Half a century ago, when Pigpen was new to the Peanuts gang, Charlie Brown asked him the obvious question: “Pig-Pen, why are you always so dirty?” Pig-Pen, answered with his face ringed with grime, “I have affixed to me the dirt and dust of countless ages.”
He isn’t the only one. Research shows that even kids as clean as Charlie Brown are enclosed in invisible halos of dirt and dust that can be detected using small personal monitors. For children with allergic asthma, that can be a problem.
Lead author, Nathan Rabinovitch, of the National Jewish Medical and Research Center in Denver, states that “each kid has his own individual pollution cloud.” What’s in this cloud depends on what’s in their house, their school, and what their daily experience entails. Even serious scientists have started to call this phenomenon the Pigpen Effect, referring to the Charles Schulz character of the 1950’s.
Scientists have known for a long time that dust and dirt make allergies worse, especially in inner-city urban areas. A study of 1,528 children, financed by the National Institutes of Health, found that a child’s symptoms and cost of care can be significantly reduced by spending a $1,469 per family on counseling, cleaning and buying supplies, such as impermeable mattress and pillow covers.
However, while many studies of inner-city kids have focused on allergens in the home, Rabinovitch, instead, chose to focus his study of the Pigpen Effect on a highly allergenic protein called an endotoxin. Endotoxin, one component of the pollution cloud, comes from bacteria that are everywhere in the environment, including on pets.
Researchers are baffled by the fact that kids that have asthma are better or worse, one day to the next. They hoped to discover why and to answer a related asthma management question: How do pets complicate a child’s asthma, even when the child is involved in activities outside of the home?
A curious wrinkle to this study comes from other research that has shown that exposure to lots of endotoxin before allergy develops, usually through insect dust, pets and animals, can actually be protective – priming the immune system to become tolerant of the things that often promote allergy. This theory is part of the “Hygiene Hypothesis.” Multiple studies have suggested that this hypothesis is grounded in fact. However, it becomes murky when some kids are allergic, even when they are exposed to endotoxin from cockroaches and dust mites when they are younger. The Hygiene Hypothesis also doesn’t explain why kids who have asthma get better or worse from day to day.
The distinction between the Hygiene Hypothesis and the tendency for asthma to wax and wane is an important one, according to Rabinovitch, since once a person has allergies, dust, dirt, and pets make matters worse.
Researchers studied students ages 6 to 13 who attended a National Jewish’s Kunsberg School. These were children whose asthma would interfere with their performance and attendance in ordinary schools. Each child was fitted with a monitor equipped with a filter that would capture airborne endotoxins. Asthma severity was measured by their breathing, and by asking the children to log severity of their symptoms using a daily scoring system. Researchers then compared readings from their monitors, with those monitors in the environment.
The monitors showed that personal exposures to endotoxin were “significantly higher” than the levels kids were exposed to in the environment, supporting the notion that children, like Pigpen, are surrounded by a personal cloud. “One kid may have a very different exposure than a second kid,” Rabinovitch says.
The final result: The bigger the child’s endotoxin cloud, the more airway obstruction they had to endure, researchers reported in the Journal of Allergy and Clinical Immunology.
Even if exposed at a young age, “Pets are not good for asthma,” according to Rabinovitch. If you play with a cat or a dog on a given day, you will get a high dose of endotoxin. If you live with a cat or dog, you will get the maximum dose.
(Summarized from USA Today: Article by Steve Sternberg)
Friday, February 27, 2009
Monday, February 23, 2009
Their Best Shot –
In the epidemic growth of allergies, the environment seems to play a larger role than researchers first thought. New studies into immunotherapy are giving sufferers…their best shot.
Health Correspondent Stacey Singer reported in the SUN SENTINEL the story of a 2-year old by the name of Grace King. At birthday parties, this sociable girl sometimes leaves before the cake is served. That is because Grace is allergic to both milk and eggs, and cake and ice cream could send her to the hospital.
One third to 50% of the population has some sort of allergy, and the severity of allergic reactions appears to be growing quickly, especially in children. As an example, the number of children who react to peanuts tripled between 1989 and 2002, according to a recent European study. The same trend is emerging for many other allergies.
The quest to understand the cause of allergies has taken scientists from farm fields to inner cities, from laboratories to grocery stores. The allergic response remains full of paradox: Filth can cause disease and asthma. Yet new studies suggest clean living probably unleashes allergies.
It is hard to imagine that Grace King’s clean house or suburban lifestyle could have unleashed Grace’s severe food allergy, but a concept known as the “hygiene hypothesis” has gained converts.
The thinking is that clean food and water and indoor living have deprived us of exposure to germs and parasites that our great-grandparents survived. As a result, our immune systems never get trained properly. Dr Marc Rothenberg, chief of Allergy and Clinical Immunology for the Cincinnati Children’s Hospital, refers to it as the immune system’s “delinquency problem.” “The immune system has too much free time, and it is getting into things that it shouldn’t,” he said.
This theory has gained support from a New England Journal of Medicine Study. Trying to understand why farm children were less likely to have allergies, researchers found that farm children’s mattresses were covered with bacteria endotoxin, the kind found in farm animal manure. Day and night, those children were breathing, touching eating, and drinking germs, and they appeared to have healthier immune systems as a result, according to Dr. Scott Weiss of the Channing Laboratory at Harvard University.
There are other theories. A French scientist showed that as measles and whooping cough have declined, while allergy, asthma and autoimmune diseases have risen. Childhood vaccines have also been implicated, he wrote in the New England Journal of Medicine. There may be a type of immune response mobilized by the shots, and these have an effect on the evolution of a child’s immunity.
This scientist also raised the possibility that babies who take antibiotics could also have problems because of the way the drugs alter intestinal flora, a key component of the immune system. One study showed that pregnant women with allergies that were given large doses of lactobacillis, commonly found in yogurt culture, had newborns with significantly less eczema.
Other research suggests that environmental pollutants may act like lighter fluid on a grill. While they may not cause allergy, they may prompt allergies to burn hotter. Things like truck exhaust, second-hand cigarette smoke, and flame retarding chemicals used in computer monitors have all shown some ability to heighten sensitivity of people to allergens in laboratory studies, according to Reuters Health.
Western diets have also been implicated. Weiss, at Harvard is studying the role of fats and oils in pregnant women’s diets. Some suspect that omega-3 fatty acids may help, while trans fats, widely used by fast-food makers, might worsen allergies and asthma.
On the prevention side, evidence is mounting that going to an allergist for a monthly allergy shot works well for treating inhaled allergies and insect-venom allergies, and can prevent new allergies and asthma, especially in children. Two recent studies showed that the shots prevented allergies from growing into asthma in a significant percentage of allergic children.
