What are the 10 silent symptoms of diabetes? How do they manifest, and when should you see a doctor? Get the answers to these questions and more in this informative guide.

The Unspoken Signs of Diabetes

Diabetes is a prevalent condition, affecting over 30 million Americans, with an additional 1.5 million new diagnoses each year. While some symptoms of diabetes are well-known, there are several subtle signs that often go unnoticed. In this comprehensive guide, we’ll explore the 10 silent symptoms of diabetes and what they mean for your health.

Frequent Urination

One of the most common signs of diabetes is frequent urination. The average person urinates 4 to 7 times per day, but if you find yourself making more trips to the bathroom, especially waking up multiple times at night, it could be a sign that your kidneys are working overtime to flush out excess sugar in your blood. However, it’s important to note that increased water intake and caffeine consumption can also lead to frequent urination, so try limiting your fluid intake in the evening and reducing caffeine to see if the issue persists.

Excessive Thirst

Feeling constantly thirsty, even after drinking water, can be a red flag for diabetes. If you find yourself drinking more than 4 liters (about a gallon) of water per day and your thirst is not being quenched, it could be a sign that your body is struggling to regulate your blood sugar levels.

Extreme Hunger

When your blood sugar isn’t properly regulated, it can send mixed signals to your brain about the need for food. If you find yourself eating more frequently throughout the day or experiencing extreme hunger even after a meal, it could be a sign that your body is struggling to properly utilize the glucose in your blood.

Weakness and Fatigue

If your body is unable to properly convert glucose into energy, you may find yourself feeling weak and fatigued, even after a good night’s sleep or a meal. This is because your kidneys have to work overtime to remove the excess sugar from your blood, leaving you feeling drained and exhausted.

Pins and Needles

High blood sugar levels can damage the nerves, particularly those located in the extremities, such as your feet. If you’re experiencing a tingling or burning sensation in your feet, it could be a sign of nerve damage caused by uncontrolled diabetes.

Blurry Vision

Excess sugar in the blood can cause swelling in the lens of your eye, making it difficult to focus. This blurry vision may come and go depending on your blood sugar levels, but it’s an important sign that your body is struggling to regulate its glucose intake.

Itchy Skin

Poor circulation and the loss of fluids from frequent urination can lead to dry, itchy skin. If you notice that your skin is becoming increasingly dry and irritated, even after increasing your water intake, it could be a sign of uncontrolled diabetes.

Slow Healing Wounds and Skin Infections

Lingering high blood sugar levels can disrupt the circulation in your veins and arteries, making it harder for your body to heal cuts, bruises, and other skin injuries. Additionally, the excess sugar in your blood can create a breeding ground for bacteria and yeast, leading to more frequent skin infections.

Volatile Moods

Riding the roller coaster of unstable blood sugar levels can take a toll on your emotional well-being, leading to mood swings, irritability, and even symptoms of depression. If your family and friends have noticed a significant change in your demeanor, it could be a sign that your diabetes is not properly managed.

Urinary Tract Infections and Yeast Infections

High sugar levels in the urine can create a hospitable environment for bacteria and yeast, leading to an increased risk of urinary tract infections (UTIs) and yeast infections. If you find yourself regularly dealing with these types of infections, it could be a sign that your diabetes is not under control.

Modifying Your Diet: A Preventative Measure

If you’re experiencing some of these subtle symptoms, Bergamo recommends trying a low-carb diet of protein and green leafy vegetables, while avoiding sugary drinks and increasing your water intake to at least 2 liters per day. This can help you determine if your symptoms are simply the result of an imbalanced diet, or if they are indicative of a more serious underlying condition, such as diabetes.

Remember, if you’re experiencing any symptoms that are particularly concerning, such as sudden numbness, weakness, or chest pains, it’s important to contact your doctor immediately. Early detection and proper management of diabetes can make all the difference in your long-term health and well-being.

10 Silent Symptoms of Diabetes

More than 30 million Americans have diabetes, including 7.2 million that are undiagnosed. Additionally, 1.5 million Americans are newly diagnosed each year. Type 2 diabetes accounts for 90 to 95 percent of all diabetes cases. Diabetes has plenty of early signs, but some symptoms are subtle. Here are 10 subtle signs of diabetes:

1. Frequent urination

Most people urinate four to seven times in a day. If you are making more trips to the bathroom, especially waking multiple times at night to go, it may be a sign that your kidneys are working overtime to flush out excess sugar in your blood.

Keep in mind that drinking a lot of water, especially in the evening, may be why you’re urinating so often.

“If you are urinating more that one to two times overnight, try not drinking after 7 p.m. and not having caffeinated beverages after 5 p.m. If you’re still getting up multiple times to go the bathroom at night, that may be a sign that something else is going on,” says Katherine Bergamo RN, MSN, FNP-C, a nurse practitioner with the UNC Diabetes and Endocrinology Clinic.

Red Flag: Frequent trips to the bathroom even when you limit water intake and caffeine in the evening.

2. Excessive thirst

If you’re drinking more than 4 liters (about a gallon) per day and water isn’t quenching your thirst, this could be due to high blood sugar.

Red Flag: You feel thirsty after drinking water.

3. Extreme hunger

When blood sugar isn’t properly regulated it sends conflicting messages to your brain about the need for food.

Red Flag: You find yourself eating more times a day than usual or experience extreme hunger even after a meal.

4. Weakness/fatigue

When sugar cannot get into your cells to energize them, your kidneys have to work overtime to remove the extra sugar. This can leave feeling weak and fatigued.

“If you are feeling like you can’t keep your eyes open after a meal, it might be a sign that your body is struggling with high blood sugar. ”

Red Flag: You find yourself too weak to do everyday activities you were able to do with ease before or you feel exhausted after eating a meal.

5. Pins and needles

Extra sugar in the blood can damage nerve-endings, especially those nerves located farthest from the spinal cord such as your feet.

Red Flag: If you feel a tingling or numbness that feels like burning in your feet when you wake up.

6. Blurry vision

Sugar lingering in the blood can cause swelling in the lens in the eye making it difficult to focus your eyes. When your sugar is really high, your vision blurs, but when your sugar drops down again, it clears.

Red Flag: If road signs, menus, books or computer screens come in and out of focus at different times during the day.

7. Itchy skin

Poor circulation paired with the loss of fluids (from the frequent urination) can cause the skin to dry out. Dry skin leads to itchy skin.

Red Flag: If you still notice yourself itching more than usual and have noticeably dry skin even after increasing your water intake.

8. Slow healing wounds and increased skin infections

Lingering sugar in the blood wreaks havoc on veins and arteries disrupting circulation. Without proper blood flow, it takes longer for cuts and bruises to heal, and you are more prone to skin infections.

Red Flag: Paper cuts, bumps and bruises take more than a few days to go away, cuts scab over repeatedly or wounds that last weeks to months.

9. Volatile moods

Riding the roller coaster of unstable blood sugar may cause a short temper. High blood sugar also mimics symptoms of depression such as low energy drive and wanting to stay in bed.

Red Flag: You are noticeably grumpy or irritable, family or friends comment on your unusual demeanor, or you have depression-mimicking symptoms.

10. Urinary tract infections and yeast infections

High sugar levels within the urine are a breeding ground for bacteria and yeast near the genitalia. Urinary tract infections (UTI) come with a burning sensation during urination and cloudy, dark or off-smelling urine. Yeast infections come with itching, burning and discharge. People with diabetes are twice as likely to suffer from these types of infections.

Red Flag: Regularly occurring UTIs or yeast infections.

Modify Your Diet Before Calling Your Doctor

Bergamo says if you’re having some of these subtle symptoms try a low-carb diet of protein and green leafy vegetables. Avoid sugary drinks and drink at least 2 liters of water for a few days to see if these symptoms get better.

“Subtle symptoms could be just that you’re eating too many carbs and your body can’t handle it,” Bergamo says. “It doesn’t necessarily mean you have diabetes, but it’s a wake-up call that maybe you’re headed that way. ”

If you have any symptoms that are frightening such as sudden numbness, weakness or chest pains, call your doctor immediately.

Are you concerned about diabetes? Talk to your doctor about having your blood glucose levels tested. Need a doctor? Find one near you.

Thunderclap headache triggered by micturition: responsive to nimodipine

J Headache Pain. 2011 Dec; 12(6): 649–651.

,¹,¹,¹,¹,² and ¹

Yuan-Yuan Han

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

Wei Gui

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

Jin Zhu

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

Yi-Min Liu

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

Kai Wang

²Neuropsychology Group, Anhui Medical University Institute of Neurology, Jixi Road 218, Hefei, 230022 China

Yu Wang

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

¹Department of Neurology, The First Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022 China

²Neuropsychology Group, Anhui Medical University Institute of Neurology, Jixi Road 218, Hefei, 230022 China

Corresponding author.

Received 2011 May 26; Accepted 2011 Jul 9.

This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Primary thunderclap headache (TCH) is a rare condition, of which the onset can be triggered by coughing, exercise, and sexual activity. Micturition is a recognized trigger of secondary TCH with pheochromocytoma in bladder, but not of primary TCH. We describe a patient with an apparent primary TCH, which repeatedly occurred immediately after micturition until she achieved a therapeutic dosage of nimodipine.

Keywords: Thunderclap headache, Micturition, Nimodipine, Vasospasm

Introduction

Thunderclap headache (TCH) is a hyper-acute, severe headache that reaches maximum intensity at onset. This type of headache is frequently described by patient as being ‘the worst headache of his or her life’. The term TCH was first used in the description of the headache caused by unruptured intracerebral aneurysms [1]. Because of its hyper-acute and severe characteristics, it is described as thunderclap [2]. TCH could be the conditions secondary to subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral venous sinus thrombosis, cervical artery dissection, spontaneous intracranial hypotension, acute hypertensive crisis, or a third ventricle colloid cyst [3]. But primary TCH has been described as a distinct entity when the known causes have been excluded. A primary TCH may be triggered by coughing, exercise and sexual activity and thus be classified as primary cough headache, primary exertional headache and primary headache associated with sexual activity [4]. There are also micturition-triggered TCHs though these conditions are very rare, but all the reported cases were found attributed to bladder pheochromocytoma and the headache symptom was associated with elevation of blood pressure following micturition [5, 6]. Here, we report, for the first time, a case of recurrent TCH triggered exclusively by micturition with neither pheochromocytoma in bladder nor elevation of blood pressure following micturition.

Case report

A 52 year-old woman presented with episodes of sudden-bursting headache immediately after micturition for the last 4 days before admission to our department. She described the onset of headache as sudden, severe, and as if she had been ‘hit in the head by a car’. She characterized it as a distending headache which first occurred on the bilateral temporal region and progressively spread to all the head within 30 s. The headache reached its peak almost at onset and was rated by her as 9/10 in severity. The headache was accompanied by nausea and vomiting, but not by sense of vertigo or limb incoordination. It lasted for 1–2 h and disappeared gradually. There was no personal history of headache or other neurological disorders. She had been treated for migraine at a community hospital, but oral pain relievers failed to ease the pain.

On examination, she was alert, oriented and anxious, with a blood pressure (BP) of 108/64 mmHg, a regular heartbeat of 68 beats/minute, and a temperature of 36.8°C. Her neurological and general examination did not reveal any pathologic findings. For several times during headache attacks immediately after micturition, her BP was monitored to be in normal range.

