Nature Creation Articles

Do you know when to use ice and when to use heat on a sports injury? Most ath­letes know to apply ice to an acute injury, like a sprained ankle, but aren’t so sure when to use heat. The fol­low­ing guide­lines will help you sort it out.

Acute and Chronic Pain

# There are two basic types of ath­letic injuries: acute and chronic. Acute Pain is of rapid onset and short-lived, or
# Chronic Pain devel­ops slowly and is per­sis­tent and long-lasting.

Acute and Chronic Injuries

Acute injuries are sud­den, sharp, trau­matic injuries that occur imme­di­ately (or within hours) and cause pain (pos­si­bly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or col­li­sion and it’s pretty obvi­ous what caused the injury.

Acute injuries also cause com­mon signs and symp­toms of injury such as pain, ten­der­ness, red­ness, skin that is warm to the touch, swelling and inflam­ma­tion. If you have swelling, you have an acute injury.

Chronic injuries, on the other hand, can be sub­tle and slow to develop. They some­times come and go, and may cause dull pain or sore­ness. They are often the result of overuse, but some­times develop when an acute injury is not prop­erly treated and doesn’t heal.

Cold Ther­apy with Ice
Cold ther­apy with ice is the best imme­di­ate treat­ment for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood ves­sels to nar­row) and it lim­its inter­nal bleed­ing at the injury site. Apply ice (wrapped in a thin towel for comfort)to the affected area for 10 to 15 min­utes at a time. Allow the skin tem­per­a­ture to return to nor­mal before icing a sec­ond or third time. You can ice an acute injury sev­eral times a day for up to three days.

Cold ther­apy is also help­ful in treat­ing some overuse injuries or chronic pain in ath­letes. An ath­lete who has chronic knee pain that increases after run­ning may want to ice the injured area after each run to reduce or pre­vent inflam­ma­tion. It’s not help­ful to ice a chronic injury before exercise.

The best way to ice an injury is with a high qual­ity ice pack that con­forms to the body part being iced. Exam­ples include ColdOne Cold Ther­apy Wraps and Snow­Pack Cold Ther­apy prod­ucts. You can also get good results from a bag of frozen peas, an ice mas­sage with water frozen in a paper cup (peel the cup down as the ice melts) or a bag of ice.

Heat Ther­apy
Heat is gen­er­ally used for chronic injuries or injuries that have no inflam­ma­tion or swelling. Sore, stiff, nag­ging mus­cle or joint pain is ideal for the use of heat ther­apy. Ath­letes with chronic pain or injuries may use heat ther­apy before exer­cise to increase the elas­tic­ity of joint con­nec­tive tis­sues and to stim­u­late blood flow. Heat can also help relax tight mus­cles or mus­cle spasms. Don’t apply heat after exer­cise. After a work­out, ice is the bet­ter choice on a chronic injury.

Because heat increases cir­cu­la­tion and raises skin tem­per­a­ture, you should not apply heat to acute injuries or injuries that show signs of inflam­ma­tion. Safely apply heat to an injury 15 to 20 min­utes at a time and use enough lay­ers between your skin and the heat­ing source to pre­vent burns.

Moist heat is best, so you could try using a hot wet towel. You can buy spe­cial ath­letic hot packs or heat­ing pads if you use heat often. Never leave heat­ing pads on for more than 20 min­utes at a time or while sleeping.

Because some injuries can be seri­ous, you should see your doc­tor if your injury does not improve (or gets worse) within 48 hours.

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Arthri­tis is inflam­ma­tion of one or more joints, which results in pain, swelling, stiff­ness, and lim­ited move­ment. There are over 100 dif­fer­ent types of arthritis.

Causes, inci­dence, and risk factors

Arthri­tis involves the break­down of car­ti­lage. Car­ti­lage nor­mally pro­tects the joint, allow­ing for smooth move­ment. Car­ti­lage also absorbs shock when pres­sure is placed on the joint, like when you walk. With­out the usual amount of car­ti­lage, the bones rub together, caus­ing pain, swelling (inflam­ma­tion), and stiffness.

You may have joint inflam­ma­tion for a vari­ety of rea­sons, including:

* Bro­ken bone
* Infec­tion (usu­ally caused by bac­te­ria or viruses)
* An autoim­mune dis­ease (the body attacks itself because the immune sys­tem believes a body part is for­eign)
* Gen­eral “wear and tear” on joints

Often, the inflam­ma­tion goes away after the injury has healed, the dis­ease is treated, or the infec­tion has been cleared.

With some injuries and dis­eases, the inflam­ma­tion does not go away or destruc­tion results in long-term pain and defor­mity. When this hap­pens, you have chronic arthri­tis. Osteoarthri­tis is the most com­mon type and is more likely to occur as you age. You may feel it in any of your joints, but most com­monly in your hips, knees or fin­gers. Risk fac­tors for osteoarthri­tis include:

* Being over­weight
* Pre­vi­ously injur­ing the affected joint
* Using the affected joint in a repet­i­tive action that puts stress on the joint (base­ball play­ers, bal­let dancers, and con­struc­tion work­ers are all at risk)

Arthri­tis can occur in men and women of all ages. About 37 mil­lion peo­ple in Amer­ica have arthri­tis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthri­tis include:

* Rheuma­toid arthri­tis (in adults)
* Juve­nile rheuma­toid arthri­tis (in chil­dren)
* Sys­temic lupus ery­the­mato­sus (SLE)
* Gout
* Scle­ro­derma
* Pso­ri­atic arthri­tis
* Anky­los­ing spondyli­tis
* Reiter’s syn­drome (reac­tive arthri­tis)
* Adult Still’s dis­ease
* Viral arthri­tis
* Gono­coc­cal arthri­tis
* Other bac­te­r­ial infec­tions (non-gonococcal bac­te­r­ial arthri­tis )
* Ter­tiary Lyme dis­ease (the late stage)
* Tuber­cu­lous arthri­tis
* Fun­gal infec­tions such as blastomycosis

Symptoms

If you have arthri­tis, you may experience:

* Joint pain
* Joint swelling
* Stiff­ness, espe­cially in the morn­ing
* Warmth around a joint
* Red­ness of the skin around a joint
* Reduced abil­ity to move the joint

Signs and tests

First, your doc­tor will take a detailed med­ical his­tory to see if arthri­tis or another mus­cu­loskele­tal prob­lem is the likely cause of your symptoms.

