pain during ejaculation for men.
• Ulcers and/or bleeding in the bladder.

The symptoms of IC/BPS vary from person to person and can change over time. Women's symptoms often get worse during their menstrual periods. Some people with IC/BPS feel only mild discomfort. Others have severe pain and symptoms.

IC/BPS can greatly affect a person’s quality of life. Severe cases of IC/BPS can keep people from going to work or school and being socially active. It can affect a person’s sex life and relationships. Living with a chronic condition can increase your risk of depression.

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Who gets IC/BPS?

More than 1.3 million Americans have IC/BPS, but some studies suggest that millions more may have symptoms of IC/BPS. About 8 in 10 people with IC/BPS are women, although more men might have IC/BPS than we think. Men who actually have IC/BPS may be diagnosed with conditions that have similar symptoms, such as some prostate conditions. Most people with IC/BPS are diagnosed in middle age, but it may be diagnosed in teenagers and senior citizens as well.

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What are the causes of IC/BPS?

No one knows what causes IC/BPS. The following factors may play a role in IC/BPS:

• A defect in the bladder wall that allows substances in the urine to irritate the bladder.
• A specific type of cell that releases histamine (HISS-tuh-meen) (chemical released during an allergic reaction) and other chemicals, which lead to symptoms of IC/BPS.
• Something in the urine that damages the bladder.
• Changes in the nerves that carry bladder sensations, making normal events, such as bladder filling, painful.
• The body’s immune system attacks the bladder.

It’s hard to know if some of these factors actually cause IC/BPS or are part of the process that leads to IC/BPS. Also, the causes of IC/BPS in some people may be different than the causes in other people with IC/BPS. Studies of people who have IC/BPS suggest that it sometimes develops after an injury to the bladder, such as an infection. Genes also may play a role in some forms of IC/BPS. In some cases, IC/BPS affects both a mother and daughter or sisters. Still, IC/BPS does not commonly run in families.

Recently, researchers have identified a substance found almost only in the urine of people with IC/BPS. This substance appears to block the normal growth of the cells that line the wall of the bladder. Learning more about this substance might help researchers better understand the causes of IC/BPS and possible treatments.

Many women with IC/BPS have other conditions, such as irritable bowel syndrome and fibromyalgia (feye-broh-meye-AL-juh). Allergies also are common in people with IC/BPS. Learning about these conditions also might provide clues on the cause of IC/BPS.

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How can I tell if I have IC/BPS?

No single test can tell if you have IC/BPS, which can make it hard to diagnose. Your doctor will ask you lots of questions about your symptoms. Your doctor also will need to rule out other health problems that may be causing your symptoms, such as:

• Urinary tract infection (UTI)
• Bladder cancer
• Endometriosis (en-doh-mee-tree-OH-suhss)
• Sexually transmitted infections (STIs)
• Kidney stones

Some tests used to help rule out other health problems that can cause bladder pain include:

• Urine test. Your doctor will insert a catheter, which is a thin tube, to drain urine. Or you may be asked to give a urine sample using the "clean catch" method. For a clean catch, you will wash your genital area before collecting urine midstream in a sterile container. Your urine will be looked at under a microscope or sent to a lab to see if you have germs that cause UTIs or STIs.
• Cystoscopy with or without bladder distention. Your doctor may use a cystoscope (SISS-tuh-skohp), which is a thin tube with a tiny camera, to see inside the bladder. Further testing may include slowly stretching the bladder, called bladder distention, by filling it with liquid. This helps the doctor get a better look inside the bladder. The doctor can look for signs of cancer, bladder stones, or other problems. It can show whether your bladder wall is swollen, thick, or stiff and can measure how much urine the bladder can hold. It can also find bleeding or ulcers in the bladder. This test is often done as an outpatient surgery.
• Biopsy. A biopsy is when a tissue sample is removed and looked at under a microscope. Samples of the bladder and urethra may be removed during cystoscopy. A biopsy helps your doctor rule out bladder cancer.

Researchers are working on developing new tests to help diagnose IC/BPS.

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Is there a cure for IC/BPS?

Doctors have not yet found a cure for IC/BPS. They cannot predict who will respond best to the different treatment options. Sometimes, symptoms may go away for no reason or after a change in diet or treatment. Even when symptoms do go away, they may return after days, weeks, months, or years.

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How is IC/BPS treated?

There are treatments available to help ease the symptoms of IC/BPS. Doctors usually start with a conservative approach, and progress to other therapies as needed. Although no one treatment helps everyone, over time many women are able to find a treatment plan that helps them to feel better. Some of these include:

Self-help strategies. Some people with IC/BPS find relief with self-care methods, such as:

• Bladder retraining — This helps the bladder hold more urine before signaling the urge to urinate.
• Dietary changes
• Wearing loose clothing
• Quitting smoking
• Reducing stress — Stress cannot cause IC/BPS, but it can trigger flare-ups.
• Pelvic exercises — A doctor or physical therapist can teach you how to do these.
• Low-impact physical activity, such as stretching and walking

Oral medicines. Several types of medicine might help with symptoms of IC/BPS. Over-the-counter pain relievers, such as aspirin and ibuprofen (eye-byoo-PROH-fuhn), might help with mild bladder pain. Talk to your doctor if you feel you need stronger pain medicine.

A prescription medicine called pentosan (PEN-tuh-san) polysulfate (pol-ee-SUHL-fayt) sodium (Elmiron) can help ease symptoms in about one-third of patients. Because Elmiron has not been tested in pregnant women, it’s not recommended for use during pregnancy, except in severe cases. Doctor’s aren’t sure how it works, but it may restore the inner surface of the bladder and protect the bladder wall from irritating substances. You may have to take this medicine for up to 6 months before you start to feel better. Other oral medicines for IC/BPS include:

• Amitriptyline (a-mee-TRIP-tih-leen), an antidepressant that can help increase bladder capacity and block pain
• Antihistamines

Bladder distention. The doctor slowly stretches the bladder by filling it with liquid. Doctors aren’t sure why, but this procedure eases pain for some patients.

