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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