Tension headache

Tension headache

Definition  :
A tension headache is generally a diffuse, mild to moderate pain that's often described as feeling like a tight band around your head. A tension headache — or tension-type headache as it's medically known — is the most common type of headache, and yet its causes aren't well understood.

It may feel as if muscle contractions are responsible for your head pain, which is why this type of headache is generally referred to as a tension-type headache, though experts no longer think muscle contractions are the cause.

Fortunately, effective treatments for tension headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.

Symptoms:
Signs and symptoms of a tension headache include:

• Dull, aching head pain
• The sensation of tightness or pressure across your forehead or on the sides and back of your head
• Tenderness on your scalp, neck and shoulder muscles
• Occasionally, loss of appetite

A tension headache can last from 30 minutes to an entire week. You may experience these headaches only occasionally, or nearly all the time. If your headaches occur 15 or more days a month for at least three months, they're considered chronic. If you have headaches that occur fewer than 15 times in a month, your headaches are considered episodic. However, people with frequent episodic headaches are at a higher risk of developing chronic headaches.

The headache is usually described as mild to moderately intense. The severity of the pain varies from one person to another, and from one headache to another in the same person.

Tension headaches can sometimes be difficult to distinguish from migraines, but unlike some forms of migraine, tension headache usually isn't associated with visual disturbances (blind spots or flashing lights), nausea, vomiting, abdominal pain, weakness or numbness on one side of the body, or slurred speech. And, while physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to light or sound can occur with a tension headache, but these aren't common symptoms.

When to see a doctor
Make an appointment with your doctor
If tension headache disrupts your life or you find that you need to take medication for your headaches more than twice a week, make an appointment to see your doctor.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).

When to seek emergency help
If you have any of these signs or symptoms, seek emergency care:

• Abrupt, severe headache, which may be like a thunderclap
• Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
• Headache after a head injury, especially if the headache gets worse
• Chronic, progressive headache that is precipitated by coughing, exertion, straining or a sudden movement

Causes:
The exact cause or causes of tension headache are unknown. Experts used to think that the pain of tension headache stemmed from muscle contraction in the face, neck and scalp, perhaps as a result of heightened emotions, tension or stress. But research suggests that there doesn't appear to be a significant increase in muscle tension in people diagnosed with tension headache.

The most common theories support interference or "mixed signals" involving nerve pathways to the brain, which is demonstrated by a heightened sensitivity to pain in people who have tension headaches. Increased muscle tenderness, a common symptom of tension headache, may be the result of overactive pain receptors.

Triggers
It's likely other factors also contribute to the development of tension headaches. Potential triggers may include:

• Stress
• Depression and anxiety
• Poor posture
• Working in awkward positions or holding one position for a long time
• Jaw clenching

Complications:
 Because tension headaches are so common, their effect on job productivity and overall quality of life is considerable. The frequent pain may make you feel unable to attend family and social activities. You might need to stay home from work, or if you do go to your job, you often work at only a fraction of your normal efficiency

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Tennis elbow

Tennis elbow

Definition  :
Tennis elbow is a painful condition that occurs when tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm. Tennis elbow can result from poor technique in executing a tennis backhand. However, many occupations also feature repetitive wrist and arm motions that can cause tennis elbow.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow. Pain can also spread into your forearm and wrist.
Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don't help or if symptoms are disabling, your doctor may suggest surgery.


Symptoms:
The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:

• Shake hands
• Turn a doorknob
• Hold a coffee cup

When to see a doctor
Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don't ease your elbow pain and tenderness.


Causes:
Tennis elbow (lateral epicondylitis) is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow (lateral epicondyle).
As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:

• Using plumbing tools
• Painting
• Driving screws
• Cutting up cooking ingredients, particularly meat
• Excessive computer mouse use

Complications:
Left untreated, tennis elbow can result in chronic pain — especially when lifting or gripping objects. Using your arm too strenuously before your elbow has healed can make the problem worse.

Treatments and drugs:
Tennis elbow often gets better on its own. But if over-the-counter pain medications and other self-care measures aren't helping, your doctor may suggest physical therapy. Severe cases of tennis elbow may require surgery.
Therapy

• Learn proper form. Your doctor may suggest that experts evaluate your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that your wrist and forearm movements don't continue to contribute to your symptoms.
• Exercises. Your doctor or a physical therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm.
• Braces. Your doctor may also suggest you wear a forearm strap or brace to reduce stress on the injured tissue.

Surgery
If your symptoms haven't improved after at least a year of extensive conservative therapy, you may be a candidate for surgery to remove damaged tissue. These types of procedures can be performed through a large incision or through several small incisions. Rehabilitation exercises are crucial to recovery.