Other preventive strategies have been scrutinized. The American Academy of Asthma, Allergy and Immunology recommends that parents with allergies introduce new foods to their infants very slowly. Breast-feeding exclusively for the first six months is preferred, the group recommends.
For Grace King, the severely allergic 2-year old, the best approach at this point is to avoid the offending foods, and keep a loaded syringe of epinephrine on hand at all times.
(Summarized from SUN-SENTINEL, Ft. Lauderdale, Fl. , Feb. 2003)
Health Correspondent Stacey Singer reported in the SUN SENTINEL the story of a 2-year old by the name of Grace King. At birthday parties, this sociable girl sometimes leaves before the cake is served. That is because Grace is allergic to both milk and eggs, and cake and ice cream could send her to the hospital.
One third to 50% of the population has some sort of allergy, and the severity of allergic reactions appears to be growing quickly, especially in children. As an example, the number of children who react to peanuts tripled between 1989 and 2002, according to a recent European study. The same trend is emerging for many other allergies.
The quest to understand the cause of allergies has taken scientists from farm fields to inner cities, from laboratories to grocery stores. The allergic response remains full of paradox: Filth can cause disease and asthma. Yet new studies suggest clean living probably unleashes allergies.
It is hard to imagine that Grace King’s clean house or suburban lifestyle could have unleashed Grace’s severe food allergy, but a concept known as the “hygiene hypothesis” has gained converts.
The thinking is that clean food and water and indoor living have deprived us of exposure to germs and parasites that our great-grandparents survived. As a result, our immune systems never get trained properly. Dr Marc Rothenberg, chief of Allergy and Clinical Immunology for the Cincinnati Children’s Hospital, refers to it as the immune system’s “delinquency problem.” “The immune system has too much free time, and it is getting into things that it shouldn’t,” he said.
This theory has gained support from a New England Journal of Medicine Study. Trying to understand why farm children were less likely to have allergies, researchers found that farm children’s mattresses were covered with bacteria endotoxin, the kind found in farm animal manure. Day and night, those children were breathing, touching eating, and drinking germs, and they appeared to have healthier immune systems as a result, according to Dr. Scott Weiss of the Channing Laboratory at Harvard University.
There are other theories. A French scientist showed that as measles and whooping cough have declined, while allergy, asthma and autoimmune diseases have risen. Childhood vaccines have also been implicated, he wrote in the New England Journal of Medicine. There may be a type of immune response mobilized by the shots, and these have an effect on the evolution of a child’s immunity.
This scientist also raised the possibility that babies who take antibiotics could also have problems because of the way the drugs alter intestinal flora, a key component of the immune system. One study showed that pregnant women with allergies that were given large doses of lactobacillis, commonly found in yogurt culture, had newborns with significantly less eczema.
Other research suggests that environmental pollutants may act like lighter fluid on a grill. While they may not cause allergy, they may prompt allergies to burn hotter. Things like truck exhaust, second-hand cigarette smoke, and flame retarding chemicals used in computer monitors have all shown some ability to heighten sensitivity of people to allergens in laboratory studies, according to Reuters Health.
Western diets have also been implicated. Weiss, at Harvard is studying the role of fats and oils in pregnant women’s diets. Some suspect that omega-3 fatty acids may help, while trans fats, widely used by fast-food makers, might worsen allergies and asthma.
On the prevention side, evidence is mounting that going to an allergist for a monthly allergy shot works well for treating inhaled allergies and insect-venom allergies, and can prevent new allergies and asthma, especially in children. Two recent studies showed that the shots prevented allergies from growing into asthma in a significant percentage of allergic children.
Other preventive strategies have been scrutinized. The American Academy of Asthma, Allergy and Immunology recommends that parents with allergies introduce new foods to their infants very slowly. Breast-feeding exclusively for the first six months is preferred, the group recommends.
For Grace King, the severely allergic 2-year old, the best approach at this point is to avoid the offending foods, and keep a loaded syringe of epinephrine on hand at all times.
(Summarized from SUN-SENTINEL, Ft. Lauderdale, Fl. , Feb. 2003)
Friday, February 20, 2009
ALLERGY EPIDEMIC
Allergy, once the bane of a small, sniffling minority, is becoming epidemic in the United States. Up to 30% of adults and 40% of children suffer from allergic rhinitis, characterized by nasal congestion and itchy eyes commonly called hay fever.
Despite their ubiquity, allergies remain mysterious. Heredity plays a role, but genes cannot explain the sharp increase over the past 30 years, particularly in developed countries. “Allergy is on the rise, and it is not clear why,” sasy Ira Finegold, chief allergist at St. Luke’s-Roosevelt Hospital Center in New York.
Many culprits have been proposed, including pollution and changes in lifestyle. The most startling possibility is that allergy may be caused by the success of civilization. As modern life becomes more hygienic, the human immune system has run out of things to do. It attacks allergens, and the body itself, as if it were bored.
The problem is not just pollen, but a host of unrelated triggers, including nuts, nickel and latex. With people spending 90% of their time indoors, allergies to cats, molds, and dust mites have become a serious concern. Allergies to food and insect stings can be fatal, and allergies are the main trigger for asthma, which kill 5,000 people per year.
Many researchers are convinced that almost half the people in the developed world are now allergic to something. Allergy consistently appears in the top-10 list of reasons for visits to doctors. “Something in the Western style of living has given rise to more allergies,” says Donald Leung, head of the pediatric allergy division at National Jewish Medical and Research Center in Denver. Humans seem to have a talent not only for altering the environment, but for introducing themselves to new allergens. For the first part of the 20th century, horses were a major allergy trigger, and now cars are more common. Most adults work in a climate controlled office, and children play indoors more instead of riding bikes on the street. As a result, indoor allergens have become a plague.
Finding out what sets off a person’s allergies is not too difficult. An allergist can perform a skin-prick test, injecting tiny does of allergens into the patient’s back or forearm to see which raise itchy red welts. Blood tests are sometimes used as well to detect antibodies to allergens. It is determining what to do next that is difficult.
The primary weapon remains antihistamines. Allergy shots remain effective, but the shots sometimes set off dangerous allergic reactions. New medications in the pipeline include an “anti-IgE” drug, a monoclonal antibody designed to hobble immunoglobulin E, the human antibody that sets allergic reactions in motion. Anti-leukotriene drugs such as Accolate and Singulair, which combat inflammatory compounds produced by white blood cells, have proved useful for treating asthma since their introduction in 1996. New, safer vaccines are also in the works.
Scientists are intensely interested in finding out how to push the immune system in the right direction. The ultimate goal in allergy treatment may be to convince the body right from outset that allergens are not worthy of an immune response.
Among the different types of allergies are allergies to food. While they are rare, they can be deadly. Food allergy reactions can be so extreme that conventional allergy shots are too risky. For now, the only way to evade the risk is to avoid the food. The world is becoming more hospitable to people with food allergies, with manufacturers increasingly listing peanuts and other common allergens on food products.