Bladder instillation (a bladder wash or bath).The bladder is filled with a liquid medicine that is held for different periods of time before being emptied. Treatments are given every week or 2 in about 6-or 8-week cycles. Some people are able to do this at home.

Nerve stimulation. Wires send mild electric pulses to the nerves that control the bladder. Scientists don’t know exactly how nerve stimulation works, but it helps ease urgency and urinary frequency in some people.

Surgery. If other treatments have failed and the pain is disabling, surgery may be an option. Surgery may or may not ease symptoms.

Keep in mind, these treatments do not cure IC/BPS. But, you may find that these treatments help to ease your IC/BPS symptoms. Researchers continue to study new treatments for IC/BPS. Talk to your doctor to find out if taking part in a clinical trial might be right for you.

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Can consuming certain foods and drinks bring on symptoms or make them worse?

Studies have not proven a link between diet and IC/BPS. Yet, some people find that that their symptoms begin or get worse after consuming certain foods or drinks, such as:

• Alcohol
• Tomatoes
• Spices
• Chocolate
• Caffeinated and citrus drinks
• High-acid foods
• Artificial sweeteners

Keeping a food diary might reveal a link, if there is one, between certain foods or drinks and the onset of symptoms. Or, you can avoid foods or drinks you think might bring on your symptoms or make them worse. Then, you can start eating or drinking these products again one at a time to see if any affect your symptoms. Some people with IC/BPS find no link between symptoms and what they eat.

If you decide to avoid certain foods or drinks, make sure that your meals are still well-balanced and healthy.

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Does IC/BPS affect pregnancy?

Doctors do not have much information about pregnancy and IC/BPS. IC/BPS is not thought to affect fertility or the health of the unborn baby. Some women find that their IC/BPS symptoms get better during pregnancy. Others find their symptoms get worse. If you are thinking about becoming pregnant, talk to your doctor about your IC/BPS and any medicines you might be using to treat IC/BPS or other conditions. Some medicines and treatments are not safe to use during pregnancy.

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I just found out I have IC/BPS. What else can I do to cope?

Learn as much as you can about IC/BPS and play an active role in your treatment and self-care. Adopt a healthy lifestyle, so you can feel your best. Try to live life as normally as possible. Reach out to loved ones and trusted friends for support. Think about joining a support group for people with IC/BPS, which can help you to cope with symptoms and stress.

Lupus

What is lupus?

Lupus (LOO-puhss) is a chronic, autoimmune (aw-toh-ih-MYOON) disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with your immune system, which is the part of the body that fights off viruses, bacteria, and other germs (“foreign invaders,” like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means your immune system cannot tell the difference between these foreign invaders and your body’s healthy tissues (“auto” means “self”). In lupus, your immune system creates autoantibodies  (AW-toh-AN-teye-bah-deez), which attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

When people talk about “lupus,” they usually mean systemic lupus erythematosus (ur-uh-thee-muh-TOH-suhss), or SLE. This is the most common type of lupus. Studies suggest that more than 16,000 new cases are reported annually across the country.

Although lupus can affect almost any organ system, the disease, for most people, affects only a few parts of the body. For example, one person with lupus may have swollen knees and fever. Another person may be tired all the time or have kidney trouble. Someone else may have rashes.

Normally, lupus develops slowly, with symptoms that come and go. Women who get lupus most often develop symptoms and are diagnosed between the ages of 15 and 45. But the disease also can develop in childhood or later in life.

For most people, lupus is a mild disease. But for others, it may cause serious problems. Even if your lupus symptoms are mild, it is a serious disease that needs treatment. It can harm your organs and put your life at risk if untreated.

Although the term “lupus” commonly refers to SLE, this is only one type of the disease. There are other, less common types of lupus:

• Discoid (DISS-koid) lupus erythematosus, also called DLE, mainly affects the skin. A red rash may appear. Or, the skin on the face, scalp, or elsewhere may become scaly or change color. Sometimes DLE causes sores in the mouth or nose. A doctor will remove a small piece of the rash or sore and look at it under a microscope to tell if someone has DLE. If you have DLE, there is a small chance that you will later get SLE. There is no way to know if someone with DLE will get SLE.
• Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. Symptoms can include: joint pain, muscle pain, and fever. Symptoms are mild for most people. Most of the time, the disease goes away when the medicine is stopped. More men get this type of lupus because the drugs with the highest risk of causing it are used to treat heart conditions that are more common in men; however, not everyone who takes these drugs will develop drug-induced lupus. The drugs most commonly connected with drug-induced lupus are procainamide (Pronestyl^®, Procanbid^®) and hydralazine (Apresoline^®; also, hydralazine is an ingredient in Apresazide^® and Bidil^®).
• Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by certain antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy.

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Who gets lupus?

It is estimated that between 161,000 and 322,000 adults in the U.S. have SLE. Nine out of 10 people who have lupus are women. African American, Latina, Asian, and Native American women are at greater risk of getting lupus than white women.

Anyone can get lupus. But 9 out of 10 people who have lupus are women. African American women are three times more likely to get lupus than white women. Lupus is also more common in Hispanic/Latina, Asian, and Native American women.

African Americans and Hispanics/Latinos tend to get lupus at a younger age and have more symptoms, including kidney problems. Lupus also tends to be more severe in these ethnic groups. For example, African Americans with lupus have more problems with seizures and strokes. Hispanic/Latino patients have more heart problems. Scientists believe that genes play a role in how lupus affects these ethnic groups.

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Why is lupus a concern for women?