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Tendinitis

Tendinitis

Definition  :
Tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your body's tendons, it's most common around your shoulders, elbows, wrists and heels.
Some common names for various tendinitis problems are:

• Tennis elbow
• Golfer's elbow
• Pitcher's shoulder
• Swimmer's shoulder
• Jumper's knee

If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain.

Symptoms:
Signs and symptoms of tendinitis occur at the point where a tendon attaches to a bone and typically include:

• Pain, often described as a dull ache, especially when moving the affected limb or joint
• Tenderness
• Mild swelling, possibly

When to see a doctor
Most cases of tendinitis can respond to self-care measures. See your doctor if your signs and symptoms persist and interfere with your day-to-day activities for more than a few days.


Causes:
Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time. Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons needed to perform the tasks. Using proper technique is especially important when performing repetitive sports movements or job-related activities. Improper technique can overload the tendon — which can occur, for instance, with tennis elbow — and lead to tendinitis.

Complications:
 Without proper treatment, tendinitis can increase your risk of experiencing tendon rupture — a much more serious condition that may require surgical repair.

Treatments and drugs:
The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, taking care of tendinitis on your own — including rest, ice and over-the-counter pain relievers — may be all the treatment that you need.
Medications
For tendinitis, your doctor may recommend these medications:

• Corticosteroids. Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain. However, repeated injections may weaken a tendon, increasing your risk of rupturing the tendon.
• Pain relievers. Taking aspirin, naproxen (Aleve) or ibuprofen (Advil, Motrin, others) may relieve discomfort associated with tendinitis. Topical creams with anti-inflammatory medication — popular in Europe and becoming increasingly available in the United States — may also be effective in relieving pain without the potential side effects of taking anti-inflammatory medications by mouth.

Therapy
You might benefit from a program of specific exercise designed to stretch and strengthen the affected muscle-tendon unit. For instance, eccentric strengthening — which emphasizes contraction of a muscle while it's lengthening — has been shown to be effective in treating chronic tendon inflammation.
Surgery
Depending on the severity of your tendon injury, surgical repair may be needed.

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TMJ disorders

TMJ disorders

Definition  :
The temporomandibular (tem-puh-roe-mun-DIB-u-lur) joint (TMJ) acts like a sliding hinge, connecting your jawbone to your skull. TMJ disorders can cause pain in your jaw joint and in the muscles that control jaw movement.

The exact cause of a person's TMJ disorder is often difficult to determine. Your pain may be due to a combination of problems, such as arthritis or jaw injury. Some people who have jaw pain also tend to clench or grind their teeth, but many people habitually clench their teeth and never develop TMJ disorders.

In most cases, the pain and discomfort associated with TMJ disorders can be alleviated with self-managed care or nonsurgical treatments. Severe TMJ disorders may require surgical repair.


Symptoms:
Signs and symptoms of TMJ disorders may include:

• Pain or tenderness of your jaw
• Aching pain in and around your ear
• Difficulty chewing or discomfort while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close your mouth

TMJ disorders can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there's no pain or limitation of movement associated with your jaw clicking, you probably don't need treatment for a TMJ disorder.

When to see a doctor
Seek medical attention if you have persistent pain or tenderness in your jaw, or if you can't open or close your jaw completely. Your doctor, your dentist or a TMJ specialist can discuss possible causes and treatments of your problem.

Causes:
The temporomandibular joint (TMJ) combines a hinge action with sliding motions. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which normally keeps the movement smooth.
Painful TMJ disorders can occur if:

• The disk erodes or moves out of its proper alignment
• The joint's cartilage is damaged by arthritis
• The joint is damaged by a blow or other impact

In many cases, however, the cause of TMJ disorders isn't clear.


Treatments and drugs:
In some cases, the symptoms of TMJ disorders may go away without treatment. If your symptoms persist, your doctor may recommend a variety of treatment options.

Medications
In conjunction with other nonsurgical treatments, medications that may help relieve the pain associated with TMJ disorders may include:

• Pain relievers. If over-the-counter pain medications aren't enough to relieve TMJ pain, your doctor or dentist may prescribe stronger pain relievers.
• Tricyclic antidepressants. These medications, such as amitriptyline, used to be used mostly for depression, but now are also used for pain relief.
• Muscle relaxants. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders.
• Sedatives. If nighttime teeth clenching is aggravating your pain, your doctor might prescribe a sedative such as clonazepam (Klonopin).

Therapies
Nonpharmaceutical treatments for TMJ disorder include:

• Bite guards (oral splints). Often, people with jaw pain will benefit from wearing a soft or firm device inserted over their teeth, but the reasons why these devices are beneficial are not well understood.
• Physical therapy. Treatments might include ultrasound, moist heat and ice — along with exercises to stretch and strengthen jaw muscles.
• Counseling. Education and counseling can help you understand the factors and behaviors that may aggravate your pain, so you can avoid them. Examples include teeth clenching or grinding, leaning on your chin, or biting fingernails.