Findings from laboratory surveys, including antinuclear antibody, C-reactive protein level, erythrocyte sedimentation rate, anticardiolipin antibody, anti-neutrophil cytoplasmic antibodies, urine tests, thyroid functions, lupus anticoagulant, serum catecholamine, were either negative or within normal limits.

Cerebrospinal fluid (CSF) examination, performed 2 h after one headache attack, had a normal opening pressure, revealed clear fluid with a leukocyte count of 3/mm³, a protein level of 0.39 g/l (normal range, 0.15–0.45 g/L), and a glucose level of 3.2 mmol/L (normal range, 2.5–4.4 mmol/L). CSF viral antibody test revealed negative for all the familiar virus including hepatitis B and C, cytomegalovirus, herpes simplex virus, Epstein-Barr virus.

Brain computerized tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) showed no signs of intracerebral hemorrhage, subarachnoid hemorrhage, infarction, thrombosis, dissection or aneurysm of the extracranial or intracranial arteries. The contrast-enhanced CT scan of the abdomen revealed no abnormalities. Electroencephalogram (EEG) was normal. Testing for anxiety and depressive disorders was conducted in the headache-free time among the attacking days, revealing a score of 16 on the Hamilton anxiety scale (HAM-A) (mild anxiety ≥14) and 9 on the Hamilton depression scale (HAM-D) (mild depression >7) [7, 8].

Antianxiety treatment with flupentixol and melitracen tablets (one tablet contains 0.5 mg flupentixol and 10 mg melitracen) at a dosage of one tablet in the morning and one tablet at noon, together with antalgesic, pregabalin, at a dosage of 150 mg daily, did not prevent the recurrence of micturitional headaches. During this time, she would micturate two to three times a day and each micturition was followed by a TCH. One week later, antianxietic and antalgesic were substituted with oral nimodipine 60 mg every 6 h and the intensity of the micturitional headaches gradually became weaker on the first day of nimodipine taking and no further micturitional headache attacks were noted on the second day. The patient was then discharged home in stable condition. Nimodipine treatment was tapered off gradually in the following 6 weeks, and no headache recurred. Six-month follow-up revealed that the patient’s condition was very well except occasional slight headaches when she met cold-wind.

Discussion

TCH is a severe, hyper-acute headache of the sudden-bursting type like a ‘clap of thunder’, of which the pain intensity reaches a peak at onset usually within 60 s. TCH is considered to have two types: primary TCH and secondary TCH. Secondary TCH could be attributed to vascular causes including subarachnoid hemorrhage (SAH), cerebral venous sinus thrombosis (CVST), pituitary apoplexy, ischemic stroke, severe hypertension crisis, and nonvascular causes including spontaneous intracranial hypotension, third ventricle colloid cyst, intracranial infections [3]. Our MRI, MRA, and CSF examinations had excluded these possible underlying causes in this patient. In very rare situations, micturition can also trigger sudden-bursting severe headache in patients, but all these reported cases were accompanied with pheochromocytoma in bladder [6, 9, 10] and the headaches were usually associated with elevations of blood pressure following micturition [5]. The contrast-enhanced abdomen CT scan and the unelevated blood pressure during headache attack had also excluded the underlying causes of bladder pheochromocytoma. The headache in our patient seems in consistent with the presentations of primary TCH. Apart from the triggering factor micturition, the headache of our patient met the diagnostic criteria for primary TCH: (i) Severe head pain, (ii) sudden onset, reaching maximum intensity in <1 min, lasting from 1 h to 10 days, (iii) Does not recur regularly over subsequent weeks or months, and (iv) Not attributed to another disorder. Though evidence that thunderclap headache exists as a primary condition is poor, primary TCH has been described as a distinct entity [4]. A primary TCH may occur spontaneously while the patient is at rest or during light activities or may only be triggered by exertion, sexual activity, coughing and thus be classified as primary cough headache, primary exertional headache and primary headache associated with sexual activity respectively. The TCH in our patient was exclusively triggered by micturition and there was no serious underlying pathology identified to explain this TCH, thus it might be plausible to consider the micturitional headache as ‘primary’. This micturitional headache is an unusual headache not defined by the ICHD-II, therefore the reporting of this case might be helpful for the more detailed headache classification in the future.

Our patient’s response to nimodipine was dramatic and impressive during the time when headaches were still worsening. The close chronological concordance between headache relief and initiation of oral nimodipine was in favor of the direct therapeutic effect of nimodipine. Indeed, nimodipine is currently recommended in aneurysmal subarachnoid hemorrhage in order to prevent vasospasm based on its role in the relaxation of the smooth muscle of arterial blood vessel walls [11]. Thus, the recurrent micturitional TCH in our patient might be associated with cerebral vasospasm though the vasospasm was not visible by MRA. Efficacy of nimodipine was reported in primary TCH [12] as well as in primary bathing TCH [13] with vasospasm detected or non-detected. It has been suggested that primary recurrent TCH can be divided in two groups: one with diffuse vasospasm and the others without any visible vasospasm by MRA, and primary TCH, to some extent, share the same spectrum with reversible cerebral vasoconstriction syndrome (RCVS) based on their similar clinical features and the same rate of ischemic complications [14, 15]. The therapeutic efficacy of nimodipine in vasospasm associated primary TCH and RCVS as well as in our micturitional headache may suggest a similar pathogenic mechanism of vasospasm for both conditions. Unfortunately, a late control MRA or transcranial Doppler was not conducted to show any presence of late vasospasm eventually in this patient. Recently, it has been shown that, in some patients, the maximal vasospasm detected by transcranial Doppler or by MRA is respectively at 18–25 days and at 16 ± 10 days after TCH onset [16, 17]. The pathophysiological relationship between micturition and cerebral vascular change is poorly understood and speculative. There is anecdotal evidence suggesting that abdominal support, voluntary diaphragm and abdominal muscle co-activation, is necessary for effective voiding, this results in an alteration of intra-abdominal pressure. This was suggested to have causative relationship to TCH triggered by singing [18]. This intra-abdominal pressure alteration may trigger an unclear neural reflex resulting in a cerebral vascular change.

Involvement of non-organic, psychiatric factors should also be considered to contribute to the recurrent headaches, as a mild depressive (HAM-D = 16) and a mild anxiety disorder (HAM-A = 9) were revealed and a distinct phobia for micturition also found in our patient. Whereas, the negative result of the antipsychotic treatment seemly indicated that the psychiatric factors may not play a critical role in the headache recurrence. Further case reports may help to elucidate the possible role of psychiatric factors in the micturitional headache.

In summary, we treated a patient with recurrent TCH apparently triggered by micturition without any underlying organic causes, which was responsive to nimodipine dramatically. We hypothesize that the pathophysiology of this primary micturitional headache is associated with cerebral vasospasm induced by neural reflex after the intra-abdominal pressure is altered.

Ethical standards: The human studies have been approved by the Anhui Medical University ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Informed consent was obtained from the patient in this report prior to the related test and report.

Conflict of interest

None.

Open Access

This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.

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Nocturia or Frequent Urination at Night

Millions of Americans are affected by a frequent need to urinate during the night. This is known as nocturia, and it is often cited as a cause of sleep disruptions. Though frequently thought of as a problem in elderly people, it can impact people of all ages.

Trips to the bathroom can cause fragmented sleep, excessive daytime sleepiness, and an elevated risk of dangerous falls. Nocturia has numerous potential causes and can be connected to a range of serious health issues.

Although nocturia is common, it shouldn’t be accepted as inevitable. In many cases, steps can be taken to reduce bathroom trips and improve sleep. Understanding the basics about frequent nighttime urination, including its causes, consequences, and treatments, can be a first step for people of any age to sleep better and with less bothersome nocturia.

What Is Nocturia?

Nocturia describes needing to wake up at night in order to urinate. It is a symptom of other conditions, not a disease itself.

According to technical definitions, a person has nocturia if they get out of bed to urinate one or more times per night. By this standard, nocturia is widespread; however, many people may not find one awakening to be problematic. Nocturia tends to be more bothersome when a person awakens two or more times and/or if they have difficulty getting back to sleep.

Nocturia is not the same thing as bedwetting, which is also known as nocturnal enuresis. Unlike nocturia, which involves waking up and recognizing the need to urinate, bedwetting typically occurs involuntarily and without the sensation of having a full bladder.

How Common is Nocturia?

Nocturia is quite common among both men and women. Studies and surveys have found that 69% of men and 76% of women over age 40 report getting up to go to the bathroom at least once per night. About one-third of adults over age 30 make two or more nightly bathroom trips.

Nocturia can affect younger people, but it becomes more common with age, especially in older men. It is estimated that nearly 50% of men in their seventies have to wake up at least twice per night to urinate. Overall, nocturia may affect up to 80% of elderly people.

Rates of nocturia have been found to be higher in people who are black and Hispanic than in white people even when controlling for gender and age. The reason for this disparity is not well understood.

Nocturia frequently occurs during pregnancy but usually goes away within three months after giving birth.

What Are the Impacts of Nocturia?

Nocturia can have significant health consequences. It may be connected to serious underlying problems, and nighttime bathroom trips can both disrupt sleep and create additional health concerns.

Does Frequent Urination Disrupt Sleep?

Multiple research studies, including a Sleep in America Poll by the National Sleep Foundation, have consistently found that nocturia is one of the most commonly reported causes of sleep disruptions. Especially in older adults, it is frequently listed as a cause of poor sleep and insomnia.

Many people, perhaps over 40%, have trouble quickly getting back to bed, which can mean reduced sleep time and more fragmented, lower-quality sleep. Not surprisingly, nocturia is commonly associated with excessive daytime sleepiness which can translate to impaired physical and mention function, irritability, and a higher risk of accidents.

What Are Other Health Risks Related to Nocturia?

The consequences of frequent urination at night go beyond just poor sleep. For older adults, nocturia creates a higher risk of falls, especially if they are rushing to get to the bathroom. Studies indicate that fall and fracture risks increase by 50% or more for people with two or more nighttime bathroom trips.

Nocturia has been associated with reduced scores on quality of life measurements as well as negative health conditions including depression. Beyond specific negative impacts, nocturia has also been connected to higher overall mortality although further research is necessary to fully understand this correlation.

What Causes Nocturia?

Three main issues provoke nocturia: producing excess urine at night, decreased bladder capacity, and sleep disruptions. Each of these issues can be caused by a variety of underlying health conditions.

Producing Excess Urine at Night

Producing excess urine at night is known as nocturnal polyuria, and it is estimated to be a contributing cause for up to 88% of cases of nocturia.

For some people, excess urine production occurs throughout the day and night. This condition, called global polyuria, is most often tied to excess fluid intake, diabetes, and/or poor kidney function. Diuretics, including medications (“water pills”) and substances like alcohol and caffeine, can cause enhanced urine production as well.

Elevated amounts of urine production that occurs only at night can occur when fluid intake goes up at night. It can also occur when peripheral edema — swelling or fluid accumulation in the legs — relocates after a person moves into a lying position. Coexisting medical problems can contribute to peripheral edema and thus raise the risk of nocturnal polyuria.

Some research indicates that changes to the body’s circadian rhythm cause older adults to have a greater proportion of their daily urine production occur at night, which may be a contributing factor to their higher rates of nocturia.