Nine out of 10 people who have lupus are women. And lupus is most common in women of childbearing years. Having lupus increases your risk of developing other health problems that are common in women. It can also cause these diseases to occur earlier in life:

• Heart disease. When you have lupus you are at increased risk for the main type of heart disease, called coronary artery disease (CAD). This is partly because people with lupus have more CAD risk factors, which may include: high blood pressure (hypertension), high cholesterol levels, type 2 diabetes, and an inactive lifestyle due to fatigue, joint problems, and/or muscle pain. Heart disease is the number one killer of all women. But, women with lupus are 50 times more likely to have chest pain or a heart attack than other women of the same age.
• Osteoporosis (OSS-tee-oh-puh-ROH-suhss). Women with lupus have more bone loss and breaks than other women. This is thought to happen because some medicines used to treat lupus cause bone loss. Bone loss also may occur as a direct result of the disease. Also, pain and fatigue can keep women with lupus from exercising. Keeping active is an important way to keep bones healthy and strong.

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What causes lupus?

You can't catch lupus from another person, and it isn't related to AIDS.

The cause of lupus is not known. More than one factor is likely to play a role in getting lupus. Researchers are looking at these factors:

• Environment (Sunlight, stress, certain medications, and viruses might trigger symptoms in people who are prone to getting lupus.)
• Hormones (Lupus is more common in women during childbearing years.)
• Problems with the immune system

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What are the symptoms of lupus?

The signs of lupus differ from person to person. Some people have just a few symptoms; others have more. Lupus symptoms also tend to come and go. Lupus is a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better).

Common signs of lupus are:

• joint pain and stiffness, with or without swelling
• muscle aches and pains
• fever with no known cause
• feeling very tired
• skin rashes
• anemia (uh-NEE-me-uh) (too few red blood cells)
• trouble thinking, memory problems, confusion
• kidney problems with no known cause
• chest pain when taking a deep breath
• butterfly-shaped rash across the nose and cheeks
• sun or light sensitivity
• hair loss

Less common symptoms include:

• blood clots
• purple or pale fingers or toes from cold or stress
• seizures
• sores in the mouth or nose (usually painless)
• severe headache
• dizzy spells
• "seeing things", not able to judge reality
• feeling sad
• strokes

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What are flares?

The times when your symptoms worsen and you feel ill are called flares. Flares tend to come and go. You may have swelling and rashes one week and no symptoms at all the next. Even if you take medicine for lupus, you may find that some things trigger your symptoms to flare. You may find that your symptoms flare after you've been out in the sun or after a hard day at work. Common triggers include:

• overwork and not enough rest
• stress
• being out in the sun or close exposure to fluorescent or halogen light
• infection
• injury
• stopping your lupus medicines
• certain medications

See What can I do to control my lupus symptoms and prevent flares?

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How can a doctor tell if I have lupus?

Lupus can be hard to diagnose. It's often mistaken for other diseases. Many people have lupus for awhile before they find out they have it. If you have symptoms, tell your doctor right away. No single test can tell if a person has lupus. But your doctor can find out if you have lupus in other ways, including:

1. Medical history. Telling your doctor about your symptoms and other problems you have had can help him or her understand your situation. Keep track of your symptoms by writing them down. See the symptom checklist.
2. Family history of lupus or other autoimmune diseases. Tell your doctor if lupus or other autoimmune diseases run in your family.
3. Complete physical exam. Your doctor will look for rashes and other signs that something is wrong.
4. Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to produce the autoantibodies of lupus. Most people with lupus test positive for ANA. But, a positive ANA does not mean you have lupus. About 2 in 10 healthy people test positive for ANA. Positive tests also are seen in other conditions, such as thyroid disease, malaria, and other autoimmune diseases. That's why your doctor will use many tools—and maybe other tests—to tell if you have lupus.
5. Skin or kidney biopsy (BEYE-op-see). With a biopsy, doctors perform a minor surgery to remove a sample of tissue. The tissue is then looked at under a microscope. Skin and kidney tissue looked at in this way can show signs of an autoimmune disease.

Together, this information can provide clues to your disease. It also can help your doctor rule out other diseases that can be confused with lupus.

Print out this table and use it to make notes to take to your doctor.
Put a check mark beside the symptoms you have. Note when you have them.
(Printer friendly version)

Symptom Checklist

Symptom		Where?	When did you first notice?	How often?	Recent dates?
Example: rash		face and chest	2 years ago	Once or twice a month	9/17, 10/8, 10/23, 11/15
Red rash or color change
Painful or swollen joints
Fever with no known cause
Feeling very tired
Trouble thinking, memory problems, confusion
Chest pain with deep breathing
Sensitivity to sun
Unusual hair loss
Pale or purple fingers or toes
Sores in mouth or nose
Other

Adapted from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

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How is lupus treated?

There is no known cure for lupus, but there are treatments. Your treatment will depend on your symptoms and needs. The goals of treatment are to:

• prevent flares
• treat symptoms when they occur
• reduce organ damage and other problems

Your treatment might include using medicines to:

• reduce swelling and pain
• prevent or reduce flares
• calm the immune system
• reduce or prevent damage to the joints
• reduce or prevent organ damage

Never take vitamins or herbal supplements without talking to your doctor first. They might not mix well with medicines you use to treat lupus.

Drugs play an important role in treating lupus. Most likely, the drugs prescribed to you will change often during your treatment. Types of drugs commonly used to treat lupus include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to reduce pain and swelling in joints and muscles. They can help with mild lupus—when pain isn't too bad and vital organs are not affected. Aspirin, ibuprofen, and naproxen are some over-the-counter NSAIDs. You need a prescription for stronger NSAIDs. NSAIDs can cause stomach upset, heartburn, drowsiness, headache, fluid retention, and other side effects. NSAIDs also can cause problems in your blood, liver, and kidneys if overused.
• Corticosteroids. Corticosteroids (KOR-tih-koh-STAIR-oyds) are hormones found in our bodies. Manmade versions are used to reduce swelling, tenderness, and pain in many parts of the body. In high doses, they can calm the immune system. Often, these drugs are called "steroids." They are different than steroids used by some people who play sports or lift weights. Corticosteroids come as pills or liquids, creams to apply to the skin, and as a shot. Prednisone (PRED-nuh-sohn) is one drug commonly used to treat lupus. Lupus symptoms tend to respond very quickly to these powerful drugs. Once this has happened, your doctor will want to lower your dose slowly until you no longer need it. The longer a person uses corticosteroids, the harder it becomes to lower the dose. But stopping this medicine right away can harm your body. Make sure to use your medicine exactly as your doctor tells you to.
  