Surgical or other procedures
When other methods don't help, your doctor might suggest procedures such as:

• Arthrocentesis. This procedure involves the insertion of needles into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.
• Injections. In some people, corticosteroid injections into the joint may be helpful. Infrequently, injecting botulinum toxin (Botox, others) into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.
• Surgery. If your jaw pain does not resolve with more-conservative treatments and if it appears to be caused by a structural problem within the joint, your doctor or dentist may suggest surgery to repair or replace the joint. The National Institute of Dental and Craniofacial Research considers TMJ surgery to be controversial and recommends that it be avoided whenever possible.

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Temporal lobe seizure

Temporal lobe seizure

Definition  :
Temporal lobe seizures are seizures that originate in the two temporal lobes of your brain.
The temporal lobes process emotions, fight-or-flight reactions, and are important for short-term memory. Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings — such as euphoria, fear, panic and deja vu.

During a temporal lobe seizure, you may remain partially conscious. Or, if the temporal lobe seizure is more intense, you may be unresponsive, even though you look awake. You also may make repetitive movements of your lips and hands.

Temporal lobe seizures may stem from an anatomical defect or scar. But the cause often remains unknown.

Temporal lobe seizures may be resistant to anti-seizure medications. Surgery may be an option for some people who don't respond to medication.


Symptoms  :
An unusual sensation, known as an aura, may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures experiences auras, and those who have auras may not remember them. The aura is actually a small seizure itself — one that has not spread into an observable seizure that impairs consciousness and ability to respond. Examples of auras include:

• A sudden sense of unprovoked fear
• A deja vu experience — a feeling that what's happening has happened before
• The sudden occurrence of a strange odor or taste
• A rising sensation in the abdomen

People who have temporal lobe seizures can remain partially conscious during a seizure, but they also may lose awareness of their surroundings and often don't remember what happened.
A temporal lobe seizure usually lasts 30 seconds to two minutes. Characteristic signs and symptoms of temporal lobe seizures include:

• Loss of awareness of surroundings
• Staring
• Lip smacking
• Repeated swallowing or chewing
• Unusual finger movements, such as picking motions

After a temporal lobe seizure, you may have:

• A brief period of confusion and difficulty speaking
• Inability to recall the events that occurred during the seizure
• Unawareness of having had a seizure until someone else tells you

In extreme cases, what starts as a temporal lobe seizure evolves into a grand mal (tonic-clonic) seizure — featuring convulsions and a loss of consciousness.

When to see a doctor
Seek medical advice in these circumstances:

• If you think you're having seizures — early diagnosis is important
• When the number or severity of seizures increases significantly without explanation
• When new signs or symptoms of seizures appear

Seek emergency medical care if:

• A seizure lasts more than five minutes
• The person doesn't recover completely or as quickly as usual after the seizure is over
• Rhythmic muscle contractions or jerky movements occur, which may indicate a grand mal seizure is developing

If it appears a grand mal seizure may be developing:

• Call for medical help immediately.
• Gently roll the person onto one side and put something soft under his or her head.
• Loosen tight neckwear.
• Don't put anything in the mouth — the tongue can't be swallowed, and objects placed in the mouth can be bitten or inhaled.
• Don't try to restrain the person. Look for a medical alert bracelet, which may indicate an emergency contact person and other information.

Causes:
Often, the cause of temporal lobe seizures remains unknown. However, they can be a result of:

• Traumatic brain injury
• Infections, such as encephalitis or meningitis, or history of such infection
• A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
• Inflammatory disorders of the brain
• Injury due to a previous lack of oxygen
• Blood vessel malformations in the brain
• Stroke
• Brain tumors
• Genetic syndromes

During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronized, a convulsion or seizure may occur. If this happens in just one area of the brain, the result is a partial seizure. When this occurs in an area of the brain known as the temporal lobe, it's called a temporal lobe seizure.

Complications:
 Over time, repeated temporal lobe seizures can cause the part of the brain that's responsible for learning and memory to shrink. This area is called the hippocampus. Brain cell loss in this area may cause memory problems.