Decreased Bladder Capacity and Increased Urinary Frequency

Even without increased nighttime urine production, reduced bladder capacity and increased urinary frequency can give rise to nocturia.

Urinary tract infections (UTIs) are one of the most common causes of changes to bladder capacity. They can also occur among people who have enlarged prostate, benign prostatic hyperplasia (BPH), or overactive bladder.

A heightened urge to urinate, inflammation of the urinary tract, and bladder stones can all be risk factors for diminished bladder capacity and increased urinary frequency that can lead to nocturia.

Some people experience increased urinary frequency and urgency throughout the day while others find them to occur primarily at night.

Sleep Disruptions

Though we tend to focus on nighttime urination as disrupting sleep, there is compelling evidence that sleeping problems are also a major factor in provoking cases of nocturia.

One of the clearest examples is obstructive sleep apnea (OSA), which causes repeated pauses in breathing during the night. Nocturia occurs in around 50% of people with OSA. OSA repeatedly reduces airflow and oxygen levels during sleep and influences hormones in a way that increases urine production. On top of that, people with OSA have frequent sleep interruptions, so they are more inclined to notice the need to urinate.

Beyond OSA, there is debate among experts about whether nocturia causes sleep disturbances or the other way around. It is more likely that sleeping problems, including insomnia, are the root cause if a person struggles to get back to sleep after going to the bathroom.

Research in older adults indicates that lighter sleep may increase susceptibility to nocturia. Older people spend less time in deep sleep stages, which means they are more easily awoken. Once awake, they may take note of an urge to urinate, leading to nocturia.

As previously described, older adults have been found to produce more of their daily urine at night, which can combine with lighter sleep to increase the prevalence of nocturia in the elderly. This also demonstrates how multiple factors, including sleep difficulties, can work simultaneously to cause frequent nighttime urination.

Reducing Nocturia and Getting Better Sleep

Because it can have significant health consequences and connections to other illnesses, it is important to talk to your doctor about bothersome nocturia. A doctor can help identify the most likely cause and appropriate therapy for any specific individual.

When an underlying condition is causing nocturia, treating that condition may reduce the nighttime trips to the bathroom. Many patients with nocturia are treated with medications or have adjustments to their existing medications (such as diuretics).

A number of lifestyle changes can help reduce problematic nocturia. These changes are designed to reduce nocturnal urine production and include:

• Reducing evening fluid intake, especially before bed.
• Decreasing consumption of alcohol and caffeine, especially in the afternoon and evening.
• Elevating the legs an hour or more before bed in order to reduce the resorption and conversion of peripheral edema to urine during sleep.

Focusing on sleep hygiene, which includes your bedroom environment and sleep habits, can reduce awakenings during which you notice a need to go to the bathroom. Examples of healthy sleep tips include:

• Keeping a consistent sleep schedule, including waking up at the same time on weekdays and weekends.
• Having a steady routine that gets you ready for bed each night.
• Learning relaxation techniques that can put your mind at ease when you go to bed and when you want to fall back asleep after going to the bathroom.
• Getting daily exercise that can help you have deeper sleep.
• Setting up your bed with a comfortable mattress, pillows, and bedding.
• Customizing your bedroom to have a minimal light and noise, a cool temperature, and a pleasant smell.
• Limiting the use of electronic devices, including cell phones, which can activate the brain and reduce the production of the sleep-promoting hormone melatonin.

Working with a doctor and making lifestyle changes can reduce the number of bathroom trips you take each night, but they often may not eliminate them completely. For that reason, it’s important to take steps to make those trips as safe as possible, especially for older people.

Motion-activated, low-wattage lighting can make it easier to walk safely to and from the bathroom. The path should be cleared of common trip hazards like cords or rugs. People with mobility issues or who have high urgency to urinate upon awakening may find that a bedside urinal or commode improves safety and reduces sleep disruption.

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Urinary tract infections in adults

Urinary tract infections (UTIs) are very common. Most UTIs are caused by bacteria and they can be painful and uncomfortable. But they usually pass within a few days or can be easily treated with a course of antibiotics. UTIs are more common in women than men.

Symptoms of urinary tract infections 

The symptoms of an infection in your upper urinary tract (kidney and ureters) are different from symptoms of infection in your lower urinary tract (bladder and urethra).

However, in some cases you may notice the symptoms of both, as one can spread to the other.

Symptoms of a UTI are similar to those of many other conditions and don’t necessarily mean you have an infection.

Lower urinary tract infection

Symptoms of a lower UTI can include:

• feeling a strong urge to urinate (pee) and more often than usual, a constant, dull pain in the pubic region and pain when urinating (dysuria)
• cloudy urine (pee) or blood in your urine (haematuria)
• urine that smells unusually unpleasant
• back pain
• a general sense of feeling unwell

Upper urinary tract infection

Symptoms of an upper UTI can include:

• pain and discomfort in your side, lower back or around your genitals
• a high temperature (it may reach 39.5C or 103.1F)
• shivering or chills
• feeling very weak or tired
• loss of appetite
• feeling sick or being sick
• diarrhoea

Treating urinary tract infections 

Your recommended treatment plan by your GP will depend on whether your infection is in the upper or lower urinary tract.

Both types of urinary tract infection can usually be treated at home using a course of antibiotics.

If an upper UTI is more serious or there is increased risk of complications, you may need hospital treatment.

When to seek medical advice

You may find your UTI symptoms are mild and pass within a few days. However, you should see your GP if you find your symptoms very uncomfortable or if they last for more than five days.

Also see your GP if you have a UTI and:

• you develop a high temperature (it may reach 39.5C or 103.1F)
• your symptoms suddenly get worse
• you are pregnant
• you have diabetes

About the urinary tract

The urinary tract is where our bodies make and get rid of urine. It’s made up of:

• the kidneys – two bean-shaped organs, about the size of your fists, that make urine out of waste materials from the blood
• the ureters – tubes that run from the kidney to the bladder
• the bladder – where urine is stored until we go to the toilet
• the urethra – the tube from the bladder through which urine leaves the body

Causes of urinary tract infections

Most urinary tract infections (UTIs) are caused by bacteria that live in the digestive system.

If these bacteria get into the urethra (the tube where urine comes out), they can cause infection. It’s thought the bacteria can spread from the skin around the anus to the urethra.

Women are more likely to develop a UTI than men. This is because a woman’s urethra is located closer to the anus than a man’s, which makes it easier for bacteria from the anus to reach the urethra.

Preventing urinary tract infection 

You can reduce your chances of developing a UTI by keeping your bladder and urethra (the tube that allows urine to pass out of your body) free from bacteria.

You can help prevent an infection by:

• drinking plenty of fluids
• keeping your genitals clean
• treating any constipation

Toilet tips

To help keep your urinary tract free from bacteria:

• go to the toilet as soon as you feel the need to urinate (to pee), rather than holding it in
• wipe from front to back after going to the toilet
• practice good hygiene by washing your genitals every day and before having sex
• empty your bladder after having sex
• if you’re a woman, avoid ‘hovering’ over a toilet seat as it can result in your bladder not being fully emptied

Diaphragms and condoms

If you use a diaphragm and have recurring UTIs, you might want to consider changing to another method of contraception. This is because the diaphragm may press on your bladder and prevent it emptying completely when you urinate.

If you get recurring UTIs and you use condoms, try using condoms that don’t have a spermicidal lubricant on them – it will say whether it does on the packet.

Spermicidal lubricant can cause irritation and may make it more likely that you’ll experience symptoms similar to a UTI.

More useful links

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

Headache

Is this your child’s symptom?

• Pain or discomfort of the head
• This includes the forehead to the back of the head
• Not caused by a head injury

Causes of Acute Headaches

• Viral Illnesses. Most acute headaches are part of a viral illness. Flu is a common example. These headaches may relate to the level of fever. Most often, they last a few days.
• Hunger Headaches. About 30% of people get a headache when they are hungry. It goes away within 30 minutes of eating something.
• MSG Headache. MSG is a flavor enhancer sometimes added to soups or other foods. In larger amounts, it can cause the sudden onset of a throbbing headache. Flushing of the face also occurs.
• Common Harmless Causes. Hard exercise, bright sunlight, blowing a wind instrument or gum chewing have been reported. So has severe coughing. “Ice cream headaches” are triggered by any icy food or drink. The worse pain is between the eyes (bridge of nose).
• Head Injury. Most just cause a scalp injury. This leads to a painful spot on the scalp for a few days. Severe, deeper or entire-head pain needs to be seen.
• Frontal Sinus Infection. Can cause a headache on the forehead just above the eyebrow. Other symptoms are nasal congestion and postnasal drip. Rare before 10 years old. Reason: the frontal sinus is not yet formed. Other sinus infections cause face pain, not headaches.
• Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache, confusion and fever. Younger children are lethargic or so irritable that they can’t be consoled. If not treated early, child can suffer brain damage.

Causes of Recurrent Headaches

• Muscle Tension Headaches. Most common type of frequent headaches. Muscle tension headaches give a feeling of tightness around the head. The neck muscles also become sore and tight. Tension headaches can be caused by staying in one position for a long time. This can happen when reading or using a computer. Other children get tension headaches as a reaction to stress or worry. Examples of this are pressure for better grades or family arguments.
• Migraine Headaches. Severe, very painful headaches that keep your child from doing normal activities. They are throbbing and often occur just on one side. Symptoms have a sudden onset and offset. Vomiting or nausea is present in 80%. Lights and sound make them worse. Most children want to lie down in a dark, quiet room. Migraines most often run in the family (genetic).
• School Avoidance. Headaches that mainly occur in the morning on school days. They keep the child from going to school. The headaches are real and due to a low pain threshold.
• Rebound Headaches. Caused by overuse of pain medicines in high doses. Most often happens with OTC meds. Caffeine is present in some pain meds and may play a role. Treatment is taking pain meds at the correct dosage.
• Not Due to Needing Glasses (Vision Headaches). Poor vision and straining to see the blackboard causes eye pain. Sometimes, it also causes a muscle tension headache. But, getting glasses rarely solves a headache problem that doesn’t also have eye pain.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Headache

Call 911 Now

• Hard to wake up or passed out
• Acts or talks confused
• Weakness of arm or leg on one side of the body
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Vomiting
• Blurred vision or seeing double
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Fever
• Sinus pain (not just congestion) of forehead
• Swelling around the eye with pain
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Headache without other symptoms lasts more than 24 hours
• Migraine headache suspected, but never diagnosed
• Sore throat lasts more than 48 hours
• Any headache lasts more than 3 days
• Headaches are a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild headache
• Migraine headache, just like past ones