  Corticosteriods can have many side effects, so your doctor will give you the lowest dose possible. Short-term side effects can include: a round or puffy face, acne, heartburn, increased appetite, weight gain, and mood swings. These side effects typically stop when the drug is stopped. Long-term side effects can include: easy bruising, thinning skin and hair, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, muscle weakness, and cataracts. Your doctor can prescribe medicines to take with corticosteroids to prevent some side effects, such as osteoporosis.
• Antimalarial drugs. Medicines used to prevent or treat malaria are used to treat joint pain, skin rashes, and mouth sores. Two common antimalarials are hydroxychloroquine (heye-DROK-see-KLOR-uh-kween) (Plaquenil^®) and chloroquine (KLOR-uh-kween) phosphate (Aralen^® phosphate). Side effects of antimalarials can include stomach upset, nausea, vomiting, diarrhea, headache, dizziness, blurred vision, trouble sleeping, and itching.
• Immunosuppressive agents/chemotherapy. These agents are used in severe cases of lupus, when major organs are not working well and other treatments do not work. These drugs suppress the immune system to limit the damage to the organ. Examples are azathioprine (az-uh-THEYE-uh-preen) (Imuran^®) and cyclophosphamide (seye-kluh-FOSS-fuh-myd) (Cytoxan^®). These drugs can cause serious side effects including nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection.

You and your doctor should review your treatment plan often to be sure it is working. Tell your doctor about any side effects or if your medicines no longer help your symptoms. Tell your doctor if you have new symptoms. Never stop or change treatments without talking to your doctor first. Also, it is likely that you will need other drugs to treat conditions that are linked to your lupus—such as drugs to treat high blood pressure or osteoporosis.

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Will I need to see a special doctor for my lupus?

Depending on your symptoms and/or if your organs have been hurt by your lupus, you may need to see special kinds of doctors. Start by seeing your family doctor and a rheumatologist (ROOM-uh-TOL-uh-jist), a doctor who specializes in the diseases of joints and muscles such as lupus.

Your rheumatologist may ask that you also see:

• a clinical immunologist (im-yuh-NOL-uh-jist), a doctor who treats immune system disorders
• a nephrologist (nuh-FROL-uh-jist), a doctor who treats kidney diseases
• a hematologist (hee-muh-TOL-uh-jist), a doctor who treats blood disorders
• a dermatologist (dur-muh-TOL-uh-jist), a doctor who treats skin problems and diseases
• a neurologist (noo-ROL-uh-jist), a doctor who treats problems with the nervous system
• a psychologist (seye-KOL-uh-jist)
• an occupational (ok-yuh-PAY-shuh-nul) therapist
• a social worker

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What can I do to control my lupus symptoms and prevent flares?

The best way to keep your lupus under control is by following your treatment plan and taking care of yourself. Take these steps:

• Learn how to tell that a flare is coming.
• See your doctors regularly.
• Maintain life balance by setting realistic goals and priorities.
• Limit the time you spend in the sun and in fluorescent and halogen light.
• Maintain a healthy diet.
• Develop coping skills to help limit stress.
• Get enough sleep and rest.
• Exercise moderately with your doctor’s okay and when you’re feeling up to it.
• Develop a support system made up of people you trust and can go to for help.

Despite your best efforts to follow your treatment plan and take good care of yourself, there will be times when your lupus symptoms are worse. Being able to spot the warning signs of a flare can help you prevent the flare or make it less severe. Before a flare your symptoms might get worse, or you might get new symptoms, such as:

• feeling more tired
• pain
• rash
• fever
• stomach ache
• severe headache

Contact your doctor right away if you suspect a flare is coming.

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Living with lupus can be hard. How can I cope?

Dealing with a long-lasting disease like lupus can be hard on the emotions. Concerns about your health and the effects of your lupus on your work and family life can be stressful. Changes in the way you look and other physical effects of lupus and the medicines used to treat lupus can bring on body image issues and affect self-esteem. Your friends, family, and coworkers might not seem to understand how you feel. At times, you might feel sad or angry. Or, that you have no control over your life with lupus. But there are things you can do that will help you to cope and to keep a good outlook:

• Pace yourself. People with lupus have limited energy and must manage it wisely. Most women with lupus feel much better when they get enough rest and avoid taking on too much at home and at work. To do this, pay attention to your body. Slow down or stop before you're too tired. Learn to pace yourself. Spread out your work and other activities.
• Reduce stress. Exercising with your doctor’s okay, finding ways to relax, and staying involved in social activities you enjoy will reduce stress and help you to cope.
• Get support. Be open about your feelings and needs with family members and close friends. Consider support groups or counseling. They can help you to see that you are not alone. Group members teach one another how to enjoy life with lupus.
• Talk to your doctor. The symptoms of lupus and some medications can bring on feelings of depression. Don't be afraid to talk to your doctor about these feelings.
• Learn about lupus. People who are well-informed and involved in their own care have less pain; make fewer visits to the doctor; feel better about themselves; and remain more active.

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I have lupus. Is it safe for me to become pregnant?