Treatments and drugs:

Medications
Numerous medications are available to treat temporal lobe seizures, including:

• Carbamazepine (Carbatrol, Tegretol, others)
• Phenytoin (Dilantin, Phenytek)
• Valproic acid (Depakene, Stavzor)
• Oxcarbazepine (Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Gralise, Neurontin)
• Topiramate (Topamax)
• Phenobarbital
• Zonisamide (Zonegran)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)
• Felbamate (Felbatol)
• Lacosamide (Vimpat)
• Vigabatrin (Sabril)

However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common. In particular, the FDA has issued a warning that the drug Lamictal has been associated with a type of meningitis. Discuss possible side effects with your doctor when deciding about treatment options.
Surgery
Success rates for temporal lobe epilepsy surgery range from about 60 to 90 percent. Success, as defined in surgical outcome studies, means having no seizures or far fewer seizures. It doesn't mean discontinuing medication.
Surgery is generally not an option if:

• Your seizures come from a region of the brain that performs vital brain functions
• Your seizures come from more than one area
• Where your seizures originate can't be identified

Preparing for surgery likely involves talking to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.
Before surgery, you'll need:

• A comprehensive evaluation
• MRI scans of your brain
• Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG

In some cases, surgery to implant intracranial electrodes may be necessary before finally deciding about temporal lobe surgery.
After surgery, most people need to continue taking medication to help ensure that seizures don't recur. However, successful surgery often means being able to reduce the dose, and some people are able to stop taking medication. Infrequently, surgery can lead to neurological problems. Discuss the possible risks with your surgeon before making final decisions about surgery.
Radiosurgery
Researchers have been investigating the use of radiosurgery, which uses a Gamma Knife to deliver a precise dose of radiation to the damaged portion of the brain. This procedure is still considered experimental, and the anti-seizure effects as well as any side effects of the procedure may be delayed for one to two years.
Vagus nerve stimulation
A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck. The device turns on and off according to an adjustable program and can be activated with a magnet. The device doesn't detect seizures. It's usually well tolerated, but it's not a replacement for medication.
Pregnancy and seizures
The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, the birth defect risk is about twice that of pregnant women who don't require seizure medications. Seizures pose a risk to a developing baby, so it is generally not recommended to stop medications during pregnancy. Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.
The risk of birth defects differs, depending on the seizure medication, and is considered to be higher in women taking more than one drug. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby. If your seizures can't be well controlled with any other medication, discuss the potential risks with your doctor.
Contraception and anti-seizure medications
Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.

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Giant cell arteritis

Giant cell arteritis

Definition:
Giant cell arteritis is an inflammation of the lining of your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis or cranial arteritis.

Giant cell arteritis frequently causes headaches, jaw pain, and blurred or double vision. Blindness and, less often, stroke are the most serious complications of giant cell arteritis.
Prompt treatment of giant cell arteritis is critical in order to prevent permanent tissue damage and loss of vision. Corticosteroid medications usually relieve symptoms of giant cell arteritis and may prevent loss of vision. You'll likely begin to feel better within days of starting your treatment.


Symptoms:
The most common symptoms of giant cell arteritis are head pain and tenderness — often severe — that usually occurs in both temples. Some people, however, have pain in only one temple or in the front of the head.
Signs and symptoms of giant cell arteritis can vary. For some people, the onset of the condition feels like the flu — with muscle stiffness and aches (myalgia) around the shoulders and hips, fever and fatigue, as well as headaches.
Generally, signs and symptoms of giant cell arteritis include:

• Persistent, severe head pain and tenderness, usually in your temple area
• Vision loss or double vision
• Scalp tenderness — it may hurt to comb your hair or even to lay your head on a pillow, especially where the arteries are inflamed
• Jaw pain (jaw claudication) when you chew or open your mouth wide
• Sudden, permanent loss of vision in one eye
• Fever
• Unexplained weight loss

Pain and stiffness in the neck, shoulders or hips are common symptoms of a related disorder, polymyalgia rheumatica. Approximately half the people with giant cell arteritis also have polymyalgia rheumatica.

When to see a doctor
If you develop a new, persistent headache or any of the problems listed above, see your doctor without delay. If you're diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent blindness.

Causes:
Your arteries are pliable tubes with thick, elastic walls. Oxygenated blood leaves your heart through your body's main artery, the aorta. The aorta then subdivides into smaller arteries that deliver blood to all parts of your body, including your brain and internal organs.

With giant cell arteritis, some of these arteries become inflamed, causing them to swell and sometimes decreasing blood flow. Just what causes these arteries to become inflamed isn't known.
Although almost any large or medium-sized artery can be affected, swelling most often occurs in the temporal arteries in your head, which are located just in front of your ears and continue up into your scalp. In some cases, the swelling affects just part of an artery with sections of normal vessel in between.

Complications:
Giant cell arteritis can cause the following complications:

• Blindness. This is the most serious complication of giant cell arteritis. The swelling that occurs with giant cell arteritis narrows your blood vessels, reducing the amount of blood — and, therefore, oxygen and vital nutrients — that reaches your body's tissues. Diminished blood flow to your eyes can cause sudden, painless vision loss in one or, in rare cases, both eyes. Unfortunately, blindness is usually permanent.
• Aortic aneurysm. Having giant cell arteritis increases your risk of aneurysm. An aneurysm is a bulge that forms in a weakened blood vessel, usually in the aorta, the large artery that runs down the center of your chest and abdomen. An aortic aneurysm is a serious condition because it may burst, causing life-threatening internal bleeding. Because it may occur even years after the initial diagnosis of giant cell arteritis, your doctor may monitor the health of your aorta with annual chest X-rays or other imaging tests, such as ultrasound, CT scan or MRI.
• Stroke. In some cases, a blood clot may form in an affected artery, obstructing blood flow completely, depriving part of your brain of necessary oxygen and nutrients, and causing stroke. This serious condition is an uncommon complication of giant cell arteritis.