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Treatment for Mild Headache

1. What You Should Know About Mild Headaches:
   • Headaches are very common with some viral illnesses. Most often, these will go away in 2 or 3 days.
   • Unexplained headaches can occur in children, just as they do in adults. They usually pass in a few hours or last up to a day.
   • Most recurrent headaches that can occur in anyone are muscle tension headaches.
   • Most headaches (including muscle tension headaches) are helped by the following measures.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
   • Headaches due to fever are also helped by bringing the fever down.
3. Food May Help:
   • Give fruit juice or food if your child is hungry.
   • If your child hasn’t eaten in more than 4 hours, offer some food.
   • Reason: Skipping a meal can cause a headache in many children.
4. Rest – Lie Down:
   • Lie down in a quiet place and relax until feeling better.
5. Cold Pack for Pain:
   • Put a cold pack or a cold wet washcloth on the forehead.
   • Do this for 20 minutes. Repeat as needed.
6. Stretch Neck Muscles:
   • Stretch and rub any tight neck muscles.
7. Muscle Tension Headache Prevention:
   • If something bothers your child, help him talk about it. Help him get it off his mind.
   • Teach your child to take breaks when he is doing school work. Help your child to relax during these breaks.
   • Teach your child the importance of getting enough sleep.
   • Some children may feel pressure to achieve more. This may cause headaches. If this is the case with your child, help him find a better balance.
   • Caution: Frequent headaches are often caused by too much stress or worry. To be sure, get your child a medical checkup first.
8. Call Your Doctor If:
   • Headache becomes severe
   • Vomiting occurs
   • Headache without other symptoms lasts more than 24 hours
   • Headache lasts more than 3 days
   • You think your child needs to be seen
   • Your child becomes worse

Treatment for Migraine Headache

1. What You Should Know About Migraine Headaches:
   • This headache is like the migraine headaches that your child has had before.
   • The sooner a migraine headache is treated, the more likely the treatment will work.
   • Often the most helpful treatment is going to sleep.
   • Here is some care advice that should help.
2. Migraine Medicine:
   • If your child’s doctor has prescribed a medicine for migraines, use it as directed. Give it as soon as the migraine starts.
   • If not, you can use ibuprofen (such as Advil). It is the best over-the-counter drug for migraines. Give it now. Repeat in 6 hours if needed.
3. Try to Sleep:
   • Have your child lie down in a dark, quiet place.
   • Try to fall asleep.
   • People with a migraine often wake up from sleep with their migraine gone.
4. Prevention of Migraine Attacks:
   • Drink lots of fluids.
   • Don’t skip meals.
   • Get enough sleep each night.
5. What to Expect:
   • With treatment, migraine headaches usually go away in 2 to 6 hours.
   • Most people with migraines get 3 or 4 attacks per year.
6. Return to School:
   • Children with a true migraine headache are not able to stay in school.
   • Children with migraine headaches also commonly get muscle tension headaches. For those, they should take a pain medicine and go to school.
7. Call Your Doctor If:
   • Headache becomes much worse than past migraines
   • Headache lasts longer than past migraines
   • You think your child needs to be seen

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Top symptoms of menstrual cycle

We recently sent out the first of many Clue Health Surveys to better
understand symptoms people experience during their cycle.

The science is quite clear: certain symptoms happen at the same times every
cycle. These symptoms can indicate the hormonal shifts and changes during the
different cycle phases (the premenstrual/menstrual, follicular, ovulatory and
luteal phase). The more regular a cycle is, the easier it is to detect a
pattern. This does not usually apply to the 1 in 3 people with irregular cycles.
Symptoms in an irregular cycle usually happen at inconsistent times. Some
symptoms may be totally normal, while others may indicate a medical condition.

Over 4,000 people responded within the first week. Here are the results:

50% experience acne

Acne (acne vulgaris) is one of the most frequently reported skin ailments
connected to your cycle (1). Period-related hormonal breakouts, known as
catamenial acne, occur in the perimenstrual phase (the 10 days before and during
your period). Progesterone leads to an overproduction of sebum (the skin’s oily
secretion), which contributes to catamenial acne. Acne can also be closely
connected to certain lifestyle factors (2). Some people see a reduction in acne
breakouts when they take hormonal birth control. Acne is common during
adolescence (3), and in people with polycystic ovary syndrome (PCOS)(4).

49% experience headache, dizziness, or lightheadedness

Headaches are a common symptom of the premenstrual phase (5). They may be caused
by prostaglandins, which are hormone-like substances that help the uterus
contract, to shed the uterine lining (6).

Migraines are influenced by the menstrual cycle, and may be a symptom of the
premenstrual phase for some people (7). Migraines are intense headaches that can
be accompanied by pulsating pain, sensitivity to light and noise, nausea and/or
vomiting. Some people experience migraine auras, which are feelings, smells or
lights felt shortly before a migraine itself. Some people also report that their
migraines change throughout their reproductive lifespan. This means a migraine
might feel different in relation to someone’s first period, oral contraceptive
use, pregnancy and/or menopause. Changing estrogen levels are believed to cause
these changes. Taking extra estrogen (as hormonal birth control or hormonal
replacement therapy) may make migraines worse (8).

Sudden hormonal changes experienced right before the period, as well as during
the ovulatory phase, can cause lightheadedness and/or dizziness (9). Anemia (a
low red blood cell count) can also cause dizziness and headaches (10).

40% experience fatigue

Fatigue is frequently brought up in the context of the menstrual cycle and is a
commonly reported symptom of PMS (11). Fatigue is also frequently reported
during adolescence, pregnancy, the postpartum period and menopause (12–15). Long
term exhaustion can be a sign of a medical condition like endometriosis, a
thyroid disorder or less commonly, polycystic ovary syndrome (PCOS) (16,17).
Anemia and diabetes can also cause fatigue (10, 18).

39% experience cold hands and feet

Cold hands and feet is the most common sign of an underactive thyroid gland
(19). It can also be caused by anemia (10).

37% experience backache and/or leg pains

Cramps are a common pain symptom in the days before and during menstruation.
Painful cramping is also sometimes felt in the lower back and thighs (20). Lower
back pain, as well as leg pain, is often experienced during pregnancy (21) and
in people with endometriosis (22).

35% experience chronic pelvic pain

Chronic pelvic pain (CPP) is a common complaint people bring to their healthcare
providers. This symptom is most commonly caused by endometriosis, fibroids and
polyps (23).

26% experience diarrhea and/or nausea

Some people experience nausea as a premenstrual symptom. Nausea is also common
during early pregnancy. Overeating, food allergies, food poisoning, indigestion,
stomach flu and anxiety may also cause nausea. Some people report nausea as a
side effect of certain medications and oral contraceptives (24).

Diarrhea is the most common gastrointestinal symptom reported before and during
the period (25). High levels of contraction-causing substances called
prostaglandins are thought to be the cause of diarrhea before and during the
period (26).

22% experience constipation

Constipation is a common and painful condition. Diet, stress and physical
activity affect bowel movements and can contribute to constipation. Some people
report constipation before and during the period (27, 11). Constipation is
common during pregnancy, and can also be caused by conditions like endometriosis
or thyroid disorder (28, 29).

18% experience painful bowel movements

A recent study showed that more than 70% of individuals experience at least one
gastrointestinal (GI) symptom before and during the period (11). The most common
cause of painful bowel movements throughout the menstrual cycle is
endometriosis. Polycystic ovary syndrome (PCOS) might make painful bowel
movements worse around the time of the period (30, 31).

18% experience brittle nails and/or hair loss

Brittle nails can be caused by dehydration, nutritional deficiencies (minerals
and amino acids), certain medications or injuries to the base of the nail.
Environmental factors (climate) can also cause nails to be dehydrated and
brittle (32). Hair loss is almost always caused by a hormonal imbalance, but can
also stem from harsh chemical hair treatments (33).

Individuals suffering from polycystic ovary syndrome (PCOS) often experience
hair loss (androgenic alopecia) (34). Thyroid disorders can also cause brittle
nails and hair loss (alopecia) (35).

17% experience pale skin

Heavy menstrual bleeding, anemia and hypothyroidism can all cause pale skin
(10,34).

15% experience fast heartbeat and/or shortness of breath

Anemia can cause shortness of breath (10). Thyroid disorders, and the
medications that manage them, might cause a rapid heartbeat and shortness of
breath (34).

13% experience watery, bloody or foul smelling vaginal discharge

Watery, bloody or foul smelling vaginal discharge can be due to many things like
certain medications, infections or allergies (36, 37). This discharge can vary
in texture (e.g. chunky, foamy), smell (e.g. foul, fishy) or color (e.g. green).

Discharge that is bloody or accompanied by a fever and/or abdominal pain may be
a sign of a sexually transmitted infection or urinary tract infection, and
should be treated as an emergency (38).

13% experience frequent urination and/or difficulty urinating

The most common causes of frequent urination and/or difficulty urinating are
bladder infections, sexually transmitted infections, endometriosis and diabetes
(39, 40).

13% experience excessive hair growth

Individuals suffering from polycystic ovary syndrome (PCOS) often experience
dermatological problems such as excessive hair growth (hirsutism) on the face,
back and belly (4).

12% experience chest pain

The most common causes of chest pain are muscular or joint problems, but chest
pain may also be caused by anemia and endometriosis (10, 41, 42).

10% experience pain and/or bleeding during or after sexual intercourse

Pain and/or bleeding during or after sex (not related to menstruation) occurs in
0.7% to 9% of menstruating people. These symptoms may be mechanical damage to
the cervix or by conditions such as polyps, fibroids and endometriosis (43).

42% struggle with weight

As you grow and age, your body weight will change. It may also change through
periods of increased or decreased physical activity, illness or pregnancy.
Weight changes might be noticed during adolescence or menopause. Conditions such
as PCOS, diabetes and thyroid disorders have a strong impact on weight
fluctuations (44–46).

10% have a diagnosed condition

The most common symptoms of PCOS are:

Acne, excessive hair growth, weight gain and irregular cycles

The most common symptoms of thyroid disorders are:

Chronic pelvic pain, cold hands and feet and sudden weight changes

The most common symptoms of endometriosis are:

Chronic pelvic pain, fatigue and painful bowel movements

The most common symptoms of diabetes are:

Headache, lightheadedness and dizziness, acne and weight gain

35% use hormonal contraception to regulate their cycle

Hormonal birth control (HBC) will help you manage many of the symptoms you
experience because of your condition. Hormones in your HBC will help maintain
the levels and ratios of hormones necessary for regular menstrual cycle
function.

Many of these symptoms can indicate an irregular cycle if they happen often or
without an obvious pattern. What causes irregular cycles?

Irregular cycles occur for many different reasons. The most common cause is
simply transitioning through a different life stage: adolescence (when the first
period happens) or pre-menopause (time when periods cease around age 45–55).

Some of the other causes include:

• Stress
• Excessive/extreme sports
• Poor diet
• Hormonal birth control or copper IUD
• Miscarriage
• Breastfeeding
• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Uterine polyps
• Fibroids
• Problems with blood clothing (also called haemophilia)

The best way to determine the cause of your symptoms or irregularity is to talk
to your healthcare provider. Tell them about your cycle (period and average
cycle length) and symptoms. How debilitating are your symptoms? Do they affect
your daily routine? Your healthcare provider might need to run a couple of
additional tests to help with determining the root causes of your irregular
cycles and symptoms.

Excessive Thirst | Brain Tumour Symptoms in Children

It’s normal for babies and children, especially toddlers, to drink a lot and pass lots of urine (wee). This is called habitual drinking. But excessive thirst and increased urination in babies, children and teenagers can be a sign of diabetes mellitus or diabetes insipidus.

What are diabetes mellitus and diabetes insipidus?

Diabetes mellitus, often just called diabetes, is not associated with having a brain tumour. It can be checked for by a doctor with a simple finger prick test.

If this test is normal, it may indicate that the excessive thirst is a symptom of diabetes insipidus.

In diabetes insipidus, the body can’t concentrate the urine enough and so it passes too much water. This is usually caused by a disturbance of the hormones released by the pituitary gland, a part of the brain. Sometimes, this disturbance can be caused by a brain tumour. But it’s important to note that diabetes insipidus is rare.