Women with lupus can safely become pregnant. If your disease is under control, pregnancy is unlikely to cause flares. But there are some important things you should know before you become pregnant:

• Your disease should be under control or in remission for 12 months before you get pregnant. Getting pregnant when your lupus is active could result in miscarriage, stillbirth, or other serious problems. Planning ahead is critical if you have lupus.
• Some women do develop flares during pregnancy. The flares happen most often in the first or second trimester or in the first few months after you have the baby. Most flares are mild and easily treated with proper medical care.
• Preeclampsia (pree-ee-KLAMP-see-uh), or "toxemia", is a serious condition that must be treated right away. Preeclampsia is a condition starting after 20 weeks of pregnancy that causes high blood pressure and problems with the kidneys and other organs. About 2 in 10 pregnant women with lupus get preeclampsia. If you get this, you might notice sudden weight gain, swelling of the hands and face, blurred vision, dizziness, or stomach pain. You might have to deliver your infant early.
• Although many women with lupus have normal pregnancies, all lupus pregnancies should be considered "high risk". This means there are certain factors that make problems during pregnancy more likely for women with lupus. It doesn't mean there will be problems.

Planning ahead and proper medical care are very important.

• Find an obstetrician (OB) who manages high-risk pregnancies and who can work closely with your regular doctor.
• Plan to have your baby at a hospital that can manage high-risk patients and provide the special care you and your baby may need.
• See your doctor often while you are pregnant.
• Talk to your doctor about which medicines are safe to use while pregnant.
• Develop a plan for help at home during your pregnancy and after your baby is born. Motherhood can be very tiring, and even more so for women with lupus.
• Develop a birth control plan for after you have your baby. It would be unwise for you to become pregnant again soon after giving birth. It is possible to get pregnant before your period begins again or while you are breastfeeding.

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I am pregnant. How can I tell whether changes in my body are normal or signs of a flare?

It may be hard to tell the difference. You may have symptoms from being pregnant that you mistake for a flare. Here are some examples:

• Skin. While pregnant, you may have red palms and a rash. Lupus can also cause a rash.
• Joints. Lupus can cause pain and swelling in your joints. Pregnancy can cause aching in your joints.
• Lungs. Taking deep breaths can be hard if you have lupus. Pregnancy also can cause shortness of breath.

Fortunately, recent studies show that flares are uncommon and tend to be mild during pregnancy. Some women with lupus find their symptoms improve during pregnancy. Still, it's important to report new symptoms to your doctor. This way, flares that do occur can be prevented or controlled.

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I am pregnant and have lupus. Will my baby be born healthy?

Babies born to women with lupus have no greater chance of birth defects or mental retardation than do babies born to women without lupus. About 3 in 100 babies born to mothers with lupus will have neonatal lupus. In most cases, this goes away after 3 to 6 months and does not come back.

During your pregnancy, your OB will regularly check the baby's heartbeat and growth with ultrasound (a machine that takes pictures of your baby's organs). About 3 in 10 women with lupus will give birth too early. Although this can present a danger to the baby, most problems can be treated in a hospital that specializes in caring for premature newborns.

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Can I breastfeed if I have lupus?

Breastfeeding is possible for mothers with lupus. Some medicines can pass through your breast milk to your infant. Talk to your doctor about whether breastfeeding is safe if you are using any medicines to control your lupus. Breastfeeding also can be very tiring because breastfed babies eat more often than formula-fed babies. If the demands of breastfeeding become too much for you, think about breastfeeding only some of the time. Pumping breast milk to be used later also might help.

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What research is being done on lupus?

Lupus is the focus of intense research. Studies are looking at:

• the genes that play a role in lupus and in the immune system
• ways to change the immune system in people with lupus
• lupus in ethnic groups
• things in the environment that may cause lupus
• the role of hormones in lupus
• birth control pills and hormone therapy in women with lupus
• heart disease in people with lupus
• the causes of nervous system damage in people with lupus
• treatments for lupus

Clinical trials are medical research studies to see whether new treatments are safe and effective. These studies help doctors learn how people respond to medicines and other new or improved treatments.

Migraine

What is migraine?

Migraine is a medical condition. Most people who suffer from migraines get headaches that can be quite severe. A migraine headache is usually an intense, throbbing pain on one, or sometimes, both sides of the head. Most people with migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved. Besides pain, migraine also can cause nausea and vomiting and sensitivity to light and sound. Some people also may see spots or flashing lights or have a temporary loss of vision.

Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days. Some people get migraines once or twice a week. Others, only once or twice a year. Most of the time, migraines are not a threat to your overall health. But migraine attacks can interfere with your day-to-day life.

We don’t know what causes migraine, but some things are more common in people who have them:

• Most often, migraine affects people between the ages of 15 and 55.
• Most people have a family history of migraine or of disabling headache.
• They are more common in women.
• Migraine often becomes less severe and less frequent with age.

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How common are migraines?

Migraine pain and symptoms affect 29.5 million Americans. Migraine is the most common form of disabling headache that sends patients to see their doctors.

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What causes migraines?

The exact cause of migraine is not fully understood. Most researchers think that migraine is due to abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they can cause inflammation. This inflammation then causes blood vessels in the brain to swell and press on nearby nerves, causing pain.

Genes also have been linked to migraine. People who get migraines may have abnormal genes that control the functions of certain brain cells.

Experts do know that people with migraines react to a variety of factors and events, called triggers. These triggers can vary from person to person and don’t always lead to migraine. A combination of triggers—not a single thing or event—is more likely to set off an attack. A person’s response to triggers also can vary from migraine to migraine. Many women with migraine tend to have attacks triggered by:

• lack of or too much sleep
• skipped meals
• bright lights, loud noises, or strong odors
• hormone changes during the menstrual cycle
• stress and anxiety, or relaxation after stress
• weather changes
• alcohol (often red wine)
• caffeine (too much or withdrawal)
• foods that contain nitrates, such as hot dogs and lunch meats
• foods that contain MSG (monosodium glutamate), a flavor enhancer found in fast foods, broths, seasonings, and spices
• foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, and Chianti wine
• aspartame (NutraSweet^® and Equal^®)

To pinpoint your migraine triggers, keep a headache diary. Each day you have a migraine headache, put that in your diary. Also write down the:

• the time of day your headache started
• where you were and what you were doing when the migraine started
• what you ate or drank 24 hours before the attack
• each day you have your period, not just the first day  (This can allow you and your doctor to see if your headaches occur at the same or similar time as your period.)

