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Depression

FitSugar — Wed, 08 Oct 2008 17:34:54 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Depression is a mood disorder in which feelings of loss, anger, sadness, or frustration interfere with everyday life. Depression affects about 17 million Americans each year. It can be mild, moderate, or severe and occur as a single episode, recurring episodes, or chronic depression (lasting more than 2 years).

The primary types of depression include:

Major depression -- five or more symptoms must be present. An episode must last at least 2 weeks, but tends to continue for 20 weeks. (A mood disorder is classified as minor depression if less than five depressive symptoms are present for at least 2 weeks.)
Dysthymia-- a chronic, generally milder form of depression. Symptoms are similar to major depression but more mild in degree.
Atypical depression-- depression accompanied by unusual symptoms, such as hallucinations, delusions, and physical rigidity

Other common forms of depression include:

Postpartum depression-- experienced by 8 - 20% of women following delivery
Premenstrual dysphoric disorder (PDD)-- experienced by 3 - 8% of women. Depressive symptoms occur 1 week prior to menstruation and disappear following menstruation.
Seasonal affective disorder (SAD)-- experienced by 5% of adults, the majority of whom are women. It occurs during the fall-winter season and disappears during the spring-summer season.

Depression may also occur with mania (known as manic-depression or bipolar disorder). In this condition, moods cycle between mania and depression.

Signs and Symptoms

While it is normal for most people to feel "down in the dumps" on occasion, someone with major depression feels significantly depressed for a prolonged period of time, has difficulty enjoying acts that were once pleasurable, and experiences at least five of the following symptoms for 2 weeks or more:

Sleep disturbances -- at least 90% of people with depression have either insomnia (sleeplessness) or hypersomnia (excessive sleeping).
Significant change in appetite (often resulting in either weight loss or weight gain)
Fatigue and loss of energy
Feelings of worthlessness, self-hate, and inappropriate guilt
Extreme difficulty concentrating
Either agitation, restlessness, and irritability or inactivity and withdrawal
Recurring thoughts of death or suicide
Feelings of hopelessness

Although not generally considered to be defining characteristics of depression, many people with the condition report a lack of sex drive and sudden bursts of anger.

Causes

The causes of depression are complex and involve a combination of biologic, genetic, and environmental factors. People with depression may have abnormal levels of certain brain chemicals, including serotonin, acetylcholine, and catecholamines (such as dopamine). The following may alter the levels of these brain chemicals and contribute to development of depression:

Heredity -- a recently identified gene called SERT that regulates the brain chemical serotonin has been linked to depression.
Chronic stress (such as from loss, abuse, or deprivation in early childhood)
Amount of exposure to light
Sleep disturbances
Social isolation
Nutritional deficiencies
Serious medical conditions, such as heart attack or cancer
Certain medications, including those for high blood pressure, high cholesterol, or irregular heartbeat

Risk Factors

Although depression is a condition that can affect anyone, regardless of age, race, or gender, the following factors may increase your risk for an initial or recurrent episode of depression:

Prior episodes of depression
Family history of depression
Suicide attempt -- a previous attempt of suicide during a major depressive episode increases the likelihood of another episode of depression.
Female gender -- the incidence of depression appears to be greater in women than in men. Some researchers speculate, however, that women may simply report their symptoms more frequently than men, and that men may be more apt to mask their depressive symptoms with alcohol. Therefore, it is still unclear whether women truly have a greater risk for depression.
Young adulthood or middle age -- the highest occurrence of depression is between the ages of 25 - 44. The elderly are also at particular risk due to death of loved ones, physical illness, and loss of independence.
Stressful life events (such as the death of a loved one), particularly if the event occurs at a young age
Postpartum period
Chronic medical or psychological conditions, including autoimmune diseases (such as lupus), cancer, heart disease, chronic headaches, chronic pain, anxiety, obsessive-compulsive disorder, and borderline personality disorder. Medical conditions that cause shifts in hormones, such as thyroid disorders or menopause, may also contribute to depression.
History of abuse (such as mental, physical, or sexual)
Lack of social support system (such as a network of close friends or family)
Current or past alcohol or drug abuse -- 25% of people with addictions have depression.