What are the signs to look out for?

Babies and young children will be unable to tell you that they’re excessively thirsty. In this case, signs and symptoms to watch out for include:

• unexplained weight loss
• large volumes of urine (weeing a lot)
• leaking from nappies.

Children and teenagers with diabetes insipidus will have:

• excessive thirst – feeling thirsty all the time and feeling ‘dry’ no matter how much they drink (including waking up regularly at night to drink)
• increased urination – needing to go to the toilet a lot and passing pale, watery urine.

If excessive thirst is caused by a brain tumour, other symptoms will often be present, in particular:

• abnormal growth
• delayed or arrested puberty.

You should look out for these symptoms carefully.

If your baby, child or teenager has increased thirst and urination, they should be seen urgently by a doctor to check whether this symptom is being caused by diabetes and, if so, what is causing the diabetes.

If symptoms appear suddenly or are severe, take your child to A&E or phone 999.

If you’re a teenager and you’re worried about increased thirst and urination (weeing), it’s best to talk to your GP as soon as possible.

What is migraine and how to live with it

The four phases of migraine

Many people consider migraine a very severe headache, but in fact everything is much more complicated. Here are four phases of migraine, not all of them occur in every attack, and some people may not have all phases.

ADVERTISING – CONTINUED BELOW

Phase 1. Prodromal

A day or two before the onset of a migraine, you can notice the following features of your health:

• thirst,
• frequent urination,
• craving for certain foods,
• constipation,
• pain in the neck,
• mood changes,
• constant yawning.

These symptoms can be very troubling. If the migraine is not the first time, you may understand that you will need to take medication soon. The sooner you start treatment, the more effective it will be.

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Phase No. 2. Aura

Every third sufferer enters this phase immediately before the onset of a migraine or at the onset of a headache. Visual discomfort usually begins: luminous dots, zigzags, distortions that can migrate across the entire field of view.It is not uncommon for a blind spot to appear, so drivers caught in the aura must park and wait for the problem to subside.

Some people feel an unpleasant chemical odor, begin to stutter and blush, and feel numbness in half of the body. Usually this phase lasts from 20 minutes to an hour, the symptoms increase, then disappear.

Phase 3. Headache (attack)

Migraine can go away quite easily, but most often it is expressed in a severe throbbing headache.Usually it is localized in one part of the head, but it can cover the entire head. It lasts from 4 to 72 hours and is often accompanied by blurred vision, dizziness and fainting.

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Migraines are episodic and chronic. In the latter case, they interfere with living more than 15 days a month for three months.

In addition to headaches, you may experience nausea, sensitivity to light and sound.Many people want to hide in a dark, quiet room and go to bed.

Migraine often forces people to break plans and agreements, and this is what especially spoils life for many.

Phase № 4. Postdromal

After the end of the main “action” you can feel something similar to a hangover: lack of confidence in movements, weakness, thirst.

Some people do not have the aura phase, others have the headache itself (most often those who are familiar with migraines from adolescence, when all phases were present).

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When to see a doctor?

If pain relievers do not help and you want to end suffering faster, you should find a good doctor who is familiar with the matter.

It is also helpful to keep a migraine diary: time of onset, duration, quality of sleep the previous night, nutritional notes, emotional state, and so on. Check with family members if anyone has had similar symptoms – migraines may be genetic.

Get immediate help in the following situations:

• headache after surgery on the skull or neck;
• Pain that gets worse with coughing, stretching, or muscle tension;
• Sudden, terrible headache, similar to a clap of thunder.

When frequent urination becomes a problem.

2020.10.15

You often have to go to the toilet

The technical name for your problem is frequent urination.In most people, the bladder is able to store urine until we find a convenient moment to go to the toilet, usually we need to use the toilet four to eight times a day. If you need to go to the bathroom more than eight times a day or wake up at night, this could mean that you are drinking too much fluids and / or too much before bed.

Frequent urination can also mean more serious health problems. It can be a symptom of many different problems, from kidney disease to simply drinking too much fluids.Frequent urination, fever, an urgent need to urinate, and abdominal pain or discomfort are symptoms of a urinary tract infection.
Other possible causes of frequent urination:

Diabetes.

Frequent urination with unusually large amounts of urine is often an early symptom of type 1 and type 2 diabetes. Thus, the body tries to get rid of unused glucose in the urine.

Prostate problems.

Men have a walnut-sized prostate that can grow after 25 years. An enlarged prostate can compress the urethra (the tube that carries urine out of the bladder) and block the flow of urine. An enlarged prostate can cause weakness and uneven urine flow. As a result, the bladder wall becomes irritated. The bladder begins to contract even when there is a small amount of urine in it. You may feel that you need to travel more often, sometimes urgently.In rare cases, this could be a sign of a more serious medical condition, such as cancer. Your doctor can help address other causes and treat an enlarged prostate.

Too much alcohol or caffeine 90 100

They can act as a diuretic and remove more water from the body.

Interstitial cystitis.

This condition of unknown cause is characterized by pain in the bladder and pelvis.Urgent and / or frequent urge to urinate is often the symptom. This condition of unknown cause is characterized by pain in the bladder and pelvis. Urgent and / or frequent urge to urinate is often the symptom. You may feel like you want to urinate all the time, but when you go to the toilet, you don’t get much urine. This can damage your lower abdomen, which worsens when you are suffering or after intercourse. This seems to happen when the bladder tissue swells and becomes very tender.The reason for this is not always clear. This condition, also called interstitial cystitis, is treated with diet and exercise, medication, surgery, and physical therapy.

Use of diuretics.

These medicines, which are used for high blood pressure or fluid retention, affect the kidneys and excrete excess fluid from the body, resulting in frequent urination.

Hyperactive bladder syndrome

Overactive bladder syndrome is very common.The main symptom is a feeling of urge to use the toilet, frequent and unpredictable urge to urinate. If you are unable to urinate quickly, urine may leak without damage until you get to the toilet. It is treated with bladder training, sometimes with medications.

Kidney stones

Minerals, salts and proteins can form small kidney stones. You begin to feel like you need to urinate more often. Nausea, fever, chills, and severe pain in the side and back may occur, which in waves spreads and spreads to the groin.It is more common in people who are overweight, low in fluids, high in protein, and have a poor family history. The stones may be removed directly during urination, or surgical removal may be required.

Tumor

Both malignant and benign tumors can cause increased urination because they take up more space in or around the bladder. Blood in the urine is the most important sign of cancer.Talk to your doctor if you see blood, notice a lump in the lower abdomen, or feel painful when urinating.

Stroke or other neurological diseases.

Damage to the nerves that make up the nerves in the bladder can lead to problems with bladder function, including frequent and sudden urge to urinate.

Less common causes of include bladder cancer, bladder dysfunction, and radiation therapy.

Frequent urination is not a symptom of a problem, it is a problem. In people with overactive bladder syndrome, the involuntary contractions of the bladder cause an urgent need to urinate, which means you need to go to the bathroom immediately, even if your bladder is not full. This can cause you to wake up one or more times during the night to use the toilet.

There are many reasons for frequent urination, but not all.In any case, consult a specialist. In some cases, consult with your family doctor , urologist, gynecologist . In rare cases – with endocrinologist , cardiologist or neurologist .

Diabetes insipidus ›Diseases› DoctorPiter.ru

The main symptom of diabetes insipidus is a combination of constant thirst and frequent, profuse urination. The first thought that naturally arises in a person tormented by this condition: “It looks like diabetes.”But when, according to the results of laboratory tests, sugar is not found either in the blood or in the urine, this confuses him. In fact, these basic symptoms are inherent in both diabetes and non-diabetes mellitus.

This disease can overtake both men and women, more often at the age of 20-40, but it is often found in young children. The renal form of diabetes insipidus occurs mainly in men.

Features

Diabetes insipidus is not in vain otherwise called “diabetes insipidus”.Frequent and profuse urination (polyuria), thirst (polydipsia), as a rule, appear suddenly. A person often wakes up at night to go to the toilet, does not get enough sleep, so he constantly feels tired. If the normal daily volume of urine is about 1.5 liters, then with diabetes insipidus its volume increases over time from 2 liters to 18-20, while the urine is almost colorless, low density, and does not contain sugar. Patients drink a lot, usually preferring cold, ice-filled liquid.Their appetite is reduced, body weight also decreases, the skin becomes dry, sweating practically disappears, they become nervous, irritable, get tired quickly, and often suffer from insomnia. In addition, with a long course of the disease, there is an increase in heart rate, a decrease in blood pressure. In women, menstrual irregularities can be observed, in men – potency. Symptoms from the gastrointestinal tract join, especially if the patient needs to drink a lot: the stomach stretches and falls.In addition, there is a distension of the bladder. If you limit fluid intake, then symptoms of dehydration develop: headache, dry skin and mucous membranes, nausea, vomiting, fever, tachycardia, mental disorders, blood clotting, collapse.

In newborns and children of the first year of life, the condition can be very serious, there is unexplained vomiting, fever, neurological disorders. In older children, urinary incontinence (enuresis) occurs.Children may lag behind in physical and sexual development.

Description

Diabetes insipidus is an endocrine disease associated with changes in the functions of the posterior lobe of the pituitary gland and areas of the brain that regulate water exchange in the body. It leads to a disruption in the production or action of vasopressin, a hormone responsible for regulating the process of reabsorption of water in the kidneys. Vasopressin ensures that there is always plenty of water in the body. At the slightest threat of dehydration, the hormone delays urination, literally “squeezing” water from the renal tubules and forcing them to return fluid to the body.If it is produced in insufficient quantities or its effect is weakened, it contributes to the formation of large amounts of urine, increases thirst, causing dehydration and low blood pressure in severe cases.

Diabetes insipidus can be central (hypothalamic-pituitary) or renal.

Central diabetes insipidus can be caused by acute and chronic infections, tumors, metastases, infectious diseases, meningitis, encephalitis, syphilis, autoimmune diseases, and accidental or surgical trauma.Known vascular lesions of the hypothalamic-pituitary system. Diabetes insipidus can occur after trauma to the skull and brain, after surgery on the brain, especially after removal of the pituitary adenomas. However, one third of all cases of diabetes insipidus remain unknown – this disease is called “idiopathic” diabetes insipidus, some forms of which are sometimes inherited.

Renal diabetes insipidus can be either acquired (taking lithium preparations, metabolic disorders) or congenital – the reason is a mutation of the vasopressin receptor gene or a mutation of the aquaporin-2 gene.

Diabetes insipidus is a painful disease. It has a long course, going on for many years. Sometimes there is a spontaneous cure, a periodic weakening of painful symptoms. The patient can live with this disease for a long time, but subject to treatment and adherence to established recommendations.

Diagnostics

Diagnosis is usually straightforward, since the manifestations of the disease (thirst and diabetes) are very characteristic.Diagnosis is based on blood and urine tests. A fluid restriction test, urine specific gravity studies are performed.

To find out the cause of the disease, the results of X-ray, ophthalmological and neuropsychiatric examinations are carefully analyzed. It is necessary to carry out magnetic resonance imaging of the brain.

In addition, diabetes insipidus should be differentiated from other diseases accompanied by polyuria – diabetes mellitus, chronic kidney disease in the stage of renal failure, neuroses.