Talk with your doctor about what sets off your headaches to help find the right treatment for you.

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Are there different kinds of migraine?

Yes, there are many forms of migraine. The two forms seen most often are migraine with aura and migraine without aura.

Migraine with aura (previously called classical migraine). With a migraine with aura, a person might have these sensory symptoms (the so-called “aura”) 10 to 30 minutes before an attack:

• seeing flashing lights, zigzag lines, or blind spots
• numbness; or tingling in the face or hands
• disturbed sense of smell, taste, or touch
• feeling mentally “fuzzy”

Only one in five people who get migraine experience an aura. Women have this form of migraine less often than men.

Migraine without aura (previously called common migraine). With this form of migraine, a person does not have an aura but has all the other features of an attack.

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How can I tell if I have a migraine or just a bad tension-type headache?

Compared with migraine, tension-type headache is generally less severe and rarely disabling. Compare your symptoms with those in this chart to see what type of headache you might be having.

Migraine vs. Bad Tension-Type Headache

Symptom	Tension	Migraine
Intensity and quality of pain
Mild-to-moderate	x	x
Moderate-to-severe		x
Intense pounding or throbbing and/or debilitating		x
Distracting, but not debilitating	x
Steady ache	x	x
Location of pain
One side of head		x
Both sides of head	x	x
Other Symptoms
Nausea, vomiting		x
Sensitivity to light and/or sounds	rare	x
Aura before onset of headache		x

Note: Rebound headache may have features of tension and/or migraine headacheAdapted from a table produced by the American Council for Headache Education

Although fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather.

There also are differences in how types of headaches respond to treatment with medicines. Although some over-the-counter drugs used to treat tension-type headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension-type headaches for most people.

You can't tell the difference between a migraine and a tension-type headache by how often they occur. Both can occur at irregular intervals. Also, in rare cases, both can occur daily or almost daily.

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How can I tell if I have a migraine or a sinus headache?

Many people confuse a sinus headache with a migraine because pain and pressure in the sinuses, nasal congestion, and watery eyes often occur with migraine. To find out if your headache is sinus or migraine, ask yourself these questions:

In addition to my sinus symptoms, do I have:

1. moderate-to-severe headache
2. nausea
3. sensitivity to light

If you answer “yes” to two or three of these questions, then most likely you have migraine with sinus symptoms. A true sinus headache is rare and usually occurs due to sinus infection. In a sinus infection, you would also likely have a fever and thick nasal secretions that are yellow, green, or blood-tinged. A sinus headache should go away with treatment of the sinus infection.

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When should I seek help for my headaches?

Sometimes, headache can signal a more serious problem. You should talk to your doctor about your headaches if:

• you have several headaches per month and each lasts for several hours or days
• your headaches disrupt your home, work, or school life
• you have nausea, vomiting, vision, or other sensory problems (such as numbness or tingling)
• you have pain around the eye or ear
• you have a severe headache with a stiff neck
• you have a headache with confusion or loss of alertness
• you have a headache with convulsions
• you have a headache after a blow to the head
• you used to be headache-free, but now have headaches a lot

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What tests are used to find out if I have migraine?

If you think you get migraine headaches, talk with your doctor. Before your appointment, write down:

1. how often you have headaches
2. where the pain is
3. how long the headaches last
4. when the headaches happen, such as during your period
5. other symptoms, such as nausea or blind spots
6. any family history of migraine
7. all the medicines that you are taking for all your medical problems, even the over-the-counter medicines (better still, bring the medicines in their containers to the doctor)
8. all the medicines you have taken in the past that you can recall and, if possible, the doses you took and any side effects you had

Your doctor may also do an exam and ask more questions about your health history. This could include past head injury and sinus or dental problems. Your doctor may be able to diagnose migraine just from the information you provide.

You may get a blood test or other tests, such as CT scan or MRI, if your doctor thinks that something else is causing your headaches. Work with your doctor to decide on the best tests for you.

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Are migraine headaches more common in women than men?

Yes. About three out of four people who have migraines are women. Migraines are most common in women between the ages of 20 and 45. At this time of life women often have more job, family, and social duties. Women tend to report more painful and longer lasting headaches and more symptoms, such as nausea and vomiting. All these factors make it hard for a woman to fulfill her roles at work and at home when migraine strikes.

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I get migraines right before my period. Could they be related to my menstrual cycle?

More than half of migraines in women occur right before, during, or after a woman has her period. This often is called “menstrual migraine.” But, just a small fraction of women who have migraine around their period only have migraine at this time. Most have migraine headaches at other times of the month as well.

How the menstrual cycle and migraine are linked is still unclear. We know that just before the cycle begins, levels of the female hormones, estrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because estrogen controls chemicals in the brain that affect a woman’s pain sensation.

Talk with your doctor if you think you have menstrual migraine. You may find that medicines, making lifestyle changes, and home treatment methods can prevent or reduce the pain.

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Can migraine be worse during menopause?

If your migraine headaches are closely linked to your menstrual cycle, menopause may make them less severe. As you get older, the nausea and vomiting may decrease as well. About two-thirds of women with migraines report that their symptoms improve with menopause.

But for some women, menopause worsens migraine or triggers them to start. It is not clear why this happens. Menopausal hormone therapy, which is prescribed for some women during menopause, may be linked to migraines during this time. In general, though, the worsening of migraine symptoms goes away once menopause is complete.

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Can using birth control pills make my migraines worse?

In some women, birth control pills improve migraine. The pills may help reduce the number of attacks and their attacks may become less severe. But in other women, the pills may worsen their migraines. In still other women, taking birth control pills has no effect on their migraines.

The reason for these different responses is not well understood.  For women whose migraines get worse when they take birth control pills, their attacks seem to occur during the last week of the cycle. This is because the last seven pills in most monthly pill packs don’t have hormones; they are there to keep you in the habit of taking your birth control daily. Without the hormones, your body’s estrogen levels drop sharply. This may trigger migraine in some women.