Next, a thor­ough phys­i­cal exam­i­na­tion may show that fluid is col­lect­ing around the joint. (This is called an “effu­sion.”) The joint may be ten­der when it is gen­tly pressed, and may be warm and red (espe­cially in infec­tious arthri­tis and autoim­mune arthri­tis). It may be painful or dif­fi­cult to rotate the joints in some direc­tions. This is known as “lim­ited range-of-motion.”

In some autoim­mune forms of arthri­tis, the joints may become deformed if the dis­ease is not treated. Such joint defor­mi­ties are the hall­marks of severe, untreated rheuma­toid arthritis.

Tests vary depend­ing on the sus­pected cause. They often include blood tests and joint x-rays. To check for infec­tion and other causes of arthri­tis (like gout caused by crys­tals), joint fluid is removed from the joint with a nee­dle and exam­ined under a micro­scope. See the spe­cific types of arthri­tis for fur­ther infor­ma­tion.
Treatment

Treat­ment of arthri­tis depends on the par­tic­u­lar cause, which joints are affected, sever­ity, and how the con­di­tion affects your daily activ­i­ties. Your age and occu­pa­tion will also be taken into con­sid­er­a­tion when your doc­tor works with you to cre­ate a treat­ment plan.

If pos­si­ble, treat­ment will focus on elim­i­nat­ing the under­ly­ing cause of the arthri­tis. How­ever, the cause is NOT nec­es­sar­ily cur­able, as with osteoarthri­tis and rheuma­toid arthri­tis. Treat­ment, there­fore, aims at reduc­ing your pain and dis­com­fort and pre­vent­ing fur­ther disability.

It is pos­si­ble to greatly improve your symp­toms from osteoarthri­tis and other long-term types of arthri­tis with­out med­ica­tions. In fact, mak­ing lifestyle changes with­out med­ica­tions is prefer­able for osteoarthri­tis and other forms of joint inflam­ma­tion. If needed, med­ica­tions should be used in addi­tion to lifestyle changes.

Exer­cise for arthri­tis is nec­es­sary to main­tain healthy joints, relieve stiff­ness, reduce pain and fatigue, and improve mus­cle and bone strength. Your exer­cise pro­gram should be tai­lored to you as an indi­vid­ual. Work with a phys­i­cal ther­a­pist to design an indi­vid­u­al­ized pro­gram, which should include:

* Range of motion exer­cises for flex­i­bil­ity
* Strength train­ing for mus­cle tone
* Low-impact aer­o­bic activ­ity (also called endurance exercise)

A phys­i­cal ther­a­pist can apply heat and cold treat­ments as needed and fit you for splints or orthotic (straight­en­ing) devices to sup­port and align joints. This may be par­tic­u­larly nec­es­sary for rheuma­toid arthri­tis. Your phys­i­cal ther­a­pist may also con­sider water ther­apy, ice mas­sage, or tran­scu­ta­neous nerve stim­u­la­tion (TENS).

Rest is just as impor­tant as exer­cise. Sleep­ing 8 to 10 hours per night and tak­ing naps dur­ing the day can help you recover from a flare-up more quickly and may even help pre­vent exac­er­ba­tions. You should also:

* Avoid posi­tions or move­ments that place extra stress on your affected joints.
* Avoid hold­ing one posi­tion for too long.
* Reduce stress, which can aggra­vate your symp­toms. Try med­i­ta­tion or guided imagery. And talk to your phys­i­cal ther­a­pist about yoga or tai chi.
* Mod­ify your home to make activ­i­ties eas­ier. For exam­ple, have grab bars in the shower, the tub, and near the toilet.

Other mea­sures to try include:

* Tak­ing glu­cosamine and chon­droitin — these form the build­ing blocks of car­ti­lage, the sub­stance that lines joints. These sup­ple­ments are avail­able at health food stores or super­mar­kets. While some stud­ies show such sup­ple­ments may reduce osteoarthri­tis symp­toms, oth­ers show no ben­e­fit. How­ever, since these prod­ucts are regarded as safe, they are rea­son­able to try and many patients find their symp­toms improve.
* Eat a diet rich in vit­a­mins and min­er­als, espe­cially antiox­i­dants like vit­a­min E. These are found in fruits and veg­eta­bles. Get sele­nium from Brewer’s yeast, wheat germ, gar­lic, whole grains, sun­flower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mack­erel, and her­ring), flaxseed, rape­seed (canola) oil, soy­beans, soy­bean oil, pump­kin seeds, and wal­nuts.
* Apply cap­saicin cream (derived from hot chili pep­pers) to the skin over your painful joints. You may feel improve­ment after apply­ing the cream for 3–7 days.