Treatment

Treatment is primarily aimed at eliminating the underlying cause of the disease. When a brain tumor is detected, it is most often surgical, with neuroinfection, antibiotics are prescribed, with the development of diabetes insipidus due to syphilis, anti-syphilitic therapy is performed. Despite the fact that the causes of diabetes insipidus may be different, substitution therapy is always prescribed: drugs – analogues of the hormone vasopressin intranasally (through the nose) or in tablets.Other drugs are prescribed as indicated. Homeopathy has also been used successfully in treatment.

The disease lasts for many years, but, as a rule, it does not threaten life – it is quite possible to coexist with it, following certain rules. Recovery is rare.

Lifestyle

A person suffering from diabetes insipidus should always have a bottle of water with him – you cannot restrict the liquid – this is extremely dangerous: there is a threat of dehydration, and the condition worsens.In addition to weakness, headache, nausea, convulsions, mental and motor agitation may develop, blood pressure drops sharply, heart rate increases …

It is very important to have regular nutrition, refusal of sweets, constant monitoring of body weight so that it does not exceed the norm. This is especially important for those who have comorbidities such as hypertension, atherosclerosis, obesity, as well as for elderly and senile people.

In the food of patients with diabetes insipidus, there should be more phosphorus necessary for normal brain activity, therefore, lean varieties of fish and meat, seafood, egg yolks should be included in the diet, but you should not overdo it – the diet for diabetes insipidus provides for the restriction of proteins (since the kidneys and so there is an increased load).The consumption of table salt is limited to 5-6 g per day. The use of vegetables, fruits, dairy products is recommended without restrictions. Fruit drinks, compotes, chilled apple mousse, any vegetable and fruit juices are good for quenching your thirst. During an exacerbation of the disease, it is useful to drink fish oil (a tablespoon per day). It is necessary to regularly take strengthening and sedatives – iron, bromine, valerian

But people with diabetes insipidus need to avoid conditions under which there may be difficulties in supplying water (for example, work in the steppe, desert).

© Dr. Peter

90,000 Headaches, fatigue, insomnia, dizziness

July 16,

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I am 24 years old.In the last month, there are headaches, fatigue, insomnia, dizziness (in certain situations: getting out of the car, raising your head sharply, getting up abruptly, a busy working day), rarely blurry eyes. Until May, six months were worried about the problems of periodic neurosis: 10 days a positive state, on the 11th day headaches and insomnia, hyperactivity, in the following days 14-20 days, severe fear and its neurotic manifestations – shaking in the body, heat-cold, loss of appetite, insomnia, anxiety-depressive state, apathy, difficulty concentrating.The transition periods are very abrupt. Took glycine, afobazole up to 4 times a day, phenibut up to 3 times a day, tenaten up to 6 times a day, to no avail. I did an MRI of the brain with contrast. The result is as follows: on the right, on the occipital lobe, at the level of the posterior horn of the lateral ventricle of the lower contour, an oval-shaped focus is determined, intensively accumulating contrast. The size is 19x11x13.6 mm, a homogeneous structure with smooth, clear contours. The formation is intimately adjacent to the wall of the ventricle. The cranivertebral transition is not changed.The pituitary gland is not enlarged. The median structures are not displaced. The ventricles are of the usual shape, the lateral ones are asymmetric (the right one is enlarged). Subarachnoid spaces are not enlarged. The paranasal sinuses are pneumatized. Conclusion MR signs of a mass in the right hemisphere (anaplastic astrocytoma?). The neurosurgeon in consultation after talking with me (I just had another improvement), examination, concluded that there are no clinical manifestations, refrain from surgical treatment, do a second MRI in six months.The neurosis is not associated with the detected formation. No treatment was prescribed. I would like to know the causes of neuroses and their frequency and how to get rid of them? Because it is they who break my whole life and make me practically inoperable.

Akimov Vitaly

Neurologist, Ph.M.Sc.

The sleep disorders, anxiety, asthenic and neurotic conditions that you describe, especially if they bother you all your life, often require a combination of medication and non-medication treatment. If your symptoms have already been sorted out, and the volumetric education is being observed, then you may no longer need a neurologist. If I were you, I would come to grips with “neurosis”, which is what psychiatrists do in our clinic first of all, you can sign up by phone + 7 (495) 933 66 55.

90,000 Migraine: More Than a Headache

Migraine is a very common, multifactorial, recurrent hereditary neurovascular disorder of headache. More than a billion people on Earth suffer from it.

Migraine attacks often begin with a conditional first phase – warning signs (prodrome), then move into a conditional second phase – auras (transient focal neurological symptoms), the origin of which is believed to be associated with the hypothalamus, brain stem and cortex.The third phase – is actually the headache phase. Its pulsating character increases with an increase in intracranial pressure, which is manifested by nausea, vomiting, and abnormal sensitivity to light, noise and smell.

Migraines can also be accompanied by abnormal skin tenderness (allodynia) and muscle soreness. Thus, tracing all the symptoms from phase to phase, it can be concluded that during a migraine attack, the whole complex of neuronal systems of the brain function abnormally.

It’s safe to say that the brain of a person with a migraine is different from that of a person without a migraine. An article in the Journal of Neuroscience for 2015, authored by Rami Burshtein and his co-authors, is devoted to a detailed analysis of this thesis. About her and will be discussed in our retelling. We are aware that this article is primarily for doctors, but we also want to educate the medical community to the best of our ability. Therefore, we enter the corresponding tag.

Process steps and their pathophysiological basis

Migraine is a genetic disorder that begins during puberty. Most often women suffer from it: the ratio of patients to patients is five to one. In some cases, the headache starts without warning signs and ends with sleep. In other cases, headache may be preceded by a prodromal phase , which includes: fatigue, euphoria, depression, irritability, food cravings, constipation, heaviness in the neck, increased yawning, and / or abnormal sensitivity to light, sound and smell.

The aura phase includes various focal cortical neurological symptoms that appear immediately before and / or during the headache phase.

Symptoms of the migraine aura develop gradually, have phases of excitement and inhibition, and completely disappear. They can appear in the form of flickering lights and cattle (blind spots in the field of view) when exposed to the visual cortex; paresthesias and numbness of the face and hands when exposed to the somatosensory cortex; tremor and unilateral muscle weakness with damage to the motor cortex or basal ganglia; difficulties with pronouncing words (aphasia) when exposed to the speech area.

One of the aura effects: blurred part of the field of view

Corresponding headache – , usually unilateral, throbbing, aggravated by normal physical activity and can last from several hours to several days ( Headache Classification Committee of the International Headache Society, 2013 ).

As the headache grows, it can be accompanied by various transient reversible vegetative symptoms (nausea, vomiting, nasal and sinus congestion, rhinorrhea – profuse runny nose, lacrimation, drooping eyelids, yawning, frequent urination and diarrhea), affective symptoms (depression and irritability), cognitive symptoms (attention deficit, difficulty finding words, transient amnesia and decreased ability to navigate in familiar conditions) and sensory symptoms (photophobia, phonophobia, muscle weakness, and cutaneous allodynia).

The number of these varied symptoms suggests a migraine – is more than a headache. It is currently regarded as a complex neurological disorder affecting several areas of the brain: the cortex, subcortex, and brainstem.

Migraine headaches are known to have triggers: insufficient sleep, skipping meals, stress or post-stress periods, hormonal fluctuations, alcohol, certain foods, flickering lights, noise, or certain odors.The first question arises: in what cases these triggers fire, and in what cases do not. It is difficult to imagine a person with migraine having an attack after every meal or after every alcohol intake. The second question is: what are the reasons for the attacks, they resolve on their own or simply weaken due to sleep, relaxation, eating and darkness.

We must also investigate the mechanisms by which the frequency of episodic migraines increases over time (monthly to weekly and daily), and why progression from episodic to chronic migraines is rare.

Disease mechanism 90 100

A mechanistic search for a common denominator in the symptoms and characteristics of migraine strongly indicates a genetic predisposition to generalized neuronal hyperexcitability. Increasing evidence of changes in brain structure and function due to recurrent migraine attacks may explain the progression of the disease.

Prodroma

Prodrome – are symptoms that precede aura and headache (in some people migraine attacks are manifested by prodrome and headache).Examination of the symptoms most often described by patients indicates potential involvement of the hypothalamus (fatigue, depression, irritability, food cravings and yawning), brainstem (muscle soreness and stiff neck), cerebral cortex (abnormal sensitivity to light, sound, and smell), as well as the limbic system (depression and anhedonia) in the prodromal phase of a migraine attack. Given that symptoms such as fatigue, yawning, food cravings, and transient mood changes occur naturally in all people, it is very important that we understand how they cause headaches in migraine patients and not in healthy people.

The hypothalamus has received a lot of attention recently, as it plays a key role in many aspects of human circadian rhythms (wake-sleep cycle, body temperature, food intake and hormonal fluctuations) and homeostasis.

Because the brain of a person with migraine is extremely sensitive to deviations from homeostasis, uncovering the mechanisms by which neurons in the hypothalamus and brainstem can cause headaches is central to our ability to develop treatments that can intercept headaches during the prodromal phase.There is an assumption that hypothalamic neurons that respond to changes in physiological and emotional homeostasis can activate meningeal nociceptors (nociceptor – pain-carrying neuron), altering the balance between parasympathetic and sympathetic tone in the meninges.

Another hypothesis suggests that neurons in the hypothalamus and brainstem (regulators of responses to deviations in homeostasis) may lower the threshold for the transmission of incoming trigeminovascular pathway signals through the thalamus to the cortex.This proposal is based on an understanding of how the thalamus selects, amplifies and prioritizes information that it ultimately transmits to the cortex, and how the nuclei of the hypothalamus and brainstem regulate relay (direct, non-collateral) thalamocortical neurons.

Main pathways of signal propagation to thalamic trigeminal neurons, apparently triggering migraines

Cortical spreading depression 90 100

Clinical and preclinical studies show that migraine aura is caused by spreading cortical depression (CSD) – a slowly spreading depolarization / excitation wave accompanied by hyperpolarization / inhibition in cortical neurons and glial cells.

Although the specific processes that trigger CSD in humans are not known, the mechanisms that trigger inflammatory molecules as a result of emotional or physiological stress, such as lack of sleep, may play an important role. In the cortex, the initial depolarization of the membrane is associated with a large outflow of potassium; inflow of sodium and calcium; the release of glutamate, ATP and hydrogen ions, as well as the launch of a cascade of pro-inflammatory reactions. The work of pro-inflammatory molecules in the meninges, as well as calcitonin gene-related peptide (CGRP) and nitric oxide, may be the link between aura and headache.

Trigeminovascular pathway: from activation to sensitization 90 100

Let’s touch on the anatomy of a migraine. The trigeminovascular pathway transfers nociceptive information from the meninges to the brain. This path begins with peripheral neurons of the pia mater, dura mater, large cerebral arteries, periorbital skin, and pericranial muscles. These neurons transmit information to the trigeminal ganglion. The central axons of the ganglia continue their path to the nociceptive plates of the dorsal horn of the spinal cord SpV.