Treatments and drugs:
Treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.
You should start feeling better within just a few days, but you may need to continue taking medication for one to two years or longer. After the first month, your doctor may gradually begin to lower the dosage until you reach the lowest dose of corticosteroids needed to control inflammation as measured by sed rate and CRP tests. Some of your symptoms may return during this tapering period.

What are corticosteroids?
Corticosteroids are powerful anti-inflammatory drugs whose effects mimic those of hormones produced by your adrenal glands. The drugs can effectively relieve pain, but prolonged use — especially at high doses — can lead to a number of serious side effects.
Older adults, who are most likely to be treated for giant cell arteritis, are particularly at risk of side effects because they're more prone to certain conditions that also may be caused by corticosteroids. These include:

• Osteoporosis
• High blood pressure
• Muscle weakness
• Glaucoma
• Cataracts

Other possible side effects of corticosteroid therapy include:

• Weight gain
• Increased blood sugar levels, sometimes leading to diabetes
• Thinning skin and increased bruising
• Weakened immune system, leading to susceptibility to infection and delayed healing

To counter the potential side effects of corticosteroid treatment, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. Your doctor is also likely to monitor your blood pressure and may recommend an exercise program, diet changes and medication to keep blood pressure within a normal range. Most side effects go away when the corticosteroid treatment is stopped.
Ask your doctor about taking between 81 and 100 milligrams of aspirin daily (anti-platelet therapy). Taken on a daily basis, aspirin may reduce the risk of blindness and stroke.

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Bruxism/teeth grinding

Bruxism/teeth grinding

Definition:
Bruxism (BRUK-siz-um) is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth together during the day or grind them at night, which is called sleep bruxism.
Bruxism may be mild and may not even require treatment. However, it can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems. Because you may have sleep bruxism and be unaware of it until complications develop, it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Symptoms:
Signs and symptoms of bruxism may include:

• Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
• Teeth that are worn down, flattened, fractured or chipped
• Worn tooth enamel, exposing deeper layers of your tooth
• Increased tooth sensitivity
• Jaw pain or tightness in your jaw muscles
• Tired jaw muscles
• Earache — because of severe jaw muscle contractions, not a problem with your ear
• Headache
• Chronic facial pain
• Damage from chewing on the inside of your cheek
• Indentations on your tongue

When to see a doctor
See your doctor or dentist if:

• Your teeth are worn, damaged or sensitive
• You have pain in your jaw, face or ear
• Others complain that you make a grinding noise while you sleep

If you notice that your child is grinding his or her teeth — or has other signs or symptoms of this condition — be sure to mention it at your child's next dentist appointment.

Causes:
Doctors don't completely understand what causes bruxism. Possible physical or psychological causes may include:

• Anxiety, stress or tension
• Suppressed anger or frustration
• Aggressive, competitive or hyperactive personality type
• Abnormal alignment of upper and lower teeth (malocclusion)
• Other sleep problems
• Response to pain from an earache or teething (in children)
• Complication resulting from a disorder, such as Huntington's disease or Parkinson's disease
• An uncommon side effect of some psychiatric medications, including certain antidepressants

Complications:
In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:

• Damage to your teeth (including restorations and crowns) or jaw
• Tension-type headaches
• Facial pain
• Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth

Treatments and drugs:
In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't grind or clench their teeth badly enough to require therapy. However, if the problem is severe, treatment options include certain therapies and medications.

Therapies

• Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help your child to talk about his or her fears just before bed or to relax with a warm bath or a favorite book.
• Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.
• Splints are usually constructed of hard acrylic and fit over your upper or lower teeth. Some dentists may make them right in the office, while others may send them to a laboratory to be made.
• Mouth guards are available over-the-counter and from your dentist. Your dentist can make a custom mouth guard to fit your mouth. Mouth guards are less expensive than are splints, they are softer than splints, and over time they may dislodge during teeth grinding. In addition, mouth guards may actually increase bruxism in some people.
• Correcting misaligned teeth may help if your bruxism seems to be associated with dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and although it will correct the wear, it may not stop the bruxism.
• Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. Ask your dentist to show you the best position for your mouth and jaw.

If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses.

Medications
In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. OnabotulinumtoxinA (Botox) injections may help some people with severe bruxism who haven't responded to other treatments. However, more research is needed, as this treatment hasn't been thoroughly studied.