MEDICATIONS

Your doc­tor will choose from a vari­ety of med­ica­tions as needed. Gen­er­ally, the first drugs to try are avail­able with­out a pre­scrip­tion. These include:

* Aceta­minophen (Tylenol) — rec­om­mended by the Amer­i­can Col­lege of Rheuma­tol­ogy and the Amer­i­can Geri­atrics Soci­ety as first-line treat­ment for osteoarthri­tis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can pro­vide sig­nif­i­cant relief of arthri­tis pain with­out many of the side effects of pre­scrip­tion drugs. DO NOT exceed the rec­om­mended doses of aceta­minophen or take the drug in com­bi­na­tion with large amounts of alco­hol. These actions may dam­age your liver.
* Aspirin, ibupro­fen, or naproxen — these non­s­teroidal anti-inflammatory (NSAID) drugs are often effec­tive in com­bat­ing arthri­tis pain. How­ever, they have many poten­tial risks, espe­cially if used for a long time. They should not be taken in any amount with­out con­sult­ing your doc­tor. Poten­tial side effects include heart attack, stroke, stom­ach ulcers, bleed­ing from the diges­tive tract, and kid­ney dam­age. In 2005, the U.S. Food and Drug Admin­is­tra­tion (FDA) asked mak­ers of NSAIDs to include a warn­ing label on their prod­uct that alerts users of an increased risk for heart attack, stroke, and gas­troin­testi­nal bleed­ing. If you have kid­ney or liver dis­ease, or a his­tory of gas­troin­testi­nal bleed­ing, you should not take these med­i­cines unless your doc­tor specif­i­cally rec­om­mends them.

Pre­scrip­tion med­i­cines include:

* Cyclooxygenase-2 (COX-2) inhibitors — These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was ini­tially believed to work as well as tra­di­tional NSAIDs, but with fewer stom­ach prob­lems. How­ever, numer­ous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and ben­e­fits of the COX-2s. Cele­coxib (Cele­brex) is still avail­able, but labeled with strong warn­ings and a rec­om­men­da­tion that it be pre­scribed at the low­est pos­si­ble dose for the short­est dura­tion pos­si­ble. Talk to your doc­tor about whether COX-2s are right for you.
* Cor­ti­cos­teroids (“steroids”) — these are med­ica­tions that sup­press the immune sys­tem and symp­toms of inflam­ma­tion. They are com­monly used in severe cases of osteoarthri­tis, and they can be given orally or by injec­tion. Steroids are used to treat autoim­mune forms of arthri­tis but should be avoided in infec­tious arthri­tis. Steroids have mul­ti­ple side effects, includ­ing upset stom­ach and gas­troin­testi­nal bleed­ing, high blood pres­sure, thin­ning of bones, cataracts, and increased infec­tions. The risks are most pro­nounced when steroids are taken for long peri­ods of time or at high doses. Close super­vi­sion by a physi­cian is essen­tial.
* Disease-modifying anti-rheumatic drugs — these have been used tra­di­tion­ally to treat rheuma­toid arthri­tis and other autoim­mune causes of arthri­tis. These drugs include gold salts, peni­cil­lamine, sul­fasalazine, and hydrox­y­chloro­quine. More recently, methotrex­ate has been shown to slow the pro­gres­sion of rheuma­toid arthri­tis and improve your qual­ity of life. Methotrex­ate itself can be highly toxic and requires fre­quent blood tests for patients on the med­ica­tion.
* Bio­log­ics– these are the most recent break­through for the treat­ment of rheuma­toid arthri­tis. Such med­ica­tions, includ­ing etan­er­cept (Enbrel), inflix­imab (Rem­i­cade) and adal­i­mumab (Humira), are admin­is­tered by injec­tion and can dra­mat­i­cally improve your qual­ity of life. Newer bio­log­ics include Oren­cia (abat­a­cept) and Rit­uxan (rit­ux­imab).
* Immuno­sup­pres­sants — these drugs, like aza­thio­prine or cyclophos­phamide, are used for seri­ous cases of rheuma­toid arthri­tis when other med­ica­tions have failed.

It is very impor­tant to take your med­ica­tions as directed by your doc­tor. If you are hav­ing dif­fi­culty doing so (for exam­ple, due to intol­er­a­ble side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthro­plasty) or to replace the joint (such as a total knee joint replace­ment) may help main­tain a more nor­mal lifestyle. The deci­sion to per­form joint replace­ment surgery is nor­mally made when other alter­na­tives, such as lifestyle changes and med­ica­tions, are no longer effective.

Nor­mal joints con­tain a lubri­cant called syn­ovial fluid. In joints with arthri­tis, this fluid is not pro­duced in ade­quate amounts. In some cases, a doc­tor may inject the arthritic joint with a man-made ver­sion of joint fluid. The syn­thetic fluid may post­pone the need for surgery at least tem­porar­ily and improve the qual­ity of life for per­sons with arthritis.

Expec­ta­tions (prognosis)

A few arthritis-related dis­or­ders can be com­pletely cured with treat­ment. Most are chronic (long-term) con­di­tions, how­ever, and the goal of treat­ment is to con­trol the pain and min­i­mize joint dam­age. Chronic arthri­tis fre­quently goes in and out of remis­sion.
Complications

* Chronic pain
* Lifestyle restric­tions or disability

Call­ing your health care provider

Call your doc­tor if:

* Your joint pain per­sists beyond 3 days.
* You have severe unex­plained joint pain.
* The affected joint is sig­nif­i­cantly swollen.
* You have a hard time mov­ing the joint.
* Your skin around the joint is red or hot to the touch.
* You have a fever or have lost weight unintentionally.

Prevention

If arthri­tis is diag­nosed and treated early, you can pre­vent joint dam­age. Find out if you have a fam­ily his­tory of arthri­tis and share this infor­ma­tion with your doc­tor, even if you have no joint symptoms.

Osteoarthri­tis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to over­work a dam­aged or sore joint. Sim­i­larly, avoid exces­sive repet­i­tive motions.