Talk with your doctor if you think birth control pills are making your migraines worse. Switching to a pill pack in which all the pills for the entire month contain hormones and using that for three months in a row can improve headaches. Lifestyle changes, such as getting on a regular sleep pattern and eating healthy foods, can help too.

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Can stress cause migraines?

Yes. Stress can trigger both migraine and tension-type headache. Events like getting married, moving to a new home, or having a baby can cause stress. But studies show that everyday stresses—not major life changes—cause most headaches. Juggling many roles, such as being a mother and wife, having a career, and financial pressures, can be daily stresses for women.

Making time for yourself and finding healthy ways to deal with stress are important. Some things you can do to help prevent or reduce stress include:

• eating healthy foods
• being active (at least 30 minutes most days of the week is best)
• doing relaxation exercises
• getting enough sleep

Try to figure out what causes you to feel stressed. You may be able to cut out some of these stressors. For example, if driving to work is stressful, try taking the bus or subway. You can take this time to read or listen to music, rather than deal with traffic. For stressors you can't avoid, keeping organized and doing as much as you can ahead of time will help you to feel in control.

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How are migraines treated?

Migraine has no cure. But your migraines can be managed with your doctor’s help. Together, you will find ways to treat migraine symptoms when they happen, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods.

Medicine. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called “abortive” or “acute” treatment) and prevention. Many people with migraine use both forms of treatment.

Acute treatment. Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don’t work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:

• Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex^®), rizatriptan (Maxalt^®), zolmitriptan (Zomig^®), almotriptan (Axert^®), eletriptan (Relpax^®), naratriptan (Amerge^®), and frovatriptan (Frova^®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure.
• Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.

Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful “rescue” drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.

Prevention. Some medicines used daily can help prevent attacks. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Some examples are:

• antidepressants, such as amitriptyline (Elavil^®) or venlafaxine (Effexor^®)
• anticonvulsants, such as divalproex sodium (Depakote^®) or topiramate (Topamax^®)
• beta-blockers, such as propranolol (Inderal^®) or timolol (Blocadren^®)
• calcium channel blockers, such as verapamil

These drugs may not prevent all migraines, but they can help a lot. Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle. Ask your doctor about prevention drugs if:

• your migraines do not respond to drugs for symptom relief
• your migraines are disabling or cause you to miss work, family activities, or social events
• you are using pain-relief drugs more than two times a week

Lifestyle changes. Practicing these habits can reduce the number of migraine attacks:

• Avoid or limit triggers.
• Get up and go to bed the same time every day.
• Eat healthy foods and do not skip meals.
• Engage in regular physical activity.
• Limit alcohol and caffeine intake.
• Learn ways to reduce and cope with stress.

Alternative methods. Biofeedback has been shown to help some people with migraine. It involves learning how to monitor and control your body’s responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling also can help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.

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What are rebound migraines?

Women who use acute pain-relief medicine more than two or three times a week or more than 10 days out of the month can set off a cycle called rebound. As each dose of medicine wears off, the pain comes back, leading the patient to take even more. This overuse causes your medicine to stop helping your pain and actually start causing headaches. Rebound headaches can occur with both over-the-counter and prescription pain-relief medicines. They can also occur whether you take them for headache or for another type of pain. Talk to your doctor if you're caught in a rebound cycle.

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I'm pregnant. Can my migraines still be treated?

Some migraine medicines should not be used when you are pregnant because they can cause birth defects and other problems. This includes over-the-counter medicines, such as aspirin and ibuprofen. Talk with your doctor if migraine is a problem while you are pregnant or if you are planning to become pregnant. Your doctor might suggest a medicine that will help you and that is safe during pregnancy. Home treatment methods, such as doing relaxation exercises and using cold packs, also might help ease your pain. The good news is that for most women migraines improve or stop from about the third month of the pregnancy.

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I am breastfeeding. Will taking medicine for migraine hurt my baby?

Ask your doctor about what migraine medicines are safe to take while breastfeeding. Some medicines can be passed through breast milk and might be harmful to your baby.

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What are some ways I can prevent migraine?

The best way to prevent migraine is to find out what triggers your attacks and avoid or limit these triggers. Since migraine headaches are more common during times of stress, finding healthy ways to cut down on and cope with stress might help. Talk with your doctor about starting a fitness program or taking a class to learn relaxation skills.

Talk with your doctor if you need to take your pain-relief medicine more than twice a week. Doing so can lead to rebound headaches. If your doctor has prescribed medicine for you to help prevent migraine, take them exactly as prescribed. Ask what you should do if you miss a dose and how long you should take the medicine. Talk with your doctor if the amount of medicine you are prescribed is not helping your headaches.

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What should I do when a migraine begins?

Work with your doctor to come up with a plan for managing your migraines. Keeping a list of home treatment methods that have worked for you in the past also can help. When symptoms begin:

• If you take migraine medicine, take it right away.
• Drink fluids, if you don't have nausea during your migraine.
• Lie down and rest in a dark, quiet room, if that is practical.

Some people find the following useful:

• a cold cloth on your head
• rubbing or applying pressure to the spot where you feel pain
• massage or other relaxation exercises

Premenstrual Syndrome

What is premenstrual syndrome (PMS)?

Premenstrual (pree-MEN-struhl) syndrome (PMS) is a group of symptoms linked to the menstrual cycle. PMS symptoms occur 1 to 2 weeks before your period (menstruation or monthly bleeding) starts. The symptoms usually go away after you start bleeding. PMS can affect menstruating women of any age and the effect is different for each woman. For some people, PMS is just a monthly bother. For others, it may be so severe that it makes it hard to even get through the day. PMS goes away when your monthly periods stop, such as when you get pregnant or go through menopause.

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What causes PMS?