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Vitamin deficiency anemia

Vitamin deficiency anemia

Definition:
Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower-than-normal amounts of certain vitamins. The vitamins linked to vitamin deficiency anemia include folate, vitamin B-12 and vitamin C.

Vitamin deficiency anemia can occur if you don't eat enough folate, vitamin B-12 or vitamin C. Or vitamin deficiency anemia can occur if your body has trouble absorbing or processing these vitamins.
The lack of red blood cells caused by vitamin deficiency anemia can cause weakness and shortness of breath. Vitamin deficiency anemia can usually be corrected with vitamin supplements and changes to your diet.

Symptoms:
Signs and symptoms of vitamin deficiency anemia include:

• Fatigue
• Shortness of breath
• Dizziness
• Pale or yellowish skin
• Swollen tongue that may appear dark red
• Weight loss
• Diarrhea
• Numbness or tingling in your hands and feet
• Muscle weakness
• Irritability
• Unsteady movements
• Mental confusion or forgetfulness

Vitamin deficiencies usually develop slowly over several months to years. Vitamin deficiency symptoms may be subtle at first, but they increase as the deficiency worsens.

Causes:
Vitamin deficiency anemia occurs when your body doesn't have enough of the vitamins needed to produce adequate numbers of healthy red blood cells. Red blood cells carry oxygen from your lungs throughout your body. If your diet is lacking in certain vitamins, vitamin deficiency anemia can develop. Or vitamin deficiency anemia may develop because your body can't properly absorb the nutrients from the foods you eat.

Causes of vitamin deficiency anemias, also known as megaloblastic anemias, include:

• Folate deficiency anemia. Folate, also known as vitamin B-9, is a nutrient found mainly in fruits and leafy green vegetables. A diet consistently lacking in these foods can lead to a deficiency.
  An inability to absorb folate from food can also lead to a deficiency. Most nutrients from food are absorbed in your small intestine. People with diseases of the small intestine, such as Crohn's disease or celiac disease, or those who have had a large part of the small intestine surgically removed or bypassed, may have difficulty absorbing folate or its synthetic form, folic acid. Alcohol decreases absorption of folate, so drinking alcohol to excess may lead to a deficiency. Certain prescription drugs, such as some anti-seizure medications, can interfere with absorption of this nutrient.
  Pregnant women and women who are breast-feeding have an increased demand for folate, as do people undergoing hemodialysis for kidney disease. Failure to meet this increased demand can result in a deficiency.
  
• Vitamin B-12 deficiency anemia (pernicious anemia). Vitamin B-12 deficiency can result from a diet lacking in vitamin B-12, which is found mainly in meat, eggs and milk. Vitamin B-12 deficiency anemia can also occur if your small intestine can't absorb vitamin B-12. This may be due to surgery to your stomach or small intestine (such as gastric bypass surgery), abnormal bacterial growth in your small intestine, or an intestinal disease, such as Crohn's disease or celiac disease, that interferes with absorption of the vitamin. Vitamin B-12 deficiency can also be caused by a tapeworm ingested from contaminated fish, because the tapeworm saps nutrients from your body. However, a vitamin B-12 deficiency is most often due to a lack of a substance called intrinsic factor.
  Intrinsic factor is a protein secreted by the stomach that joins vitamin B-12 in the stomach and escorts it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B-12 can't be absorbed and leaves your body as waste. Lack of intrinsic factor may be due to an autoimmune reaction, in which your immune system mistakenly attacks the stomach cells that produce it. Vitamin B-12 deficiency anemia caused by a lack of intrinsic factor is called pernicious anemia.
  
• Vitamin C deficiency anemia. Though rare, vitamin C deficiency can develop if you don't get enough vitamin C from the foods you eat. Vitamin C deficiency is also possible if something impairs your ability to absorb vitamin C from food. For instance, smoking impairs your body's ability to absorb vitamin C.

Complications:
Being deficient in vitamins increases your risk of many health problems:

• Pregnancy complications. Pregnant women with folate deficiency may be more likely to experience miscarriage and deliver babies that are premature or are smaller than average. A developing fetus that doesn't get enough folate from its mother can develop birth defects of the brain and spinal cord. If you're thinking of becoming pregnant, ask your doctor whether you should consider taking folic acid supplements, so your body's stores of folate will be enough to support your baby.
• Nervous system disorders. While vitamin B-12 is important for the production of red blood cells, it's also important for a healthy nervous system. Untreated, vitamin B-12 deficiency can lead to neurological problems, such as persistent tingling in your hands and feet. It can lead to mental confusion and forgetfulness, because vitamin B-12 is necessary for healthy brain function. Without treatment for vitamin B-12 deficiency, neurological complications can become permanent. Vitamin B-12 deficiency can cause these and other health problems before it leads to anemia.
• Scurvy. Vitamin C deficiency can lead to scurvy. Signs and symptoms of this rare disease include bleeding under the skin and around the gums.