Excess weight also increases the risk for devel­op­ing osteoarthri­tis in the knees, and pos­si­bly in the hips and hands. See the arti­cle on body mass index to learn whether your weight is healthy.

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A headache is pain or dis­com­fort in the head, scalp, or neck. Seri­ous causes of headaches are extremely rare. Most peo­ple with headaches can feel much bet­ter by mak­ing lifestyle changes, learn­ing ways to relax, and occa­sion­ally by tak­ing medications.

Com­mon Causes

Ten­sion headaches are due to tight, con­tracted mus­cles in your shoul­ders, neck, scalp, and jaw. They are often related to stress, depres­sion, or anx­i­ety. Over­work­ing, not get­ting enough sleep, miss­ing meals, and using alco­hol or street drugs can make you more sus­cep­ti­ble to them. Headaches can be trig­gered by choco­late, cheese, and monosodium glu­ta­mate (MSG). Peo­ple who drink caf­feine can have headaches when they don’t get their usual daily amount.

Other com­mon causes include:

* Hold­ing your head in one posi­tion for a long time, like at a com­puter, micro­scope, or type­writer
* Poor sleep posi­tion
* Overex­ert­ing your­self
* Clench­ing or grind­ing your teeth

Ten­sion headaches tend to be on both sides of your head. They often start at the back of your head and spread for­ward. The pain may feel dull or squeez­ing, like a tight band or vice. Your shoul­ders, neck, or jaw may feel tight and sore.

Migraine headaches are severe, recur­rent headaches gen­er­ally accom­pa­nied by other symp­toms like visual dis­tur­bances or nau­sea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an “aura” (warn­ing symp­toms that start before your headache) and feel throb­bing, pound­ing, or pul­sat­ing pain.

For infor­ma­tion on migraine, see migraine headache.

Other types of headaches:

* Clus­ter headaches are sharp, extremely painful headaches that tend to occur sev­eral times per day for months and then go away for a sim­i­lar period. They are far less com­mon.
* Sinus headaches cause pain in the front of your head and face. They are due to inflam­ma­tion in the sinus pas­sages that lie behind the cheeks, nose, and eyes. The pain tends to be worse when you bend for­ward and when you first wake up in the morn­ing. Post­nasal drip, sore throat, and nasal dis­charge usu­ally occur with these headaches.

Headaches may occur if you have a cold, the flu, fever, or pre­men­strual syndrome.

If you are over age 50 and are expe­ri­enc­ing headaches for the first time, a con­di­tion called tem­po­ral arteri­tis may prove to be the cause. Symp­toms of this con­di­tion include impaired vision and pain aggra­vated by chew­ing. There is a risk of becom­ing blind with this con­di­tion. There­fore, it must be treated by your doc­tor right away.

Rare causes of headache include:

* Brain aneurysm — a weak­en­ing of the wall of a blood ves­sel that can rup­ture and bleed into the brain
* Brain tumor
* Stroke or TIA
* Brain infec­tion like menin­gi­tis or encephalitis

Home Care

Keep a headache diary to help iden­tify the source or trig­ger of your symp­toms. Then mod­ify your envi­ron­ment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and think­ing about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by rest­ing with your eyes closed and head sup­ported. Relax­ation tech­niques can help. A mas­sage or heat applied to the back of the upper neck can be effec­tive in reliev­ing ten­sion headaches.

Try aceta­minophen, aspirin, or ibupro­fen for ten­sion headaches. DO NOT give aspirin to chil­dren because of the risk of Reye syndrome.

Migraine headaches may respond to aspirin, naproxen, or com­bi­na­tion migraine medications.

If over-the-counter reme­dies do not con­trol your pain, talk to your doc­tor about pos­si­ble pre­scrip­tion medications.

Pre­scrip­tion med­ica­tions used for migraine headaches include ergo­t­a­mine, dihy­droer­go­t­a­mine, ergo­t­a­mine with caf­feine (Cafer­got), isomethep­tene (Midrin), and trip­tans like suma­trip­tan (Imitrex), riza­trip­tan (Max­alt), eletrip­tan (Rel­pax), almotrip­tan (Axert), and zolmitrip­tan (Zomig). Some­times med­ica­tions to relieve nau­sea and vom­it­ing are help­ful for other migraine symptoms.

If you get headaches often, your doc­tor may pre­scribe med­ica­tion to pre­vent headaches before they occur. Exam­ples of these include:

* Anti­de­pres­sants such as nor­tripty­line (Pamelor), amitripty­line (Elavil), flu­ox­e­tine (Prozac, Sarafem), ser­tra­line (Zoloft), or parox­e­tine (Paxil) for ten­sion or migraine headache
* Beta-blockers such as pro­pra­nolol (Inderal) for fre­quent migraine headaches
* Cal­cium chan­nel block­ers such as ver­a­pamil for fre­quent migraine headaches
* Anti-epileptic med­i­cines such as top­i­ra­mate (Topamax)

If you are using pain med­ica­tions more than 2 days a week, you may be suf­fer­ing from rebound headaches. Rebound headaches are caused by a cycle of using pain med­ica­tions for short-term relief, fol­lowed by the headache pain return­ing for increas­ingly longer peri­ods of time despite tak­ing more pain medications.