Diagnosis

If feelings of depression or any of the related symptoms are present, it is important to address them with a doctor or someone who can help direct care appropriately. Unfortunately, many people with depression tend to refrain from disclosing any or all of their symptoms in this setting. Occasionally, even when the symptoms are discussed during an appointment, a doctor may try to treat them individually, rather than recognizing the complete picture of depression. Working together with a primary care doctor is extremely important because they are often the health care providers who make a referral to a psychiatrist who, in turn, makes a definite diagnosis of depression. Proper diagnosis of depression is the first step toward proper treatment.

Only psychiatrists can prescribe medication, but psychologists and social workers, as well as psychiatrists, use psychotherapy as an important mode of treatment. These specialists will often administer a screening test, such as the Beck Depression Inventory or the Hamilton Rating Scale, which consists of about 20 questions that assess an individual's risk for depression. Even before these psychological screening tests, however, several blood tests will be performed to determine whether nutrient deficiencies or underlying medical conditions (such as a thyroid disorder) may be causing or contributing to depression.

Although the vast majority of people with depression are treated as outpatients, hospitalization is necessary for people who intend to, or do, attempt suicide, and may be necessary under other circumstances as well.

Preventive Care

The following steps can help prevent depression or decrease the chances of relapse:

Adequate sleep, regular exercise, and a balanced, healthy diet may help prevent depression and diminish symptoms of this mood disorder.
Mind-body techniques, such as biofeedback, meditation, and tai chi, are effective ways to prevent or reduce symptoms associated with depression.
Psychotherapy directed at coping skills generally helps prevent relapse.
Family therapy may prevent children or teens of depressed parents from becoming depressed later in life.
Compliance with the prescribed treatment regimen decreases the chance of relapse.

Treatment Approach

People with depression have several options for treatment, but a combination of psychotherapy and antidepressant medications is the regimen of choice, particularly for people with major depression. Cognitive-behavioral therapy appears to be the most effective type of psychotherapy, particularly for adolescents and people with atypical or postpartum depression. As many as 90% of people with depression improve from a combination of psychotherapy and antidepressants. However, adverse side effects from certain medications make it difficult for many to take their medications. Some complementary and alternative therapies may be helpful in reducing the side effects from such medications, while other complementary and alternative therapies may actually diminish the symptoms of depression.

Lifestyle

Exercise

Studies have consistently shown that regular exercise (either aerobic or strength and flexibility training) significantly reduces depressive symptoms in people with mild to moderate depression and improves the mood of people with major depression. Some even suggest that exercise may be as effective as psychotherapy for people with mild-to-moderate depression, although additional research is needed. In the meantime, exercise can be used safely in conjunction with medication for those with depression.

Medications

Antidepressant medications are very effective; reports indicate that they are 90% successful in treating depression. In general, medications are taken for at least 4 - 6 months to assure complete and effective treatment. However, antidepressants often cause adverse side effects, making it difficult for some people to comply with taking their medications. Medications must not be stopped before first talking with a physician. Most antidepressants cause withdrawal symptoms if they are not discontinued slowly over time with guidance from a physician.

There are several classes of antidepressant medications, including:

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs increase the activity of a chemical in the brain called serotonin. Most health care providers will prescribe SSRIs before any other antidepressant medication for depression, in part because the side effects associated with SSRIs are generally fewer than for other classes of antidepressants. Typical side effects caused by SSRIs include stomach upset, weight gain or loss, drowsiness, sexual dysfunction (such as impotence, decreased libido, and diminished orgasm), headache, jaw grinding, and apathy. Very unusual side effects from this class of prescription drugs include extreme agitation, impulsivity, tremors, and insomnia. People who discontinue taking SSRIs due to side effects usually attribute their discontent to sexual dysfunction.