Dust has become public enemy No. 1. There has been a barrage of products and advice for coping with it. If you need to take action against dust mites, the bedroom is the front line. The warm, moist conditions in beds provide the perfect microclimate for them to thrive, but there are simple ways to make the linens and mattress less hospitable.
Feather pillows used to be off-limits, but studies have proved just the opposite. These pillows have a tighter weave. Synthetic pillows actually emit more allergens and should be outfitted with good anti-allergen covers. You may also need to strip the room of carpets, which can rival beds as a dust-mite haven.
Throughout the house, frequent cleaning with a HEPA vacuum is recommended, although vacuuming a carpet removes only a small proportion of the allergens. Dehumidifiers also thwart dust mites, which can’t live in dry conditions. Whatever the source of dust, a HEPA or electrostatic filter on heating and air-conditioning systems will help capture some of it.
(Summarized from U.S. News & World Report, May 8, 2000 pp46-53. Article by Nancy Shite)
Despite their ubiquity, allergies remain mysterious. Heredity plays a role, but genes cannot explain the sharp increase over the past 30 years, particularly in developed countries. “Allergy is on the rise, and it is not clear why,” sasy Ira Finegold, chief allergist at St. Luke’s-Roosevelt Hospital Center in New York.
Many culprits have been proposed, including pollution and changes in lifestyle. The most startling possibility is that allergy may be caused by the success of civilization. As modern life becomes more hygienic, the human immune system has run out of things to do. It attacks allergens, and the body itself, as if it were bored.
The problem is not just pollen, but a host of unrelated triggers, including nuts, nickel and latex. With people spending 90% of their time indoors, allergies to cats, molds, and dust mites have become a serious concern. Allergies to food and insect stings can be fatal, and allergies are the main trigger for asthma, which kill 5,000 people per year.
Many researchers are convinced that almost half the people in the developed world are now allergic to something. Allergy consistently appears in the top-10 list of reasons for visits to doctors. “Something in the Western style of living has given rise to more allergies,” says Donald Leung, head of the pediatric allergy division at National Jewish Medical and Research Center in Denver. Humans seem to have a talent not only for altering the environment, but for introducing themselves to new allergens. For the first part of the 20th century, horses were a major allergy trigger, and now cars are more common. Most adults work in a climate controlled office, and children play indoors more instead of riding bikes on the street. As a result, indoor allergens have become a plague.
Finding out what sets off a person’s allergies is not too difficult. An allergist can perform a skin-prick test, injecting tiny does of allergens into the patient’s back or forearm to see which raise itchy red welts. Blood tests are sometimes used as well to detect antibodies to allergens. It is determining what to do next that is difficult.
The primary weapon remains antihistamines. Allergy shots remain effective, but the shots sometimes set off dangerous allergic reactions. New medications in the pipeline include an “anti-IgE” drug, a monoclonal antibody designed to hobble immunoglobulin E, the human antibody that sets allergic reactions in motion. Anti-leukotriene drugs such as Accolate and Singulair, which combat inflammatory compounds produced by white blood cells, have proved useful for treating asthma since their introduction in 1996. New, safer vaccines are also in the works.
Scientists are intensely interested in finding out how to push the immune system in the right direction. The ultimate goal in allergy treatment may be to convince the body right from outset that allergens are not worthy of an immune response.
Among the different types of allergies are allergies to food. While they are rare, they can be deadly. Food allergy reactions can be so extreme that conventional allergy shots are too risky. For now, the only way to evade the risk is to avoid the food. The world is becoming more hospitable to people with food allergies, with manufacturers increasingly listing peanuts and other common allergens on food products.
Dust has become public enemy No. 1. There has been a barrage of products and advice for coping with it. If you need to take action against dust mites, the bedroom is the front line. The warm, moist conditions in beds provide the perfect microclimate for them to thrive, but there are simple ways to make the linens and mattress less hospitable.
Feather pillows used to be off-limits, but studies have proved just the opposite. These pillows have a tighter weave. Synthetic pillows actually emit more allergens and should be outfitted with good anti-allergen covers. You may also need to strip the room of carpets, which can rival beds as a dust-mite haven.
Throughout the house, frequent cleaning with a HEPA vacuum is recommended, although vacuuming a carpet removes only a small proportion of the allergens. Dehumidifiers also thwart dust mites, which can’t live in dry conditions. Whatever the source of dust, a HEPA or electrostatic filter on heating and air-conditioning systems will help capture some of it.
(Summarized from U.S. News & World Report, May 8, 2000 pp46-53. Article by Nancy Shite)
Monday, February 16, 2009
A Silent Epidemic Has Struck: The Mystery Is Why
Ten year old Giovanni Delgado had his second asthma attack in three days. He felt as if he were drowning in a dark sea. Giovanni’s fate would be in the hands of a Passaic county, New Jersey school nurse - either sent to the emergency room, or being treated and going back to class.
Fifty miles to the west, Ainsworth Scott, the 68 year-old mayor of Belvidere, New Jersey, reaches for his vial of medicine. He is trying to explain why there is this strange rise in asthma in his tiny bucolic village tucked along the Delaware River.
In the past 20 years, asthma has enveloped the United States, nearly doubling its reach in a medical mystery story that puzzles scientists. Some of the most surprising chapters are being written in New Jersey.
In Passaic, New Jersey, 22% of the children have asthma, nearly three times the national average. However, in rural Warren County, amid lush mountains and smog-free air, another team of scientists log the same numbers.
Scientists know what triggers asthma attacks – pollution, dust, and mold – but the reason people develop the disease remains unclear. Asthma is now in the center of one of the most divisive political battles – the fight over pollution rules for heavy industry. The dirty air spewing from smokestacks in the Midwest and South drifts over New Jersey. It is blamed for a third of the state’s air pollution. Revised pollution standards actually make it easier for plants to upgrade and reduce pollution. However, other new rules would allow utilities to continue to spew smog and soot over New Jersey for years to come.
Asthma kills 4,500 people per year. It killed 123 New Jerseyans in 2001. Roberto Nachajon, a respiratory pulmonologist at St. Joseph’s Regional Medical Center in Paterson, N.J. states, “I would say every one of those deaths can be prevented.”
Most asthma attacks are allergic reactions, the body protecting itself from what it sees as a foreign invader. When a strange whiff of smoke from a power plant that could be 400 miles away, or a speck of roach droppings finds their way to the air passages, an overactive immune system counteracts, flooding the lungs with antibodies. This causes the inner linings of the airways to swell, narrowing the tunnels through which oxygen reaches the blood vessels. Muscles squeeze the airflow further. Mucus clogs up the remaining space.
The death rate from asthma has been dropping across the United States, thanks to an arsenal of new drugs and better-educated patients. However, the disease stills exacts a heavy toll: drugs, ER visits, missed workdays, and other costs of coping with asthma total $13 billion annually nationwide.