All types of pain pills (includ­ing over-the-counter drugs), mus­cle relax­ants, some decon­ges­tants, and caf­feine can cause this pat­tern. If you think this may be a prob­lem for you, talk to your health care provider.
Call your health care provider if

Take the fol­low­ing symp­toms seri­ously. If you can­not see your health care provider imme­di­ately, go to the emer­gency room or call 911:

* Your headache comes on sud­denly and is explo­sive or vio­lent.
* You would describe your headache as “your worst ever”, even if you are prone to headaches.
* Your headache is asso­ci­ated with slurred speech, change in vision, prob­lems mov­ing your arms or legs, loss of bal­ance, con­fu­sion, or mem­ory loss.
* Your headache gets pro­gres­sively worse over a 24-hour period.
* Your headache is accom­pa­nied by fever, stiff neck, nau­sea, and vom­it­ing.
* Your headache occurs with a head injury.
* Your headache is severe and local­ized to one eye with red­ness in that eye.
* You are over age 50 and your headaches just began, espe­cially with impaired vision and pain while chewing.

See your provider soon if:

* Your headaches wake you up from sleep.
* A headache lasts more than a few days.
* Headaches are worse in the morn­ing.
* You have a his­tory of headaches but they have changed in pat­tern or inten­sity.
* You have headaches fre­quently, and there is no known cause.

What to expect at your health care provider’s office

Your health care provider will obtain your med­ical his­tory and will per­form an exam­i­na­tion of your head, eyes, ears, nose, throat, neck, and ner­vous system.

The diag­no­sis is usu­ally based on your his­tory of symp­toms. A “headache diary” may be help­ful for record­ing infor­ma­tion about headaches over a period of time. Your doc­tor may ask ques­tions such as the following:

* Is the headache located in the fore­head, around the eyes, in the back of the head, near the tem­ples, behind the eye­ball, or all over?
* Is the headache on one side only?
* Is this a new type of headache for you?
* Would you describe the headache as throb­bing?
* Is there a pres­sure or band-like sen­sa­tion?
* When does the headache occur? How long have you had headaches? How long does each headache last?
* Does the headache awaken you from sleep? Are the headaches worse dur­ing the day and bet­ter at night?
* Did other symp­toms begin shortly after the headaches began? Do headaches occur repeat­edly?
* Does the headache reach max­i­mum inten­sity over 1 to 2 hours?
* Are the headaches worse when you are lying down? Stand­ing up?
* Are the headaches worse when you cough or strain?
* Do they occur at a spe­cific time related to your men­strual period?
* What home treat­ment have you tried? How effec­tive was it?

Diag­nos­tic tests that may be per­formed include the following:

* Head CT scan
* Head MRI
* Sinuses x-rays
* Tem­po­ral artery biopsy
* Lum­bar puncture

If a migraine is diag­nosed, med­ica­tions that con­tain ergot may be pre­scribed. Tem­po­ral arteri­tis must be treated with steroids to help pre­vent blind­ness. Other dis­or­ders are treated as is appropriate.

Prevention

The fol­low­ing healthy habits can lessen stress and reduce your chance of get­ting headaches:

* Get­ting ade­quate sleep
* Eat­ing a healthy diet
* Exer­cis­ing reg­u­larly
* Stretch­ing your neck and upper body, espe­cially if your work involves typ­ing or using a com­puter
* Learn­ing proper pos­ture
* Quit­ting smok­ing
* Learn­ing to relax using med­i­ta­tion, deep breath­ing, yoga, or other techniques

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From acupunc­ture to chi­ro­prac­tic, from mas­sage to med­i­ta­tion, alter­na­tive treat­ments are in great demand. That’s espe­cially true for peo­ple with pain-related ill­nesses such as fibromyal­gia. Alter­na­tive med­i­cine, includ­ing herbal ther­apy and home­opa­thy, it is used in place of con­ven­tional med­i­cine. These sys­tems are based on the belief that the body has the power to heal itself with mul­ti­ple tech­niques includ­ing those that involve the mind, body and spirit. Com­ple­men­tary med­i­cine is used together with con­ven­tional medicine.

For peo­ple with fibromyal­gia, some alter­na­tive treat­ments work well. That’s because holis­tic ther­a­pies influ­ence your total being. In that way, they may allow you to reduce your med­ica­tions and increase your nor­mal activities.

Study find­ings show that stan­dard acupunc­ture may be effec­tive in treat­ing some peo­ple with fibromyal­gia. Both biofeed­back and elec­troacupunc­ture have also been used for relief of fibromyal­gia symp­toms. How­ever, before you try alter­na­tive treat­ments, talk with your doc­tor. Check to see what lim­i­ta­tions might apply to you. Work­ing with your doc­tor, you can find an accept­able way to blend con­ven­tional med­i­cine with alter­na­tive treat­ments or nat­ural reme­dies. When you do, you may be able to increase rest­ful sleep and reduce your fibromyal­gia pain.
Can acupunc­ture treat fibromyalgia?

With acupunc­ture, a prac­ti­tioner inserts one or more dry nee­dles into the skin and under­ly­ing tis­sues at spe­cific points. Gen­tly twist­ing or oth­er­wise manip­u­lat­ing the nee­dles causes a mea­sur­able release of endor­phins into the blood­stream. Endor­phins are the body’s nat­ural opi­oids. In addi­tion, accord­ing to acupunc­ture prac­ti­tion­ers, energy blocks are removed. Remov­ing them is said to restore the flow of energy along the merid­i­ans, which are spe­cific energy channels.

Stud­ies show that acupunc­ture may alter brain chem­istry. It appears to do this by chang­ing the release of neu­ro­trans­mit­ters. These neu­ro­trans­mit­ters stim­u­late or inhibit nerve impulses in the brain that relay infor­ma­tion about exter­nal stim­uli and sen­sa­tions such as pain. In this way, the patient’s pain tol­er­ance is increased. One acupunc­ture treat­ment in some patients may last weeks to help alle­vi­ate chronic pain.
What is electroacupuncture?