Drugs classified as SSRIs include:

Fluoxetine
Sertraline
Paroxetine -- most likely in this class to cause sexual dysfunction
Fluvoxamine
Citalopram -- least likely in this class to cause sexual dysfunction

Another group of antidepressant medications (which are similar to SSRIs, but target other brain chemicals in addition to serotonin) may cause fewer negative sexual side effects. These include:

Bupropion -- should not be used if there is history of or risk for seizure
Nefazodone -- no sexual dysfunction reported. It begins to work very quickly and may cause a decrease in blood pressure when going from lying or sitting to standing.
Venlafaxine -- may impair sexual function and is not recommended in the elderly. It may improve quality of life more effectively than other antidepressants, but can cause irregular heart rhythm. Withdrawal from the medication is difficult.
Mirtazapine -- may be particularly effective if feelings of anxiety are also present. It helps with insomnia but may cause drowsiness, blurred vision, weight gain, and damage to production of cells in the bone marrow (very rare).
Maprotiline -- may cause dry mouth, drowsiness, sensitivity to the sun, and seizures

Tricyclic Antidepressants

Tricyclics increase the activity of the brain chemicals serotonin and norepinephrine. They are as effective as SSRIs, but are usually prescribed only to those who do not respond well to SSRIs because side effects are quite common and are usually less tolerable. Tricyclic antidepressants include:

Amitriptyline
Amoxapine -- increases risk of seizure in those who are prone to have a seizure
Clomipramine -- used for obsessive-compulsive disorder
Desipramine
Doxepin -- may help with insomnia
Imipramine -- may cause a rare lung disorder called idiopathic pulmonary fibrosis
Nortriptyline -- less risk of irregular heart rhythm than others in this class
Protriptyline -- less drowsiness than others in this class and may even cause weight loss and sun sensitivity
Trimipramine -- high risk for irregular heart rhythm

Side effects of tricyclics may include:

Dry mouth
Blurred vision
Constipation
Sexual dysfunction
Weight gain
Dizziness
Drowsiness
Urinary urgency (a sense that one has to urinate even when the bladder is empty)
Drop in blood pressure when going from lying or sitting to standing (causes dizziness and lightheadedness)
Irregular heart rhythm

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs boost levels of norepinephrine, dopamine, and serotonin in the brain. MAOIs are generally prescribed only when other antidepressants have not been effective, which may occur in people with atypical depression. People who take MAOIs may experience a sharp increase in blood pressure after consuming food or drink containing the amino acid tyramine (found in such foods as aged cheeses and red wine). MAOIs also negatively interact with other medications, including Ritalin (used for attention deficit hyperactivity disorder) and pseudoephedrine (decongestant in many over-the-counter and prescription medications), and should not be taken with other classes of antidepressants.

MAOIs include:

Phenelzine -- should be avoided by people with a history of seizures or bipolar disorder (manic-depression)
Isocarboxazid -- side effects include drowsiness, sexual dysfunction, weakness, trembling, and blurred vision.
Tranylcypromine -- should not be used if there is any history of kidney disease or bipolar disorder

Surgery and Other Procedures

Electroconvulsive Therapy (ECT) for depression is usually reserved for when all other therapies have been unsuccessful. In this procedure, a small electrical current induces a seizure lasting approximately 40 seconds. A muscle relaxant and mild sedative are administered prior to the procedure. ECT is generally repeated every 2 - 5 days for a total of six treatments. It may cause temporary confusion, memory impairment, headache, muscle aches, irregular heart rhythm, or nausea.
Magnetic Resonance Imaging (MRI)-Guided Cingulotomy involves the application of an electrical current to a specific part of the brain. The MRI is used as a guide for an exact placement. Long-term improvement has been reported using this technique in over 50% of people with depression who have not responded to other treatment methods.