Still, nobody knows why so many are suffering from asthma. Scientists argue asthma is not one disease, but several – allergic asthma, exercise-induced asthma, elderly asthma, and other varieties, with different triggers and treatments.
Theories abound: secondhand smoke, sedentary lifestyles, a Western diet of processed foods, tighter buildings that trap more indoor pollutants, and the “hygiene hypothesis” – the theory that today’s children are too shielded from viruses and bacteria that their immune systems don’t get the proper shakedown early in life.
On the other side, there is mounting evidence that pollution, even at low levels, leaves a lasting mark on your lungs. Researchers at the University of California completed an 11-year old study tracking thousands of youngsters in the nation’s dirtiest air. They found that those youngsters who lived in the smoggy cities were three times as likely to develop asthma. The lungs of children in more polluted air grew more slowly, and they move air less efficiently.
Another UCLA study showed that individuals exposed to both diesel particulates and dust mites had triple the immune response of those exposed to dust mites alone. Still, air pollution isn’t the final word as a cause for asthma. In Beijing, China’s air continues to worsen as China industrializes, yet only 8 percent of school-age children there have asthma, reports Noreen Clark, dean of the University of Michigan’s School of Public Health. By contrast, the air is cleaner and people smoke less in Detroit, yet 20% of the city’s students have the disease, she says.
An answer could be in the fact that even individuals in suburban areas are still breathing air that blows in from nearby and distant urban areas. In New Jersey, suburbs and cities are so close together that residents of both breathe the same tainted air. In addition, suburban sprawl has caused an increase of cars on the road. The fact that children may spend less time walking and biking, slowing the growth of their lungs, may make them more susceptible to respiratory problems.
This theory is particularly evident in the town of Belvidere, New Jersey. Across the Delaware River in this pristine town is Martins Creek, a power plant that produces sulfur dioxide. In addition to Martins Creek, says Ainsworth Scott, “All across Pennsylvania they burn, and we get the westerly winds.” In addition, Roche Vitamins announced that its plant in the town of Belvidere was emitting excessive amounts of toxic air pollutants for years.
In the end, there’s not just one smoking stack behind the asthma woes.
(Summarized from THE RECORD, Hackensack, NJ; copyright Knight-Ridder Newspapers: Distributed by Knight-Ridder / Tribune Information Services.)
Fifty miles to the west, Ainsworth Scott, the 68 year-old mayor of Belvidere, New Jersey, reaches for his vial of medicine. He is trying to explain why there is this strange rise in asthma in his tiny bucolic village tucked along the Delaware River.
In the past 20 years, asthma has enveloped the United States, nearly doubling its reach in a medical mystery story that puzzles scientists. Some of the most surprising chapters are being written in New Jersey.
In Passaic, New Jersey, 22% of the children have asthma, nearly three times the national average. However, in rural Warren County, amid lush mountains and smog-free air, another team of scientists log the same numbers.
Scientists know what triggers asthma attacks – pollution, dust, and mold – but the reason people develop the disease remains unclear. Asthma is now in the center of one of the most divisive political battles – the fight over pollution rules for heavy industry. The dirty air spewing from smokestacks in the Midwest and South drifts over New Jersey. It is blamed for a third of the state’s air pollution. Revised pollution standards actually make it easier for plants to upgrade and reduce pollution. However, other new rules would allow utilities to continue to spew smog and soot over New Jersey for years to come.
Asthma kills 4,500 people per year. It killed 123 New Jerseyans in 2001. Roberto Nachajon, a respiratory pulmonologist at St. Joseph’s Regional Medical Center in Paterson, N.J. states, “I would say every one of those deaths can be prevented.”
Most asthma attacks are allergic reactions, the body protecting itself from what it sees as a foreign invader. When a strange whiff of smoke from a power plant that could be 400 miles away, or a speck of roach droppings finds their way to the air passages, an overactive immune system counteracts, flooding the lungs with antibodies. This causes the inner linings of the airways to swell, narrowing the tunnels through which oxygen reaches the blood vessels. Muscles squeeze the airflow further. Mucus clogs up the remaining space.
The death rate from asthma has been dropping across the United States, thanks to an arsenal of new drugs and better-educated patients. However, the disease stills exacts a heavy toll: drugs, ER visits, missed workdays, and other costs of coping with asthma total $13 billion annually nationwide.
Still, nobody knows why so many are suffering from asthma. Scientists argue asthma is not one disease, but several – allergic asthma, exercise-induced asthma, elderly asthma, and other varieties, with different triggers and treatments.
Theories abound: secondhand smoke, sedentary lifestyles, a Western diet of processed foods, tighter buildings that trap more indoor pollutants, and the “hygiene hypothesis” – the theory that today’s children are too shielded from viruses and bacteria that their immune systems don’t get the proper shakedown early in life.
On the other side, there is mounting evidence that pollution, even at low levels, leaves a lasting mark on your lungs. Researchers at the University of California completed an 11-year old study tracking thousands of youngsters in the nation’s dirtiest air. They found that those youngsters who lived in the smoggy cities were three times as likely to develop asthma. The lungs of children in more polluted air grew more slowly, and they move air less efficiently.
Another UCLA study showed that individuals exposed to both diesel particulates and dust mites had triple the immune response of those exposed to dust mites alone. Still, air pollution isn’t the final word as a cause for asthma. In Beijing, China’s air continues to worsen as China industrializes, yet only 8 percent of school-age children there have asthma, reports Noreen Clark, dean of the University of Michigan’s School of Public Health. By contrast, the air is cleaner and people smoke less in Detroit, yet 20% of the city’s students have the disease, she says.
An answer could be in the fact that even individuals in suburban areas are still breathing air that blows in from nearby and distant urban areas. In New Jersey, suburbs and cities are so close together that residents of both breathe the same tainted air. In addition, suburban sprawl has caused an increase of cars on the road. The fact that children may spend less time walking and biking, slowing the growth of their lungs, may make them more susceptible to respiratory problems.
This theory is particularly evident in the town of Belvidere, New Jersey. Across the Delaware River in this pristine town is Martins Creek, a power plant that produces sulfur dioxide. In addition to Martins Creek, says Ainsworth Scott, “All across Pennsylvania they burn, and we get the westerly winds.” In addition, Roche Vitamins announced that its plant in the town of Belvidere was emitting excessive amounts of toxic air pollutants for years.
In the end, there’s not just one smoking stack behind the asthma woes.
(Summarized from THE RECORD, Hackensack, NJ; copyright Knight-Ridder Newspapers: Distributed by Knight-Ridder / Tribune Information Services.)