Elec­troacupunc­ture is another way of stim­u­lat­ing the acupunc­ture points. It uses a nee­dle hooked up to small wires con­nected to very slight elec­tri­cal cur­rents. Heat — mox­i­bus­tion — and mas­sage — acu­pres­sure — can also be used dur­ing this elec­troacupunc­ture process.

Laser acupunc­ture is yet another off­shoot of this alter­na­tive ther­apy. It may occa­sion­ally be effec­tive for the treat­ment of carpal tun­nel syn­drome. While it uses the same points, there are no nee­dles involved.

There are pre­cau­tions to take if you want to try acupunc­ture. First, make sure you find a licensed acupunc­tur­ist who has a lot of expe­ri­ence. Also, make sure the acupunc­tur­ist uses only dis­pos­able needles.

There are mul­ti­ple styles of acupunc­ture. The style used depends on where the prac­ti­tioner stud­ied. For instance, Chi­nese acupunc­ture depends on larger bore nee­dles and the prac­ti­tioner may be more aggres­sive with mov­ing them. Japan­ese acupunc­ture uses thin­ner bore nee­dles with a rel­a­tively gen­tle approach. You’ll need to find the style that suits your fibromyal­gia needs.

How can chi­ro­prac­tic help fibromyalgia?

Chi­ro­prac­tic care is a very com­mon alter­na­tive treat­ment for fibromyal­gia pain. Peo­ple use it to treat pain of pres­sure points, back pain, neck pain, shoul­der pain, headaches, and pain from mus­cu­loskele­tal injuries. Chi­ro­prac­tic may be effec­tive for fibromyal­gia because it helps improve pain lev­els and increase cer­vi­cal and lum­bar ranges of motion.

Chi­ro­prac­tic is based on the prin­ci­ple that the body is a self-healing organ­ism. To reduce pain and increase heal­ing, the doc­tor of chi­ro­prac­tic uses spinal adjust­ments. The goal is to increase the mobil­ity between spinal ver­te­brae, which have become restricted, locked, or slightly out of proper position.

Chi­ro­prac­tors do this by using hand adjust­ments. With gen­tle pres­sure or stretch­ing, mul­ti­ple gen­tle move­ments of one area, or spe­cific high-velocity thrusts, the adjust­ments are said to help return the bones to a more nor­mal posi­tion or motion. This return is said to relieve pain and reduce ill health.
Can mas­sage ease fibromyal­gia pain?

With Swedish mas­sage, the prac­ti­tioner uses a sys­tem of long strokes, knead­ing, and fric­tion tech­niques. With these, the prac­ti­tioner mas­sages the more super­fi­cial lay­ers of the mus­cles. The mas­sage is com­bined with active and pas­sive move­ments of the joints.

Oil is usu­ally used to facil­i­tate the stroking and knead­ing of the body, thereby stim­u­lat­ing metab­o­lism and cir­cu­la­tion. The mas­sage ther­a­pist applies pres­sure and rubs the mus­cles in the same direc­tion as the flow of blood return­ing to the heart.

Deep tis­sue mas­sage may be help­ful for those with fibromyal­gia. The rea­son is ther­a­pists use greater pres­sure than is used in Swedish mas­sage. In so doing, they tar­get the deep lay­ers of mus­cle. Using a series of slow strokes and direct pres­sure, the ther­a­pist will strive to release chronic pat­terns of mus­cu­lar ten­sion. Some­times, the ther­a­pists use their elbows or thumbs to push hard into the deep­est grain of the mus­cle to reduce tension.

Neu­ro­mus­cu­lar mas­sage com­bines the basic prin­ci­ples of ancient Ori­en­tal ther­a­pies, such as acu­pres­sure and shi­atsu, with spe­cific hands-on deep tis­sue ther­apy. The goal is to reduce chronic mus­cle or myofas­cial (soft-tissue) pain.
How does biofeed­back work to ease fibromyalgia?

To indi­vid­u­al­ize the reduc­tion of stress in the treat­ment of fibromyal­gia, biofeed­back is often rec­om­mended. This mind/body relax­ation tech­nique uses elec­tron­ics to mea­sure stress-related responses in the body. The idea behind biofeed­back is that peo­ple can use infor­ma­tion about their body’s inter­nal processes to learn to con­trol those processes.

A con­sen­sus state­ment from the National Insti­tutes of Health indi­cates there is good evi­dence that biofeed­back might help relieve many types of chronic pain. For exam­ple, it might be use­ful in treat­ing ten­sion and migraine headaches. In one study at the Uni­ver­sity of South Alabama, 80% of chil­dren with migraines were symptom-free after receiv­ing inten­sive biofeed­back train­ing. In other research, some headache patients who were able to increase hand tem­per­a­ture using ther­mal biofeed­back also expe­ri­enced fewer and less intense migraine headaches.

How does biofeed­back work to ease fibromyal­gia? continued…

With biofeed­back, you are con­nected to a machine that informs you and your ther­a­pist when you are phys­i­cally relax­ing your body. Sen­sors detect mus­cle ten­sion, heart rate, breath­ing pat­tern, the amount of sweat pro­duced, or body tem­per­a­ture. Any one or all of these can let the trained biofeed­back ther­a­pist know if you are learn­ing to relax.

The instru­ments mag­nify sig­nals that you might not oth­er­wise notice. As a result, you can use this visual or audi­tory response to learn how to con­trol cer­tain bod­ily func­tions. The ulti­mate goal of biofeed­back is to use this skill out­side the therapist’s office when you are fac­ing real stressors.