Treatments and drugs:
Treatment for vitamin deficiency anemia includes supplements and changes in diet.

• Folate deficiency anemia. Treatment involves eating a healthy diet and taking folic acid supplements as prescribed by your doctor. In most cases, folic acid supplements are taken orally. Once your body's level of folate increases to normal, you may be able to stop taking the supplements. But if the cause of your folate deficiency can't be corrected, you may need to take folic acid supplements for life.
• Vitamin B-12 deficiency anemia (pernicious anemia). For milder cases of vitamin B-12 deficiency, treatment may involve changes to your diet and vitamin B-12 supplements in pill form or as a nasal spray. In more severe cases, you may receive vitamin B-12 injections. At first you may receive the shots as often as every other day. Eventually you'll need injections just once a month, which may continue for life, depending on your situation.
• Vitamin C deficiency anemia. Treatment for anemia related to vitamin C deficiency is with vitamin C tablets. Additionally, you increase your intake of foods and beverages that contain vitamin C.

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Dry eyes

Dry eyes

Definition:
Dry eyes occur when your tears aren't able to provide adequate moisture for your eyes. Tears can be inadequate for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears.

Dry eyes feel uncomfortable. If you have dry eyes, your eyes may sting or burn. You may experience dry eyes in certain situations, such as on an airplane, in an air-conditioned room, while riding a bike, or after looking at a computer screen for a few hours.

Treatments for dry eyes may make you more comfortable. These treatments can include lifestyle changes and eyedrops. For more-serious cases of dry eyes, surgery may be an option.

Symptoms:
 Signs and symptoms, which usually affect both eyes, may include:

• A stinging, burning or scratchy sensation in your eyes
• Stringy mucus in or around your eyes
• Increased eye irritation from smoke or wind
• Eye fatigue
• Sensitivity to light
• Eye redness
• A sensation of having something in your eyes
• Difficulty wearing contact lenses
• Periods of excessive tearing
• Blurred vision, often worsening at the end of the day or after focusing for a prolonged period

When to see a doctor
See your doctor if you've had prolonged signs and symptoms of dry eyes, including red, irritated, tired or painful eyes. Your doctor can take steps to determine what's bothering your eyes or refer you to a specialist.

Causes:
Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils, and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection.

For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don't produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications and other causes, such as environmental factors, also can lead to dry eyes.

Poor tear quality
The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes symptoms.

• Oil. The outer layer of the tear film, produced by small glands on the edge of your eyelids (meibomian glands), contains fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If your oil glands don't produce enough oil, the watery layer evaporates too quickly, causing dry eyes. Dry eyes are common in people whose meibomian glands are clogged. Meibomian dysfunction is more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea and other skin disorders.
• Water. The middle layer is mostly water with a little bit of salt. This layer, produced by the tear glands (lacrimal glands), cleanses your eyes and washes away foreign particles or irritants. If your eye produces inadequate amounts of water, the oil and mucous layers can touch and cause a stringy discharge.
• Mucus. The inner layer of mucus helps spread tears evenly over the surface of your eyes. If you don't have enough mucus to cover your eyes, dry spots can form on the front surface of the eye (cornea).

Decreased tear production
Dry eyes can occur when you're unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VIE-tis SIK-uh).
You may not produce enough tears if you:

• Are older than 50. Tear production tends to diminish as you get older. Dry eyes are common in people older than 50.
• Are a postmenopausal woman. A lack of tears is more common among women, especially after menopause. This may be due in part to hormonal changes.
• Have a medical condition that reduces your tear production. Dry eyes are also associated with some medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren's syndrome, thyroid disorders and vitamin A deficiency.
• Have had laser eye surgery. Refractive eye surgeries such as laser-assisted in-situ keratomileusis (LASIK) may cause decreased tear production and dry eyes. Symptoms of dry eyes related to these procedures are usually temporary.
• Have tear gland damage. Damage to the tear glands from inflammation or radiation can hamper tear production.

Eyelid problems
Blinking spreads a continuous thin film of tears across the surface of your eyes. If you have an eyelid problem that makes it difficult to blink, tears may not be spread across your eye adequately or your tears may evaporate too quickly, causing dry eyes. Eyelid problems can include an out-turning of the lids (ectropion) or an in-turning of the lids (entropion).

Medications that cause dry eyes
Medications that can cause dry eyes include:

• Some drugs used to treat high blood pressure
• Antihistamines and decongestants
• Hormone replacement therapy
• Certain antidepressants
• Isotretinoin-type drugs for treatment of acne

Additional causes
Other causes of dry eyes include:

• Wind
• Dry air
• Tasks that require enough concentration that you blink less often, such as working at a computer, driving or reading

Complications:
Generally, dry eyes don't cause serious problems. However, possible complications include:

• More-frequent eye infections. Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection.
• Scarring on the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, scarring on the surface of your corneas and vision problems.
• Decreased quality of life. Dry eyes can make it difficult to perform everyday activities.