Friday, February 13, 2009
Asthma Can Be Tamed, and It’s No Mystery
Asthma is a silent epidemic across the nation, the Bergen County RECORD has reported. Scientists don’t know why it is becoming so common. However, they do know that air pollution, especially from power plans and vehicles, makes it much worse.
While asthma can’t be cured, it can be managed. With diligence and good care, patients can stay out of the hospital and suffer fewer, less severe attacks.
When Curtis James came close to death one day from an asthma attack, it scared him into changing his habits. He began seeing a lung specialist, Dr. Robert Amoruso, who worked out a treatment plan. Now, Curtis uses preventive medicines every day, monitors his lung capacity, and travels with a nebulizer, a machine that aero-solizes medication, so that it can be inhaled. He hasn’t been to the hospital since Dr. Amoruso stabilized his condition.
The problem in asthma management is that there is a real gap between what many doctors know and can do, and what actually happens in practice. Far too many patients go from crisis to crisis. Follow-up visits to a primary care doctor may not help enough. In surveys, 40% of physicians say they often don’t follow national guidelines for asthma treatment. Specialist care – provided by an allergist of pulmonologist - produces better results. However, many health plans block an individual’s ability to see a specialist.
Regular, daily use of prescription medicine is needed to prevent crises and poor breathing for people with moderate to severe asthma, but many people lack coverage for drugs. In addition, there is no guarantee that individuals will get what they need to manage their disease.
In addition to what doctors can and should provide in preventive care, prevention must also take place in patients’ homes. Lifestyle changes – stopping smoking, ridding the home of pet dander, roaches and dust, and putting dust covers on bedding – are key preventive measures for asthma patients. However, changing behavior requires patient education by health-care professionals, sensitivity to cultural differences, and ultimately a commitment from the patient, and / or a family of the patient. Doctors must help to educate patients on the importance of lifestyle changes.
It has been recognized by many managed care companies that effective asthma management not only saves lives, but it reduces health care costs. Many HMOs and other health insurance companies now have condition management programs, where nurses will contact individuals who have been hospitalized and discuss the management of their disease. AmeriChoice, in a pilot program with 145 severe asthmatics, was able to cut hospital stays for by more than half and ER visits by a quarter.
However, one of the key barriers to preventive care relates to culture. Immigrant communities are the most vulnerable to asthma crises. In addition to the language barriers that often exist, many immigrants’ first instinct is to reach for home remedies rather than Western medicine, said Noreen Clark, director of a University of Michigan program that promotes grass-roots asthma education across the country. Many immigrants use alternative therapies without telling their doctors, and some see doctors only after these therapies do not work.
Doctors, and the health care community at large, need to learn the cultural tendencies of asthma sufferers. Historically, Latinos and Caribbeans tend to mistake asthma for a one-time illness, rather than a lifetime condition that needs constant care. Some Puerto Ricans have been wary of treating asthma with inhaled steroids, fearing they might be addictive or harmful to children.
In order to tame asthma and make it a manageable disease then, focus needs to be on (1) physicians providing preventive asthma medications and patient education about needed lifestyle changes, and (2) the healthcare community’s steady reach into immigrant and poor communities to educate and ensure these populations receive the best education and treatment for their condition.
(Summarized from THE RECORD, Bergen County, NJ; Article by Lindy Washburn and Alex Nussbaum)
While asthma can’t be cured, it can be managed. With diligence and good care, patients can stay out of the hospital and suffer fewer, less severe attacks.
When Curtis James came close to death one day from an asthma attack, it scared him into changing his habits. He began seeing a lung specialist, Dr. Robert Amoruso, who worked out a treatment plan. Now, Curtis uses preventive medicines every day, monitors his lung capacity, and travels with a nebulizer, a machine that aero-solizes medication, so that it can be inhaled. He hasn’t been to the hospital since Dr. Amoruso stabilized his condition.
The problem in asthma management is that there is a real gap between what many doctors know and can do, and what actually happens in practice. Far too many patients go from crisis to crisis. Follow-up visits to a primary care doctor may not help enough. In surveys, 40% of physicians say they often don’t follow national guidelines for asthma treatment. Specialist care – provided by an allergist of pulmonologist - produces better results. However, many health plans block an individual’s ability to see a specialist.
Regular, daily use of prescription medicine is needed to prevent crises and poor breathing for people with moderate to severe asthma, but many people lack coverage for drugs. In addition, there is no guarantee that individuals will get what they need to manage their disease.
In addition to what doctors can and should provide in preventive care, prevention must also take place in patients’ homes. Lifestyle changes – stopping smoking, ridding the home of pet dander, roaches and dust, and putting dust covers on bedding – are key preventive measures for asthma patients. However, changing behavior requires patient education by health-care professionals, sensitivity to cultural differences, and ultimately a commitment from the patient, and / or a family of the patient. Doctors must help to educate patients on the importance of lifestyle changes.
It has been recognized by many managed care companies that effective asthma management not only saves lives, but it reduces health care costs. Many HMOs and other health insurance companies now have condition management programs, where nurses will contact individuals who have been hospitalized and discuss the management of their disease. AmeriChoice, in a pilot program with 145 severe asthmatics, was able to cut hospital stays for by more than half and ER visits by a quarter.
However, one of the key barriers to preventive care relates to culture. Immigrant communities are the most vulnerable to asthma crises. In addition to the language barriers that often exist, many immigrants’ first instinct is to reach for home remedies rather than Western medicine, said Noreen Clark, director of a University of Michigan program that promotes grass-roots asthma education across the country. Many immigrants use alternative therapies without telling their doctors, and some see doctors only after these therapies do not work.
Doctors, and the health care community at large, need to learn the cultural tendencies of asthma sufferers. Historically, Latinos and Caribbeans tend to mistake asthma for a one-time illness, rather than a lifetime condition that needs constant care. Some Puerto Ricans have been wary of treating asthma with inhaled steroids, fearing they might be addictive or harmful to children.
In order to tame asthma and make it a manageable disease then, focus needs to be on (1) physicians providing preventive asthma medications and patient education about needed lifestyle changes, and (2) the healthcare community’s steady reach into immigrant and poor communities to educate and ensure these populations receive the best education and treatment for their condition.
(Summarized from THE RECORD, Bergen County, NJ; Article by Lindy Washburn and Alex Nussbaum)
Thursday, February 12, 2009
Alternative Medicine as “Pain Killers”
While chronic pain afflicts millions of Canadians, most family doctors do not often have the time or interest to help manage their patients’ pain. The big medicine guns in pain management are usually narcotics which “take the edge off”, but don’t provide complete relief. In addition, there is the fear of addiction in taking these pain killers.
Alternative pain management techniques are available at several pain clinics. At Thorson Burnaby’s Health Centre, there is a team approach to pain management. Physicians, chiropractors, physiotherapists, psychologists, and many other disciplines work together to treat individuals’ chronic pain.