The causes of PMS are not clear, but several factors may be involved. Changes in hormones during the menstrual cycle seem to be an important cause. These changing hormone levels may affect some women more than others. Chemical changes in the brain may also be involved. Stress and emotional problems, such as depression, do not seem to cause PMS, but they may make it worse. Some other possible causes include:

• Low levels of vitamins and minerals
• Eating a lot of salty foods, which may cause you to retain (keep) fluid
• Drinking alcohol and caffeine, which may alter your mood and energy level

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What are the symptoms of PMS?

PMS often includes both physical and emotional symptoms, such as:

• Acne
• Swollen or tender breasts
• Feeling tired
• Trouble sleeping
• Upset stomach, bloating, constipation, or diarrhea
• Headache or backache
• Appetite changes or food cravings
• Joint or muscle pain
• Trouble with concentration or memory
• Tension, irritability, mood swings, or crying spells
• Anxiety or depression

Symptoms vary from woman to woman.

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How do I know if I have PMS?

PMS Symptom Tracker – Click to download [PDF file, 104 Kb]

Your doctor may diagnose PMS based on which symptoms you have, when they occur, and how much they affect your life. If you think you have PMS, keep track of which symptoms you have and how severe they are for a few months. Record your symptoms each day on a calendar or tracking form. Take this form with you when you see your doctor about your PMS.

Your doctor will also want to make sure you don’t have one of the following conditions that shares symptoms with PMS:

• Depression
• Anxiety
• Menopause
• Chronic fatigue syndrome (CFS)
• Irritable bowel syndrome (IBS)
• Problems with the endocrine (EN-doh-kryn) system, which makes hormones

How common is PMS?

There’s a wide range of estimates of how many women suffer from PMS. The American Congress of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least 1 PMS symptom as part of their monthly cycle. Most of these women have fairly mild symptoms that don’t need treatment. Others (about 3 to 8 percent) have a more severe form of PMS, called premenstrual dysphoric (dis-FOHR-ik) disorder (PMDD). See "What is premenstrual dysphoric disorder (PMDD)?" below to learn more.

PMS occurs more often in women who:

• Are between their late 20s and early 40s
• Have at least 1 child
• Have a family history of depression
• Have a past medical history of either postpartum depression or a mood disorder

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What is the treatment for PMS?

Many things have been tried to ease the symptoms of PMS. No treatment works for every woman. You may need to try different ones to see what works for you. Some treatment options include:

• Lifestyle changes
• Medications
• Alternative therapies

Lifestyle Changes
If your PMS isn’t so bad that you need to see a doctor, some lifestyle changes may help you feel better. Below are some steps you can take that may help ease your symptoms.

• Exercise regularly. Each week, you should get:
  • Two hours and 30 minutes of moderate-intensity physical activity;
  • One hour and 15 minutes of vigorous-intensity aerobic physical activity; or
  • A combination of moderate and vigorous-intensity activity; and
  • Muscle-strengthening activities on 2 or more days.
• Eat healthy foods, such as fruits, vegetables, and whole grains.
• Avoid salt, sugary foods, caffeine, and alcohol, especially when you’re having PMS symptoms.
• Get enough sleep. Try to get about 8 hours of sleep each night.
• Find healthy ways to cope with stress. Talk to your friends, exercise, or write in a journal. Some women also find yoga, massage, or relaxation therapy helpful.
• Don’t smoke.

Medications
Over-the-counter pain relievers may help ease physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:

• Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin, Midol Cramp)
• Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)
• Naproxen (nuh-PROK-suhn) (for instance, Aleve)
• Aspirin

In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs that stop ovulation, such as birth control pills. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods.

Researchers continue to search for new ways to treat PMS. To learn more about current PMS treatment studies, visit the clinicaltrials.gov Web site. Talk to your doctor about whether taking part in a clinical trial might be right for you.

Alternative Therapies
Certain vitamins and minerals have been found to help relieve some PMS symptoms. These include:

• Folic acid (400 micrograms)
• Calcium with vitamin D (see chart below for amounts)
• Magnesium (400 milligrams)
• Vitamin B-6 (50 to 100 mg)
• Vitamin E (400 international units)

Amounts of Calcium You Need Each Day

Ages	Milligrams per day
9-18	1300
19-50	1000
51 and older	1200
Pregnant or nursing women need the same amount of calcium as other women of the same age.

Some women find their PMS symptoms relieved by taking supplements such as:

• Black cohosh
• Chasteberry
• Evening primrose oil

Talk with your doctor before taking any of these products. Many have not been proven to work and they may interact with other medicines you are taking.

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What is Premenstrual Dysphoric Disorder (PMDD)?

A brain chemical called serotonin (ser-uh-TOH-nuhn) may play a role in Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS. The main symptoms, which can be disabling, include:

• Feelings of sadness or despair, or even thoughts of suicide
• Feelings of tension or anxiety
• Panic attacks
• Mood swings or frequent crying
• Lasting irritability or anger that affects other people
• Lack of interest in daily activities and relationships
• Trouble thinking or focusing
• Tiredness or low energy
• Food cravings or binge eating
• Trouble sleeping
• Feeling out of control
• Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

You must have 5 or more of these symptoms to be diagnosed with PMDD. Symptoms occur during the week before your period and go away after bleeding starts.

Making some lifestyle changes may help ease PMDD symptoms. See “What is the treatment for PMS?” above to learn more.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) have also been shown to help some women with PMDD. These drugs change serotonin levels in the brain. The Food and Drug Administration (FDA) has approved 3 SSRIs for the treatment of PMDD:

• Sertraline (SUHR-truh-leen) (Zoloft)
• Fluoxetine (floo-AYK-suh-teen) (Sarafem)
• Paroxetine (puh-ROCK-suh-teen) HCI (Paxil CR)

Yaz (drospirenone (droh-SPIR-uh-nohn) and ethinyl (ETH-uh-nil) estradiol (es-truh-DEYE-ohl)) is the only birth control pill approved by the FDA to treat PMDD. Individual counseling, group counseling, and stress management may also help relieve symptoms.