Treatments and drugs:

For most people with occasional or mild dry eyes symptoms, treatment involves over-the-counter eyedrops, such as artificial tears, and other home remedies. It's best to avoid eyedrops that reduce redness, however. If your dry eyes symptoms are persistent and more serious, your treatment options will depend on what's causing your dry eyes. Some conditions that cause dry eyes can be reversed or managed. Other treatments can improve your tear quality or stop your tears from quickly draining away from your eyes.

Treating the underlying cause of dry eyes
In some cases, treating an underlying health issue can help reverse dry eyes. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn't cause that side effect.

If you have an eyelid condition, such as an anatomic abnormality or a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).
If your signs and symptoms suggest an autoimmune condition, such as rheumatoid arthritis or Sjogren's syndrome, your doctor may refer you to a rheumatologist for evaluation.

Medications
Prescriptions used to treat dry eyes include:

• Antibiotics to reduce eyelid inflammation. If inflammation along the edge of your eyelids keeps the oil glands from secreting oil into your tears, your doctor may recommend antibiotics to reduce inflammation. Antibiotics can be administered as eyedrops or ointment, or they can be taken in pill form.
  
• Prescription eyedrops to control cornea inflammation. Inflammation on the surface of your eyes may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or that contain corticosteroids to control inflammation.
  
• Prescription eye inserts that work like artificial tears. For people with moderate to severe dry eyes symptoms who can't use artificial tears, one option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eyedrops to lubricate your eye.

Treatments
Treatments that may be used include:

• Closing your tear ducts to reduce tear loss. Your doctor may suggest treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away. Tear ducts can be plugged with tiny silicone plugs (punctal plugs) that conserve both your own tears and artificial tears you may add. Silicone plugs can be removed or left in. Or, tear ducts can be plugged with a procedure that uses heat. In a more permanent procedure called thermal cautery, your doctor numbs the area with an anesthetic and then applies a hot wire that shrinks the tissues of the drainage area and causes scarring, which closes the tear duct.
  
• Covering your eyes with a special contact lens. People with severe dry eyes may opt for special contact lenses. These contact lenses help protect or shield the surface of your eyes, trapping moisture close to your eyes in order to relieve your dry eyes symptoms. Ask your eye doctor whether these special lenses, called bandage lenses or corneal shields, are an option for you.
  
• Unblocking blocked oil glands. A new treatment called LipiFlo thermal pulsation helps clear blocked oil glands. During the treatment, a device that looks like an eyecup is placed over your eye. The device then delivers a gentle, warm massage to the lower eyelid. The procedure takes less than 15 minutes, and you can go home right afterward. Results usually begin within a few days. Because this is a new treatment, it may not yet be available everywhere.

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Double uterus

Double uterus

Definition:
In a female fetus, the uterus starts out as two small tubes. As the fetus develops, the tubes normally join to create one larger, hollow organ — the uterus. Sometimes, however, the tubes don't join completely. Instead, each one develops into a separate structure. This condition is called double uterus (uterus didelphys).

Double uterus is rare — and sometimes not even diagnosed. The percentage of women with a double uterus is likely higher in women with a history of miscarriage or premature birth.
Treatment is needed only if a double uterus causes symptoms or complications, such as pelvic pain or repeated miscarriages.


Symptoms:
Some women have a double uterus and never realize it — even during pregnancy and childbirth. Each cavity in a double uterus often leads to its own cervix. Some women with a double uterus also have a duplicate or divided vagina.
Possible signs and symptoms may include:

• Unusual pain before or during a menstrual period
• Abnormal bleeding during a period, such as blood flow despite the use of a tampon

When to see a doctor
If you have signs and symptoms common to a double uterus, make an appointment with your doctor. Receiving an early diagnosis is especially important if you plan to become pregnant, or if you've had repeated miscarriages. Your doctor can recommend treatment options to improve your chances of getting pregnant, staying pregnant and having a safe delivery.
If you've been diagnosed with a double uterus and are considering pregnancy, talk with your doctor first. Together you can make a plan for optimal care during pregnancy and delivery.

Causes:
Researchers don't know what causes double uterus. This condition may be associated with kidney abnormalities, which suggests that something may influence the development of these related structures before birth.

Complications:
Many women with a double uterus have normal sex lives, pregnancies and deliveries. But sometimes a double uterus and other abnormalities of uterine development lead to infertility or miscarriage. A double uterus may also cause premature birth or unusual positions of the baby in the uterus, such as bottom down (breech presentation).

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