Vancouver’s St. Paul Hospital (SPH) Pain Centre is also a multi-disciplinary clinic that treats British Columbia’s chronic pain cases. Here, they use spinal-cord stimulation, as one option to chronic pain. This involves the insertion of a device into the lower back, which is then connected with wires to the spinal cord. The device blocks pain signals from reaching the brain.
Other alternative pain relieving techniques include IMS or intramuscular stimulation, developed by Dr. Chan Gunn. IMS marries the best of western medical knowledge with the acupuncturist’s needle. This technique is in increasing use throughout the world.
A special device, called Farabloc, was invented by Frieder Kemp in response to his father’s chronic and disabling phantom limb pain. It is a thin fabric cloth with interwoven metal fibers. Placed over the sensitive tissue, it calms nerve ends and stimulates blood circulation.
For many, these alternative, multi-disciplinary approaches are the answer to pain relief.
SOURCE: BC BUSINESS (Burnaby, Canada) June 2003, pp. 38+ Original Article by Vicki O’Brien
Alternative pain management techniques are available at several pain clinics. At Thorson Burnaby’s Health Centre, there is a team approach to pain management. Physicians, chiropractors, physiotherapists, psychologists, and many other disciplines work together to treat individuals’ chronic pain.
Vancouver’s St. Paul Hospital (SPH) Pain Centre is also a multi-disciplinary clinic that treats British Columbia’s chronic pain cases. Here, they use spinal-cord stimulation, as one option to chronic pain. This involves the insertion of a device into the lower back, which is then connected with wires to the spinal cord. The device blocks pain signals from reaching the brain.
Other alternative pain relieving techniques include IMS or intramuscular stimulation, developed by Dr. Chan Gunn. IMS marries the best of western medical knowledge with the acupuncturist’s needle. This technique is in increasing use throughout the world.
A special device, called Farabloc, was invented by Frieder Kemp in response to his father’s chronic and disabling phantom limb pain. It is a thin fabric cloth with interwoven metal fibers. Placed over the sensitive tissue, it calms nerve ends and stimulates blood circulation.
For many, these alternative, multi-disciplinary approaches are the answer to pain relief.
SOURCE: BC BUSINESS (Burnaby, Canada) June 2003, pp. 38+ Original Article by Vicki O’Brien
Monday, February 9, 2009
Treating Migraine Headache
Drug therapy, biofeedback training, stress reduction, and eliminating certain foods from the diet are the most common methods of preventing and controlling migraine. There are two main approaches to the drug treatment of migraine headache: prevention of attacks, and / or relieving symptoms after the headache occurs.
For mild migraine headaches, over the counter drugs, typically acetaminophen or aspirin, can be ingested upon the first onset of the migraine to either stop the headache or alleviate the pain. For moderate or severe migraines, or cluster headaches – shorter versions of migraine that occur in a “cluster” such as several a day – strong drugs are necessary to control pain.
One of the most commonly used drugs for relief of severe migraine is ergotamine tartrate, a vasoconstrictor which helps relieve the dilation stage of a migraine. For optimal benefit, it should be taken at the start of a migraine.
For migraines that occur with frequency more than three times per month, doctors typically recommend a course of preventive treatment. These preventative drugs can include methysergide maleate, a substance which minimizes blood vessel constriction, and propranolol hydrochloride, a medication that stops blood vessel dilation. Also, amitryptyline, an antidepressant, has also been used in treating migraines.
Antidepressants called MAO inhibitors also prevent migraine. However, MAO inhibitors can have potentially serious side effects – particularly while ingesting food and beverages that contain tyramine, a substance that constricts arteries.
Recently, scientists have developed new drugs that prevent migraines, such as the serotonin agonists, which imitate its equivalent brain chemical. The key to preventing migraines resides within timely administration of these prescriptions.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996
For mild migraine headaches, over the counter drugs, typically acetaminophen or aspirin, can be ingested upon the first onset of the migraine to either stop the headache or alleviate the pain. For moderate or severe migraines, or cluster headaches – shorter versions of migraine that occur in a “cluster” such as several a day – strong drugs are necessary to control pain.
One of the most commonly used drugs for relief of severe migraine is ergotamine tartrate, a vasoconstrictor which helps relieve the dilation stage of a migraine. For optimal benefit, it should be taken at the start of a migraine.
For migraines that occur with frequency more than three times per month, doctors typically recommend a course of preventive treatment. These preventative drugs can include methysergide maleate, a substance which minimizes blood vessel constriction, and propranolol hydrochloride, a medication that stops blood vessel dilation. Also, amitryptyline, an antidepressant, has also been used in treating migraines.
Antidepressants called MAO inhibitors also prevent migraine. However, MAO inhibitors can have potentially serious side effects – particularly while ingesting food and beverages that contain tyramine, a substance that constricts arteries.
Recently, scientists have developed new drugs that prevent migraines, such as the serotonin agonists, which imitate its equivalent brain chemical. The key to preventing migraines resides within timely administration of these prescriptions.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996
Saturday, February 7, 2009
Pain Killers
There is help out there for managing pain – whether from a car smash-up, sports injury, workplace accident or disease – if you’re willing to look further than your family doctor for alternatives to drugs.
Chronic pain is a silent epidemic affecting some 10 million Canadians. Although there are many types of chronic pain and many pain levels, the universe of pain shares some common issues. Most family doctors know little about chronic pain and offer little in a 10-minute visit. Although some GPs take a special interest in pain treatment, many prefer not to deal with often-difficult patients. Whether justified or not, pain patients frequently say they are angry and frustrated with the cursory treatment they receive.
There’s also a lot of needless suffering. Some people won’t take medication for fear they’ll become a vegetable or an addict. The big guns in today’s pain arsenal are the narcotics derived from morphine or codeine. However, physicians often refuse to prescribe them in sufficient quantities because of addiction concerns. In addition, most people won’t get complete relief with narcotics. These drugs just “take the edge off” leaving the patient feeling drowsy and disoriented. Experts agree it’s better to learn alternative pain management techniques.
In the conference room at Burnby’s Thorson Health Centre there is a lively group of physicians, chiropractors, physiotherapists, psychologists, counselors and technicians who are brainstorming complex issues. “We encourage personal growth and help clients accept responsibility for their physical and emotional well-being,” says Thorson. At the clinic that’s done with support and education, plus treatments such as nerve blocks, trigger point therapy, group work, biofeedback, stress management, psychotherapy, hypnotherapy, physiotherapy, massage, chiropractic, nutrition, exercise and acupuncture.
Neuropathic pain, or pain resulting from a damaged nerve, is another type of chronic pain. Dr. Chan Gunn, head of the Institute for the Study and Treatment of Chronic Pain (iSTOP) uses IMS or intramuscular stimulation to ease nerve pain. Therapy involves inserting long, thin needles of up to several inches in length, into the constricted part of the muscle, also known as the “knot” or trigger point. When introduced accurately, the muscle will contract and grab the needle and then relax. Gunn claims to resolve acute neuropathic problems in one or two visits, though some cases take longer.