With fibromyal­gia pain, you know the “real stres­sor” is the pain itself. Nev­er­the­less, other daily stres­sors can cause your fibromyal­gia to flare. What you want to do is respond in a healthy way to the chronic stres­sors. If learned prop­erly, elec­tronic biofeed­back can help you con­trol your heart rate, blood pres­sure, breath­ing pat­terns, and mus­cle ten­sion, poten­tially reduc­ing pain.
What is home­o­pathic medicine?

Home­opa­thy is a ther­a­peu­tic sys­tem of med­i­cine that started in the late 18th cen­tury. Home­opa­thy is based on the prin­ci­ple of “like cures like.” That means that reme­dies that would cause a poten­tial prob­lem in large doses will actu­ally encour­age the body to heal more rapidly if given in small doses. Prac­ti­tion­ers use small diluted for­mu­las of plant, min­eral, and ani­mal sub­stances to treat var­i­ous ail­ments. The hope is these for­mu­las will stim­u­late the body to throw off the offender.
Can herbal med­i­cine help fibromyalgia?

Herbal reme­dies have been used for gen­er­a­tions. They can be put in tea or soup or taken in other forms. While some herbal ther­a­pies have not been shown to have a spe­cific ben­e­fit for fibromyal­gia symp­toms, some patients have found improved sleep or more energy with herbal sup­ple­ments.
How can med­i­ta­tion help fibromyalgia?

With med­i­ta­tion, you allow your thoughts to take a break from daily ana­lyt­i­cal rou­tines and give sup­port to the spir­i­tual dimen­sion of life. When you med­i­tate, your body switches from the pump­ing “fight or flight” response to a calmer, more peace­ful mood. Stud­ies show that med­i­ta­tion pro­duces brain waves con­sis­tent with seren­ity and hap­pi­ness. Med­i­ta­tion pro­vides nour­ish­ment for your soul, sati­ates inner spir­i­tual hunger, and helps you to develop your abil­ity to pay atten­tion to all areas of life with­out dis­trac­tion.
What should I remem­ber if I want to try an alter­na­tive treatment?

It’s impor­tant to be openly dis­crim­i­nat­ing when choos­ing alter­na­tive treat­ments. The fact that some­thing is called “nat­ural” does not mean it is safe. Work­ing with your doc­tor, look for the alter­na­tive ther­a­pies that will best boost sleep and decrease pain. The right ther­apy can help get you on the healthy road again.

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Symp­toms of fibromyal­gia include:

* Chronic mus­cle pain, mus­cle spasms or tight­ness, weak­ness in the limbs, and leg cramps
* Mod­er­ate or severe fatigue and decreased energy
* Insom­nia or wak­ing up feel­ing just as tired as when you went to sleep
* Stiff­ness upon wak­ing or after stay­ing in one posi­tion for too long
* Dif­fi­culty remem­ber­ing, con­cen­trat­ing, and per­form­ing sim­ple men­tal tasks
* Abdom­i­nal pain, bloat­ing, nau­sea, and con­sti­pa­tion alter­nat­ing with diar­rhea (irri­ta­ble bowel syn­drome)
* Ten­sion or migraine headaches
* Jaw and facial ten­der­ness
* Sen­si­tiv­ity to one or more of the fol­low­ing: odors, noise, bright lights, med­ica­tions, cer­tain foods, and cold
* Feel­ing anx­ious or depressed
* Numb­ness or tin­gling in the face, arms, hands, legs, or feet
* Increase in uri­nary urgency or fre­quency (irri­ta­ble blad­der)
* Reduced tol­er­ance for exer­cise and mus­cle pain after exer­cise
* A feel­ing of swelling (with­out actual swelling) in the hands and feet
* Painful men­strual peri­ods
* Dizziness

Fibromyal­gia symp­toms may inten­sify depend­ing on the time of day — morn­ing, late after­noon, and evening tend to be the worst times, while 11 a.m. to 3 p.m. tends to be the best time. They may also get worse with fatigue, ten­sion, inac­tiv­ity, changes in the weather, cold or drafty con­di­tions, overex­er­tion, hor­monal fluc­tu­a­tions (such as just before your period or dur­ing menopause), stress, depres­sion, or other emo­tional factors.

If the con­di­tion is not diag­nosed and treated early, symp­toms can go on indef­i­nitely, or they may dis­ap­pear for months and then recur.
Call Your Doc­tor About Fibromyal­gia If:

You have chronic mus­cle pain and over­whelm­ing fatigue.

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The hol­i­day sea­son, which begins for most Amer­i­cans with Thanks­giv­ing and con­tin­ues through New Year’s Day, often brings unwel­come guests — stress and depres­sion. And it’s no won­der. In an effort to pull off a per­fect hol­i­day, you might find your­self fac­ing a dizzy­ing array of demands — par­ties, shop­ping, bak­ing, clean­ing and enter­tain­ing, to name a few. So much for peace and joy, right?

Actu­ally, with some prac­ti­cal tips, you can min­i­mize the stress and depres­sion that often accom­pany the hol­i­days. You may even end up enjoy­ing the hol­i­days more than you thought you would.
Rec­og­nize hol­i­day triggers

Learn to rec­og­nize com­mon hol­i­day trig­gers, so you can dis­arm them before they lead to a meltdown:

* Rela­tion­ships. Rela­tion­ships can cause tur­moil, con­flict or stress at any time, but ten­sions are often height­ened dur­ing the hol­i­days. Fam­ily mis­un­der­stand­ings and con­flicts can inten­sify — espe­cially if you’re thrust together for sev­eral days. On the other hand, fac­ing the hol­i­days with­out a loved one can be tough and leave you feel­ing lonely and sad.
* Finances. With the added expenses of gifts, travel, food and enter­tain­ment, the hol­i­days can put a strain on your bud­get — and your peace of mind. Not to men­tion that over­spend­ing now can mean finan­cial wor­ries for months to come.
* Phys­i­cal demands. Even die-hard hol­i­day enthu­si­asts may find that the extra shop­ping and social­iz­ing can leave them wiped out. Being exhausted increases your stress, cre­at­ing a vicious cycle. Exer­cise and sleep — good anti­dotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burn­ing the wick at both ends makes you more sus­cep­ti­ble to colds and other unwel­come guests.