Ascending axonal projections of trigeminovascular SpV neurons transmit monosynaptic nociceptive signals to the following brainstem nuclei: ventrolateral, periaquedual, gray, superior salivary, parabrachial, wedge-shaped, solitary tract nucleus and reticular formation; nuclei of the hypothalamus: anterior, lateral, perifornal, dorsomedial, suprachiasmatic and supraoptic; nuclei of the basal ganglia: pallid ball, shell, caudate nucleus; nuclei of the thalamus: ventral posteromedial (VPM), posterior (PO), parafascular nuclei.

The figure illustrates the complexity of the trigeminovascular pathway.

These centers can be critical for nausea, vomiting, yawning, watery eyes, urination, loss of appetite, fatigue, anxiety, irritability, depression.

Relay (without collaterals) trigeminovascular thalamic pathways, which are projected onto the somatosensory, insular, motor, parietal, auditory, visual and olfactory cortex, create the specific nature of migraine headache and cortical-mediated symptoms that accompany it.These include transient motor disorders, difficulty focusing, amnesia, allodynia, phonophobia, photophobia, and osmophobia.

Activation

Animal studies show that cortical spreading depression (CSD) initiates delayed (delayed onset of post-aura headache) or immediate (immediate onset of post-aura headache) activation of peripheral and central trigeminovascular neurons. Systemic administration of the M-type potassium channel opener KCNQ 2/3 can prevent CSD-induced activation of nociceptors.These data support the opinion that the onset of the migraine headache phase with aura coincides with the activation of meningeal nociceptors at the periphery of the trigeminovascular pathway.

It is currently unclear which vascular, cellular and molecular processes of cortical depression lead to the activation of meningeal nociceptors. A large body of research suggests that transient narrowing and dilatation of the arteries of the pia mater, the development of plasma protein extravasation in the dura mater, neurogenic inflammation, platelet aggregation and mast cell degranulation against the background of CSD-dependent release of CGRP can introduce pro-inflammatory molecules into the meninges, thereby altering way of molecular environment for meningeal nociceptors.

Sensitization

When activated in the altered molecular environment described above, peripheral trigeminal vascular neurons become sensitized (the threshold of their response decreases, and the magnitude of their response increases) and begin to respond to stimuli from the dura mater, to which they showed minimal or no response at the beginning of the study … When central trigeminovascular neurons in lamina I and V SpV and in the nuclei of thalamic PO / VPM become sensitized, and they begin to respond to harmless mechanical and thermal stimulation of the scalp and outside the brain, as if it were harmful.Human correlates of electrophysiological indicators of neuronal sensitization in animal studies are evident in contrast analysis of BOLD signals recorded on MRI scans of the human trigeminal ganglion, dorsal trigeminal nucleus, and thalamus during migraine attacks.

The clinical manifestation of peripheral sensitization during a migraine, which takes about 10 minutes to develop, includes the perception of a throbbing headache and a brief increase in headache when bending over or coughing, actions that momentarily increase intracranial pressure.The clinical manifestation of sensitization of central trigeminovascular neurons in SpV, which takes 30–60 min to develop and 120 min to reach its full extent, includes the development of signs of head allodynia, such as scalp and muscle sensitivity and hypersensitivity to touch. These signs are often recognized in patients reporting that they avoid wearing glasses, earrings, hats, or any other item that comes in contact with their facial skin during a migraine. The clinical manifestation of thalamic sensitization during migraine, which develops after 2–4 hours, also includes signs of extracranial allodynia, which causes patients to remove tight clothing and jewelry and avoid touching, massage, or hugging.

Evidence that triptans, 5HT 1B / 1D agonists, which disrupt the communication between peripheral and central trigeminovascular neurons in the dorsal horn, are more effective in interrupting migraine with early use (i.e., before the development of central sensitization and allodynia), further support the idea that that meningeal nociceptors control the initial phase of headache. Additional support for this concept has recently been provided by studies showing that anti-CGRP monoclonal antibodies that are too large to cross the blood-brain barrier (according to manufacturers) are effective in preventing migraines.Thus, only the membranes of the brain can be the point of application for them. In addition, it has also been reported that drugs that act on central trigeminovascular neurons [eg, dihydroergotamine (DHE)] are equally effective during the stage of advanced central sensitization. This may explain the effectiveness of DHE in interrupting migraines following failed triptan therapy.

Genetics and the hyperexcitable brain 90 100

A genetic link to migraine was first identified and identified in patients with familial hemiplegic migraine (FHM).Three genes identified with FHM encode proteins that regulate the availability of glutamate at the synapse. FHM1 encodes the P / Q type pore-forming α1 calcium channel subunit; FHM2 encodes the α2-subunit of the Na ⁺ / K ⁺ -ATPase pump; and FHM3 encodes the α1 subunit of the Na v 1.1 voltage-gated neural channel. Collectively, these genes regulate transmitter release, the glial ability to clear (absorb) glutamate from the synapse, and the generation of action potentials.Since these early results were obtained, large studies of genomic associations have identified 13 variants of susceptibility genes for migraine with and without aura, three of which regulate glutaminergic neurotransmission, and two of them regulate synaptic development and plasticity. These data provide the most plausible explanation for the “generalized” neuronal hyperexcitability of the migraine brain.

In the context of migraine, increased work in the glutamatergic systems can lead to over-activation of the NMDA receptor, which in turn can enhance pain transmission, as well as the development of allodynia and central sensitization.Networked, widespread neuronal hyperexcitability can also be caused by thalamocortical dysrhythmia, defective brainstem modulation circuits that regulate excitability at several levels along the neuraxis; and an inherently dysregulated function of the cortex, thalamus, and brainstem to limbic structures such as the hypothalamus, amygdala, nucleus accumbens and caudate, shell, and globus pallidus.

Along these lines, it is also tempting to suggest that at least some of the structural changes seen in the migraine brain can be inherited and, as such, may be the “cause” of the migraine rather than being secondary to recurrent headaches.But this concept is awaiting proof.

Structural and functional changes in the brain 90 100

Changes in the brain can be divided into the following two processes: (1) changes in the work (functionality) of the brain and (2) changes in the structure of the brain. Functionally, different imaging techniques used to measure the relative activation in different brain regions in migraines (compared to healthy volunteers) showed increased activation in the periaqueductal gray matter; red core and substantia nigra; hypothalamus; posterior thalamus; cerebellum, cingulate and prefrontal cortex, anterior temporal pole and hippocampus; and decreased activation in the somatosensory cortex, cuneiform and caudate nuclei, shells, and globus pallidus.All these changes in activity occurred in response to non-repetitive stimuli, and in the cingulate and prefrontal cortex they occurred in response to repetitive stimuli.

Taken together, these studies support the concept that the migraine brain lacks the ability to adjust to itself and therefore becomes overly excitable. However, the question of whether such changes are unique to migraine headaches remains a matter of controversy.

The existence of nearly identical activation patterns in other pain conditions, such as low back pain, neuropathic pain, fibromyalgia, irritable bowel syndrome, and heart pain, increases the likelihood that differences between somatic pain and migraine pain are not related to differences in pain treatment. in the brain.

Anatomical studies of voxel-based morphometry and diffusion imaging in migraine patients (versus control subjects) revealed thickening of the somatosensory cortex, increased gray matter density in the caudate nucleus, and loss of gray matter volume in the superior temporal gyrus, middle and inferior frontal gyrus, precentral gyrus, anterior cingulate gyrus, amygdala, parietal operculum and insula.

Changes in the functional activity of the brain associated with migraine and sex differences

Changes in cortical and subcortical structures may also depend on the frequency of migraine attacks for a number of cortical and subcortical areas.As discussed above, it is unclear whether such changes are genetically predetermined or simply the result of repeated exposure to pain. The latter are supported by studies showing that similar changes in gray matter that occur in patients experiencing other chronic pain conditions are reversible, and that the magnitude of these changes can correlate with the duration of the disease. Further complicating our ability to determine how the brain of a migraine differs from the brain of a patient experiencing other chronic pain conditions are anatomical studies showing a decrease in gray matter density in the prefrontal cortex, thalamus, posterior insula, secondary somatosensory cortex, precentral and postcentral gyri, hippocampus and the temporal pole in patients with chronic back pain; in the anterior and orbitofrontal cortex in patients with complex regional pain syndrome; in the islet, anterior cingulate gyrus, hippocampus, and inferior temporal cortex in osteoarthritis patients with chronic back pain.

Developmental care 90 100

Migraine therapy has two goals: to end acute attacks and to prevent the next attack. The latter can potentially prevent the progression of the disease from an episodic to a chronic condition. In terms of efforts to end acute attacks, migraine is one of the few pain conditions for which a specific drug – triptan – has been developed based on an understanding of disease mechanisms.In contrast, efforts to prevent migraine headaches are likely to face a much more serious problem, given that migraines can occur in an unknown number of brain regions (see above) and are associated with generalized functional and structural disorders of the brain. A number of attention-getting procedures are briefly discussed below.

Medicines

The most promising drug currently under development is a humanized monoclonal antibody to CGRP.The development of these monoclonal antibodies targets both CGRP itself and its receptors. The concept is based on the localization of CGRP in the trigeminal ganglion and its significance for the pathophysiology of migraine. In recent phase II randomized, placebo-controlled trials, neutralizing humanized anti-CGRP monoclonal antibodies have been injected to prevent migraine recurrence and have shown promising results. Remarkably, one injection can prevent or significantly reduce migraine attacks within 3 months.

Given our growing understanding of the importance of the prodrome and aura in the pathophysiology of migraine, drugs targeting the ghrelin, leptin and orexin receptors can be considered therapeutic developments based on their ability to restore hypothalamic function. All of these can be critical in reducing the allostatic load and therefore initiating the next migraine attack.

Brain modification

Neuroimaging studies showing that neural networks, brain morphology and brain chemistry change in both episodic and chronic migraines justify attempts to develop methods that widely modify brain networks and their functions.

Transcranial magnetic stimulation, which is believed to modify the hyperexcitability of the cortex, is becoming one such approach. Another approach for generalized brain modification is cognitive behavioral therapy.

Conclusions

Migraine remains a common and difficult to treat disease. There is currently no objective diagnosis or treatment that is universally effective in interrupting or preventing seizures.Migraine is a neurological condition in which systems that continually evaluate errors often fail, thus increasing allostatic stress (the body’s overreaction to stress).

Given the enormous material losses to society from migraines, there is an urgent need to focus on a better understanding of the neurobiology of disease in order to enable new approaches to treatment to be discovered.

Text: Marina Kalinkina

Migraine: Multiple Processes, Complex Pathophysiology

Rami Burstein, Rodrigo Noseda and David Borsook

Journal of Neuroscience April 29, 2015, 35 (17) 6619-6629; DOI: https: // doi.org / 10.1523 / JNEUROSCI.0373-15.2015

90,000 symptoms, treatment, prevention we discuss with obstetrician-gynecologist

The weekend was great. You went on a hike with headscarves or went to the beach, where you swam to your heart’s content, and then sat in a cold wet bathing suit, or you went to a picnic, where everything was fine, except that on a cool evening you sat on the cold ground for too long … as a result, you feel a sharp pain when urinating, a feeling of inability to go to the toilet, you have to squeeze out the liquid literally drop by drop? Sad as it may seem, most likely you have developed cystitis.

Our consultant: obstetrician-gynecologist “EuroMed Clinic” Alina Vladimirovna CHAPLOUTSKAYA.

Cystitis is an inflammation of the bladder. This term is often used to refer to a urinary infection associated with inflammation of the bladder mucosa and impairment of its function.