At the Comox Valley Nursing Centre, nurses assist patients in the management of their chronic pain. Clients can attend a chronic pain education program, join relaxation, exercise or therapeutic swim classes or participate in a chronic pain support group. Most important says Diane Lewis, a nurse in the program, is that they get plenty of time and support.
Farabloc, is another pain relieving device. It is the invention of Frieder Kempe whose father suffered phantom leg pain after being wounded in 1944 and losing his leg. Kempe realized that his father’s scar had no healthy skin covering, hence no protection from electro-magnetic fields. By 1978, he’d developed a thin fabric cloth with interwoven metal fibres that significantly reduced his father’s pain. The product, called Farabloc, is produced at Kempe’s Coquitlam factory. Manufactured in many shapes and sizes and sold across the globe, it has proven to reduce phantom limb pain and delay the onset of muscle soreness experienced by athletes. German researchers are currently studying its effectiveness with painful fibro-myalgia.
Chronic pain disables more people than cancer or heart disease. For many, their best hope is contained with multi-disciplinary clinics with offer a variety of treatment options.
SOURCE: BC BUSINESS (Burnaby, Canada) June 2003, pp. 38+ Original article by Vicki O’Brien
Chronic pain is a silent epidemic affecting some 10 million Canadians. Although there are many types of chronic pain and many pain levels, the universe of pain shares some common issues. Most family doctors know little about chronic pain and offer little in a 10-minute visit. Although some GPs take a special interest in pain treatment, many prefer not to deal with often-difficult patients. Whether justified or not, pain patients frequently say they are angry and frustrated with the cursory treatment they receive.
There’s also a lot of needless suffering. Some people won’t take medication for fear they’ll become a vegetable or an addict. The big guns in today’s pain arsenal are the narcotics derived from morphine or codeine. However, physicians often refuse to prescribe them in sufficient quantities because of addiction concerns. In addition, most people won’t get complete relief with narcotics. These drugs just “take the edge off” leaving the patient feeling drowsy and disoriented. Experts agree it’s better to learn alternative pain management techniques.
In the conference room at Burnby’s Thorson Health Centre there is a lively group of physicians, chiropractors, physiotherapists, psychologists, counselors and technicians who are brainstorming complex issues. “We encourage personal growth and help clients accept responsibility for their physical and emotional well-being,” says Thorson. At the clinic that’s done with support and education, plus treatments such as nerve blocks, trigger point therapy, group work, biofeedback, stress management, psychotherapy, hypnotherapy, physiotherapy, massage, chiropractic, nutrition, exercise and acupuncture.
Neuropathic pain, or pain resulting from a damaged nerve, is another type of chronic pain. Dr. Chan Gunn, head of the Institute for the Study and Treatment of Chronic Pain (iSTOP) uses IMS or intramuscular stimulation to ease nerve pain. Therapy involves inserting long, thin needles of up to several inches in length, into the constricted part of the muscle, also known as the “knot” or trigger point. When introduced accurately, the muscle will contract and grab the needle and then relax. Gunn claims to resolve acute neuropathic problems in one or two visits, though some cases take longer.
At the Comox Valley Nursing Centre, nurses assist patients in the management of their chronic pain. Clients can attend a chronic pain education program, join relaxation, exercise or therapeutic swim classes or participate in a chronic pain support group. Most important says Diane Lewis, a nurse in the program, is that they get plenty of time and support.
Farabloc, is another pain relieving device. It is the invention of Frieder Kempe whose father suffered phantom leg pain after being wounded in 1944 and losing his leg. Kempe realized that his father’s scar had no healthy skin covering, hence no protection from electro-magnetic fields. By 1978, he’d developed a thin fabric cloth with interwoven metal fibres that significantly reduced his father’s pain. The product, called Farabloc, is produced at Kempe’s Coquitlam factory. Manufactured in many shapes and sizes and sold across the globe, it has proven to reduce phantom limb pain and delay the onset of muscle soreness experienced by athletes. German researchers are currently studying its effectiveness with painful fibro-myalgia.
Chronic pain disables more people than cancer or heart disease. For many, their best hope is contained with multi-disciplinary clinics with offer a variety of treatment options.
SOURCE: BC BUSINESS (Burnaby, Canada) June 2003, pp. 38+ Original article by Vicki O’Brien
Monday, February 2, 2009
Headache: Hope through Research
An estimated 45 million Americans experience chronic headaches. For at least half of these people, the problem is severe and sometimes disabling. It can also be costly: headache sufferers make over 8 million visits a year to doctors’ offices. Migraine victims alone lose over 157 million workdays because of headache pain.
Understanding why headaches occur and improving therapies are among research goals of the National Institute of Neurological Disorders and Stroke (NINDS). As the leading supporter of brain research in the Federal Government, the NINDS also supports and conducts studies to improve the diagnosis of headaches and find ways to prevent them.
When Should You See a Physician?
Not all headaches require medical attention. However, some types of headache are signals of more serious disorders and call for prompt medical attention, for example: a sudden severe headache; headache associated with convulsions; headache accompanied by confusion or loss of consciousness; headache following a head injury; headache associated with eye or ear pain; persistent headache in someone who was previously headache free; recurring headache in children; headache associated with fever; and headache that interferes with normal life.
Diagnosing a Headache
Experts agree that a detailed question and answer session with a patient can often produce enough information for a diagnosis. Most physicians will also obtain a full medical history from the patient, inquiring about past head trauma, surgery and medication use. A blood test may be ordered to screen for thyroid disease, anemia, or infections which might cause headache. X-rays or CT Scans or MRIs may be ordered to rule out the possibility of a brain tumor or blood clot. Sometimes eye exams are recommended, and an experimental technique called Thermography – using an infrared camera to measure blood flow through the skin – can show strikingly different heat patterns from headache sufferers vs. those that rarely get headaches.
A physician will analyze the results of all of these tests and arrive at the following headache diagnoses: (1) Vascular, (2) Muscle contraction (tension), (3) Traction, or (4) Inflammatory headache.
Vascular headaches include the well-known Migraine type. It is thought to involve abnormal function of the brain’s blood vessels or vascular system. Migraine headache involves severe pain on one or both sides of the head, an upset stomach, and, at times disturbed vision. Sometimes migraine headaches begin with an “aura.” The individual sees zigzag lines or flashing lights before the headache actually begins.
While researchers are unclear about the precise cause of migraine headaches, there seems to be agreement that a key element is blood flow changes in the brain. People who get migraines appear to have blood vessels that overreact to various triggers.