When stress is at its peak, it’s hard to stop and regroup. Try to pre­vent stress and depres­sion in the first place, espe­cially if the hol­i­days have taken an emo­tional toll on you in the past.

1. Acknowl­edge your feel­ings. If some­one close to you has recently died or you can’t be with loved ones, real­ize that it’s nor­mal to feel sad­ness and grief. It’s OK to take time to cry or express your feel­ings. You can’t force your­self to be happy just because it’s the hol­i­day sea­son.
2. Reach out. If you feel lonely or iso­lated, seek out com­mu­nity, reli­gious or other social events. They can offer sup­port and com­pan­ion­ship. Vol­un­teer­ing your time to help oth­ers also is a good way to lift your spir­its and broaden your friend­ships.
3. Be real­is­tic. The hol­i­days don’t have to be per­fect or just like last year. As fam­i­lies change and grow, tra­di­tions and rit­u­als often change as well. Choose a few to hold on to, and be open to cre­at­ing new ones. For exam­ple, if your adult chil­dren can’t come to your house, find new ways to cel­e­brate together, such as shar­ing pic­tures, emails or video­tapes.
4. Set aside dif­fer­ences. Try to accept fam­ily mem­bers and friends as they are, even if they don’t live up to all your expec­ta­tions. Set aside griev­ances until a more appro­pri­ate time for dis­cus­sion. And be under­stand­ing if oth­ers get upset or dis­tressed when some­thing goes awry. Chances are they’re feel­ing the effects of hol­i­day stress and depres­sion too.
5. Stick to a bud­get. Before you go gift and food shop­ping, decide how much money you can afford to spend. Then stick to your bud­get. Don’t try to buy hap­pi­ness with an avalanche of gifts. Try these alter­na­tives: Donate to a char­ity in someone’s name, give home­made gifts or start a fam­ily gift exchange.
6. Plan ahead. Set aside spe­cific days for shop­ping, bak­ing, vis­it­ing friends and other activ­i­ties. Plan your menus and then make your shop­ping list. That’ll help pre­vent last-minute scram­bling to buy for­got­ten ingre­di­ents. And make sure to line up help for party prep and cleanup.
7. Learn to say no. Say­ing yes when you should say no can leave you feel­ing resent­ful and over­whelmed. Friends and col­leagues will under­stand if you can’t par­tic­i­pate in every project or activ­ity. If it’s not pos­si­ble to say no when your boss asks you to work over­time, try to remove some­thing else from your agenda to make up for the lost time.
8. Don’t aban­don healthy habits. Don’t let the hol­i­days become a free-for-all. Overindul­gence only adds to your stress and guilt. Have a healthy snack before hol­i­day par­ties so that you don’t go over­board on sweets, cheese or drinks. Con­tinue to get plenty of sleep and phys­i­cal activ­ity.
9. Take a breather. Make some time for your­self. Spend­ing just 15 min­utes alone, with­out dis­trac­tions, may refresh you enough to han­dle every­thing you need to do. Take a walk at night and stargaze. Lis­ten to sooth­ing music. Find some­thing that reduces stress by clear­ing your mind, slow­ing your breath­ing and restor­ing inner calm.
10. Seek pro­fes­sional help if you need it. Despite your best efforts, you may find your­self feel­ing per­sis­tently sad or anx­ious, plagued by phys­i­cal com­plaints, unable to sleep, irri­ta­ble and hope­less, and unable to face rou­tine chores. If these feel­ings last for a while, talk to your doc­tor or a men­tal health professional.

Take con­trol of the holidays

Don’t let the hol­i­days become some­thing you dread. Instead, take steps to pre­vent the stress and depres­sion that can descend dur­ing the hol­i­days. With a lit­tle plan­ning and some pos­i­tive think­ing, you may find that you enjoy the hol­i­days this year more than you thought you could.

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A “Ner­vous Break­down” is a pop­u­lar term — it is not a clin­i­cal term — that is often used to describe a men­tal dis­or­der that a per­son expe­ri­ences. It is used for a num­ber of rea­sons, includ­ing: to hide a diag­no­sis; to avoid the stigma of a diag­no­sis; not under­stand­ing the rea­sons for cer­tain loss of func­tion (such as not see­ing a doc­tor, but hav­ing symp­toms); and not accept­ing a diag­no­sis among others.

There are many dis­or­ders that can fit within the cri­te­ria of “Ner­vous Break­down”, but those that most com­monly occur are those related to:

* Anx­i­ety Dis­or­ders
o Gen­er­al­ized Anx­i­ety Dis­or­der
o Panic Dis­or­der
* Panic Attacks
* Trauma Dis­or­ders
o Post-Traumatic Stress Dis­or­der
o Acute Stress Dis­or­der
* Psy­chotic Dis­or­ders
o Schiz­o­phre­nia
* Mood (Affec­tive) Dis­or­ders
o Depres­sion
o Bipo­lar Disorder

The Dis­or­der that is mim­ics the most directly how­ever is Major Depres­sive Dis­or­der (Depression).

On the his­tor­i­cal note, the rea­son the term “Ner­vous Break­down” came into being was that peo­ple pre­ferred to have a phys­i­cal (Nerves) ill­ness as opposed to a psy­cho­log­i­cal or psy­chi­atric illness.

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