The appearance of cystitis can be provoked by trauma to the mucous membrane of the bladder, problems with urination, diseases of the bladder and nearby organs (prostate, urethra, genitals), intestinal bacteria, stagnation of blood in the veins of the pelvis, hormonal disorders, vitamin deficiencies, hypothermia, etc.

Women are more likely to suffer from cystitis than men – approximately 20 to 40% of the female population have experienced this disease.

Cystitis is primary and secondary, acute and chronic, infectious and non-infectious. The symptoms of cystitis depend on the type of cystitis.

Symptoms

Acute cystitis is characterized by frequent urination, accompanied by “cutting” pain, hematuria (blood in the urine), discomfort in the lower abdomen, aggravated by urination, clouding of urine, fever, general malaise.

In chronic cystitis, symptoms may be virtually absent. The only thing that you can pay attention to is the increased urge to urinate.

Acute cystitis is diagnosed by the clinical picture – pronounced symptoms make it easy to identify this disease. Chronic cystitis is determined by characteristic symptoms, urinalysis results, bacteriological data, cystoscopy, functional studies of the lower urinary tract.

Treatment

Do not delay seeking medical attention! Only a doctor will be able to assess your condition and prescribe effective treatment, thanks to which you will forget about discomfort very quickly. With cystitis, antibacterial drugs are usually prescribed, as well as drugs that relieve spasm of the muscles of the bladder, which reduces pain.

In acute cystitis, patients are recommended a special diet with a low calcium content and plenty of drinking, including herbal infusions that have a diuretic effect.But it is better to refuse tea, coffee and alcohol for the period of treatment. To reduce pain, you can use heating pads, take warm baths.

Prevention

• Drink at least 8 glasses of liquid a day.
• Do not hold back urination, empty your bladder regularly. Stagnant urine is an excellent breeding ground for bacteria.
• It is important to observe hygiene – wash at least once a day, while the direction of movement of the sponge should be from front to back – to avoid bacteria from entering the anus into the vagina.Use toilet paper in a similar way.
• Choose protected sex.
• After intercourse, urinate. This will flush away any bacteria trapped in your urethra during the act.
• Underwear should be made of natural fabrics, you should not wear synthetic panties on a regular basis, and especially thongs, no matter how beautiful they are.
• Avoid hypothermia: do not sit on cold surfaces, immediately after leaving the water, take off your wet swimsuit and put on dry underwear, etc.d.

Pyelonephritis – symptoms, prevention and treatment

The main / Pyelonephritis – symptoms, prevention and treatment

Pyelonephritis is a bacterial inflammation of the kidneys, or rather its pelvis and parenchyma. This pathology may be secondary, that is, it may arise due to other kidney diseases (for example, urolithiasis, glamerulonephritis), or it may be primary (for example, against the background of hypothermia).
The most common causative agents of this disease are staphylococci, streptococci, enterococci, proteas, Escherichia coli, Klebsiella.

The main provoking factors of pyelonephritis. Knowing the main provoking factors of the onset of the disease, it is possible to prevent the occurrence of a chronic form of inflammation and the development of complications:

1. Hypothermia.
2. Pyelonephritis appeared earlier.
3. Diseases of the genitourinary system (glamerulonephritis, urethritis, cystitis, kidney stones.).
4. Inflammatory diseases (tonsillitis, sinusitis, etc.).
5. Untreated pyelonephritis.
6. Frequent stress, overexertion.
7. Weakening of the immune system.
8. Diabetes mellitus.
9. Pregnancy.
10. Injury to the kidneys and bladder.
11. Prolonged stagnation of urine in the bladder.
12. Anomalies of the genitourinary system.
13. The presence of hypovitaminosis (lack of vitamins).
14. HIV infection (provokes the occurrence of other diseases, including pyelonephritis). Women are more prone to pyelonephritis than men due to the anatomical structure of the urogenital system of women.They have a wider and shorter urethra, so infection can easily reach the kidneys.

Signs of acute pyelonephritis . This ailment usually makes itself felt with high fever, vomiting, lethargy, unpleasant sensations in the muscles, as well as chills. After two to three days, you may experience lower back pain. In such cases, urination usually becomes painful and the urine is cloudy. Before back pain appears, you may have discomfort in your groin.

General symptoms of acute pyelonephritis:

1. Sharp chills.
2. Febrile body temperature (39-40 degrees).
3. Urination becomes rapid and painful.
4. Sweating.
5. Intense thirst.
6. Dyspeptic disorders (general malaise, abdominal pain, nausea, vomiting, diarrhea).
7. Intoxication of the body (headaches, severe fatigue, deterioration of health).

Local symptoms:

1. Pain in the affected kidney.(Dull, aching, constant pain, aggravated by any movement).
2. Identification of a positive symptom of Pasternatsky (pain occurs when the edge of the palm of the hand is tapped on the kidneys).
3. Tension and soreness of the muscles of the abdominal wall with the subsequent occurrence of kidney infiltration.

There are also clinical forms of acute pyelonephritis:

1. The sharpest. (The patient’s condition is very serious, there is an increase in body temperature up to 39-40 degrees and severe chills, repeated several times a day, about 2-3 times).

2. Sharp. (Symptoms are also present, but to a lesser extent than in the previous form, there is intoxication of the body, severe dehydration and chills).

3. Subacute. (Here, local symptoms are already more pronounced than acute ones, which are either mild or absent altogether).

4. Latent, otherwise hidden. This form of pyelonephritis does not threaten the patient’s life, but it can become chronic.
If you find such symptoms, you should immediately consult a doctor (urologist or nephrologist) for further diagnosis and treatment! You should not postpone a visit to a specialist, and even more so, self-medicate!

The described disease is detected by urine analysis.Symptoms of peritonitis sometimes occur. Pyelonephritis is often confused with abdominal ailments. It can be mistaken for a stomach ulcer, appendicitis, or something else.

If we are talking about primary pyelonephritis , then renal dysfunction is usually not observed.

Signs of chronic pyelonephritis

This form has a quieter flow. Symptoms are not as pronounced as in the acute form. Sometimes, symptoms may be absent, but after a while the chronic form manifests itself.Most often, it is the acute form that provokes the onset of the chronic.

In total, the following clinical forms are distinguished of chronic pyelonephritis :

1. Latent (latent form) – characterized by minimal symptoms. Patients may feel only severe weakness, fatigue, fever up to 37 degrees, headache, swelling, pain and discomfort in the lumbar region. Some people may have a positive Pasternatsky symptom.In urine tests: slight proteinuria (protein in the urine), leukocyturia (leukocytes in the urine) and bacteriuria (bacteria in the urine), sometimes the patient may be accompanied by hypertension.

2. Recurrent is a form during which exacerbations and remissions occur alternately. A person feels constant discomfort in the area of ​​an inflamed kidney, a slight increase in temperature to subfebrile levels (37 – 38 degrees) and chills. During an exacerbation, pyelonephritis manifests itself in the form of an acute form of inflammation.

3. Hypertensive is a form in which symptoms of hypertension are manifested. Patients have dizziness, headaches, deterioration in general health, insomnia, pain in the heart, shortness of breath, hypertensive crises.

4. Anemic form – characterized by severe symptoms of anemia. The patient feels rapid fatigue, fatigue, deterioration in working capacity, weakness, etc.

5. Azothermic is the most unexpected, dangerous and hidden form of disease manifestation.It manifests itself only when a person has already begun chronic renal failure (chronic renal failure). It is believed that this form is a further continuation of the latent form untimely identified.

Edema is rare. Frequent urination is sometimes encountered. The result is dry skin and constant thirst. This ailment is diagnosed through kidney x-rays and urea studies.

Pyelonephritis in babies. If this ailment occurs in a baby, he usually experiences discomfort in the abdomen.This is accompanied by indigestion. The crumb can lose several pounds. Sometimes it is quite difficult to determine the cause of this condition. This is usually done by examination.

Violation of urination makes itself felt in different ways. The child may have bedwetting. Note that it can be both rare and frequent.

Treatment of acute and chronic forms of pyelonephritis:

Only a urologist or a nephrologist deals with treatment.Depending on the severity of the course of the disease and the duration, the doctor may prescribe the following treatment principles:

1. Conservative etiotropic therapy (drugs). For the treatment of all forms of pyelonephritis, antibiotics of various groups (penicillins, cephalosporins, fluoroquinolones, etc.) are used, such as amoxicillin, ampicillin, gentamicin, cefaclor, ciprofloxacin, etc .; sulfonamides: sulfadimezin, urosulfan and others; nitrofurans: eg furazolin, furagin; nalidixic acid (nalidix, black.), non-steroidal anti-inflammatory drugs (diclofenac, metamizole, etc.), antispasmodics (nosh-pa, papaverine), enterosorbents (for example, activated carbon), anticoagulants (blood thinners): heparin, troxevasin; diuretics (furosemide, lasix, etc.) With prolonged 90,100 pyelonephritis treatment 90,100, it is necessary to take probiotics and antifungal drugs, since antibiotics can provoke the appearance of fungal bacteria in the body. If there are contraindications to antibiotic therapy or it is desirable to add additional treatment, then phytopreparations are used that include individual useful herbs, or complex fees that include several herbs.Common herbs: lingonberry leaf, cornflower flowers, bearberry, wild rose, black poplar buds and others. Herbal preparations: phytolysin, uroflux, etc.
Phytopreparations also have anti-inflammatory, diuretic and antibacterial effects. There is the most common herbal phytopreparation – kanefron. Has all of the above actions.

2. Physiotherapy. This is more of an additional method than the main one. Physiotherapy helps to improve the condition, kidney function and accelerate the effect of etiotropic therapy.
Types of physiotherapy: electrophoresis of furadonin or calcium chloride (other drugs can also be used), ultrasound (if there are no kidney stones), thermal effects on the kidneys (for example, diathermy, therapeutic mud, etc.), microwave therapy, etc.

3. If all methods of treatment turn out to be useless, and the patient’s condition remains the same or worsens, then a surgical method is used. Basically, surgery is performed with purulent pyelonephritis, kidney carbuncle or abscess.Depending on the condition, the doctor himself chooses the type of surgical correction.

Complications of pyelonephritis:

Unfortunately, it is not always possible to recover safely and forget about this disease. If you do not visit a doctor, do not fulfill his appointment, or, in general, do not check, then the following complications may appear:
1. Violation of the filtration function of the kidneys.
2. Chronic renal failure.
3. Sepsis.
4. Accumulation of pus in the kidneys. (Otherwise, pyonephrosis).
5. Paranephrite. (Inflammation of the perineal tissue).

Prevention of pyelonephritis:

1. Dress for the season. Try to keep your lumbar area under a layer of warm clothing.
2. Treat inflammation in the body, because they can also cause pyelonephritis.
3. Visit the polyclinic twice a year for a routine check-up.
4. Practice good personal hygiene.
5. Try not to overcool.
6. If you already have pyelonephritis, then visit a urologist, nephrologist and follow all his appointments.
7. In which case, do not self-medicate.
8. Follow a diet (exclude salty, canned food and bakery products, if there is edema and increased blood pressure, then limit the use of water and drinks containing caffeine).
9. If you feel unwell, call a doctor immediately!

For questions treatment of pyelonephritis you can contact our clinic “MC For the whole family”, located at Irkutsk, st.