There are two ways to approach the treatment of migraine with drugs: prevent the attack, or relieve symptoms after the headache occurs. For infrequent migraines, drugs can be taken at the first sign of a headache in order to stop it or at least relieve the pain. For occasional or mild migraine, sometimes aspirin or acetaminophen taken at the start of the headache can help. Small amounts of caffeine may be useful also if taken in the early stages of migraine.
For those who get moderate to severe headaches, and for all cluster patients – those that get a severe, but shorter-type of migraine that comes in groups or clusters – there are stronger drugs such as Ergotamine Tartrate. This is a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken at the start of the headache.
For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel contriction; propranolol hydrochloride, which stops blood vessel dilation; and amitryptline, an antidepressant.
Several drugs for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. Prompt administration of these drugs is important.
There are other vascular headaches besides Migraine. Some can be caused by infection, exposure to chemicals, solvents and certain drugs.
Muscle Contraction Headaches are also known as “tension” headaches. They are often triggered by stress. They are named contraction headaches as the headache is caused by the contraction of neck, face, and scalp muscles as a result of stressful events. It is believed ninety percent of all headaches are classified as tension/muscle-contraction headaches.
Non-drug therapy for these headaches includes biofeedback, relaxation training, and sometimes counseling. A technique called cognitive restructuring teaches people to change their attitudes and responses to stress. In progressive relaxation therapy, patients are taught to first tense and then relax individual muscle groups. Sometimes, those suffering from infrequent headaches may benefit from something as simple as a hot shower or moist heat applied to the back of the neck.
People with chronic muscle contraction headaches may also be helped by taking antidepressants or MAO inhibitors. Mixed muscle contraction and migraine headaches are sometimes treated with barbiturate compounds, which slow down nerve function in the brain and spinal cord.
The two other types of headache: Traction and Inflammatory can be caused by very serious disorders. Traction headaches occur if the pain-sensitive parts of the head are pulled, stretched or displaced, such as with a brain tumor. Inflammatory headaches could be caused by meningitis, or diseases of the sinuses, spine, neck, ears or teeth. These headaches are treated by curing the underlying problem.
Children can also experience headaches as a result of infections, stress or trauma. These headaches can also include migraine. Parents should alert the family pediatrician if a child develops headaches along with other symptoms such as change in mood and sleep patterns.
Finally, today’s headache research offers hope for many chronic headache sufferers. The work of NINDS- supported scientists around the world promise to improve our understanding of this complex disorder and provide better ways to treat it.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996
Understanding why headaches occur and improving therapies are among research goals of the National Institute of Neurological Disorders and Stroke (NINDS). As the leading supporter of brain research in the Federal Government, the NINDS also supports and conducts studies to improve the diagnosis of headaches and find ways to prevent them.
When Should You See a Physician?
Not all headaches require medical attention. However, some types of headache are signals of more serious disorders and call for prompt medical attention, for example: a sudden severe headache; headache associated with convulsions; headache accompanied by confusion or loss of consciousness; headache following a head injury; headache associated with eye or ear pain; persistent headache in someone who was previously headache free; recurring headache in children; headache associated with fever; and headache that interferes with normal life.
Diagnosing a Headache
Experts agree that a detailed question and answer session with a patient can often produce enough information for a diagnosis. Most physicians will also obtain a full medical history from the patient, inquiring about past head trauma, surgery and medication use. A blood test may be ordered to screen for thyroid disease, anemia, or infections which might cause headache. X-rays or CT Scans or MRIs may be ordered to rule out the possibility of a brain tumor or blood clot. Sometimes eye exams are recommended, and an experimental technique called Thermography – using an infrared camera to measure blood flow through the skin – can show strikingly different heat patterns from headache sufferers vs. those that rarely get headaches.
A physician will analyze the results of all of these tests and arrive at the following headache diagnoses: (1) Vascular, (2) Muscle contraction (tension), (3) Traction, or (4) Inflammatory headache.
Vascular headaches include the well-known Migraine type. It is thought to involve abnormal function of the brain’s blood vessels or vascular system. Migraine headache involves severe pain on one or both sides of the head, an upset stomach, and, at times disturbed vision. Sometimes migraine headaches begin with an “aura.” The individual sees zigzag lines or flashing lights before the headache actually begins.
While researchers are unclear about the precise cause of migraine headaches, there seems to be agreement that a key element is blood flow changes in the brain. People who get migraines appear to have blood vessels that overreact to various triggers.
There are two ways to approach the treatment of migraine with drugs: prevent the attack, or relieve symptoms after the headache occurs. For infrequent migraines, drugs can be taken at the first sign of a headache in order to stop it or at least relieve the pain. For occasional or mild migraine, sometimes aspirin or acetaminophen taken at the start of the headache can help. Small amounts of caffeine may be useful also if taken in the early stages of migraine.
For those who get moderate to severe headaches, and for all cluster patients – those that get a severe, but shorter-type of migraine that comes in groups or clusters – there are stronger drugs such as Ergotamine Tartrate. This is a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken at the start of the headache.
For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel contriction; propranolol hydrochloride, which stops blood vessel dilation; and amitryptline, an antidepressant.
Several drugs for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. Prompt administration of these drugs is important.
There are other vascular headaches besides Migraine. Some can be caused by infection, exposure to chemicals, solvents and certain drugs.
Muscle Contraction Headaches are also known as “tension” headaches. They are often triggered by stress. They are named contraction headaches as the headache is caused by the contraction of neck, face, and scalp muscles as a result of stressful events. It is believed ninety percent of all headaches are classified as tension/muscle-contraction headaches.
Non-drug therapy for these headaches includes biofeedback, relaxation training, and sometimes counseling. A technique called cognitive restructuring teaches people to change their attitudes and responses to stress. In progressive relaxation therapy, patients are taught to first tense and then relax individual muscle groups. Sometimes, those suffering from infrequent headaches may benefit from something as simple as a hot shower or moist heat applied to the back of the neck.
People with chronic muscle contraction headaches may also be helped by taking antidepressants or MAO inhibitors. Mixed muscle contraction and migraine headaches are sometimes treated with barbiturate compounds, which slow down nerve function in the brain and spinal cord.
The two other types of headache: Traction and Inflammatory can be caused by very serious disorders. Traction headaches occur if the pain-sensitive parts of the head are pulled, stretched or displaced, such as with a brain tumor. Inflammatory headaches could be caused by meningitis, or diseases of the sinuses, spine, neck, ears or teeth. These headaches are treated by curing the underlying problem.
Children can also experience headaches as a result of infections, stress or trauma. These headaches can also include migraine. Parents should alert the family pediatrician if a child develops headaches along with other symptoms such as change in mood and sleep patterns.
Finally, today’s headache research offers hope for many chronic headache sufferers. The work of NINDS- supported scientists around the world promise to improve our understanding of this complex disorder and provide better ways to treat it.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996
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