Nutrition and Dietary Supplements

A comprehensive treatment plan for depression may include a range of complementary and alternative therapies. Preliminary studies suggest that nutritional supplements may reduce the symptoms of some depression. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables such as kelp and dulce.
Avoid refined foods, such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
Use healthy oils for cooking, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

You my address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
Omega-3 fatty acids, such as fish oil, one to two capsules or one tablespoonful oil one to three times daily, to help decrease inflammation and help with mental balance.
Vitamin C, 500 - 1000 mg one to three times daily, as an antioxidant and for immune support.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
5-hydroxytryptophan (5-HTP), 50 mg two to three times daily, for mood stabilization. Ask your health care provider about potential prescription interactions.
Probiotic supplement (containing Lactobacillus acidophilus and other species), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
Dihydroepiandosterone (DHEA), start at 5 mg three times a day and work up to 100 mg per day for 7 - 12 months. It is recommended to use DHEA under the supervision of a qualified health care provider. If adverse effects develop, discontinue use.
L-theanine, 200 mg one to three times daily, for nervous system support.
Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Ask your health care provider about potential prescription interactions.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

St. John's wort (Hypericum perforatum) standardized extract, 300 mg two to three times per day, for depression. Check with your health care provider if you are taking prescription medications.
Kava kava (Piper methysticum) standardized extract, 100 - 250 mg one to three times daily, as needed for symptoms of stress and anxiety. Talk with your health care provider before taking kava kava if you have an unhealthy liver.
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for blood flow and depression.
Green tea ( Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and general health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Rhodiola ( Rhodiola rosea ) standardized extract, 100 - 600 mg daily, for antioxidant and anti-stress activity.

Acupuncture

Two randomized, controlled, clinical trials suggest that electroacupuncture may reduce symptoms of depression as effectively as amitriptyline, a tricyclic antidepressant medication. Electroacupuncture involves the application of a small electrical current through acupuncture needles. Other studies suggest that acupuncture may be effective for people with mild depression and for those with depression related to a chronic medical illness. Further research is warranted in this area.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies to alleviate the symptoms of depression based on their knowledge and experience.

Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. A few homeopathic remedies that may work for depression include:

Ignatia -- for a sudden sense of grief or disappointment following the death of a loved one, the end of a romantic relationship, or an unexpected loss of one's job
Natrum muriaticum -- for grief following the death of a loved one or sadness from the end of a romantic relationship

Massage and Physical Therapy

Studies of formerly depressed adolescent mothers, children hospitalized for depression, and women with eating disorders, suggest that massage decreases stress hormone levels, feelings of anxiety, and symptoms of depression. Giving massage may also be beneficial for people who are depressed. Elderly volunteers with depression showed notable improvement in their symptoms when they massaged infants.

Aromatherapy, or the use of essential oils in massage therapy, may also be of value as a supplemental treatment for depression. Theoretically, the smells of the oils elicit positive emotions through the limbic system (the area of the brain responsible for memories and emotions). However, the benefits of aromatherapy appear to be related to the relaxation effects of the treatment as well as to the recipient's belief that the treatment will be beneficial. Essential oils used during massage for depression are quite varied and include:

Lavender ( Lavandula officinalis)
Basil (Ocimum basilicum)
Orange (Citrus aurantium)
Sandalwood (Santalum album)
Lemon (Citrus limonis)
Jasmine (Jasminum spp.)
Sage (Salvia officinalis)
Chamomile (Chamaemelum nobile)
Peppermint (Mentha piperita)
Rosemary (Rosmarinus officinalis)

Mind-Body Medicine

Mind-body therapies and techniques that may be useful as a part of an overall treatment regimen for depression include:

Psychotherapy

Cognitive-behavioral therapy is a type of psychotherapy in which individuals learn to identify and change distorted perceptions about themselves and adapt new behaviors to better cope with the world around them. This therapy is frequently considered the treatment of choice for people with mild-to-moderate depression, but it may not be recommended for those with severe depression. Studies of people with depression indicate that cognitive-behavioral therapy is at least as effective as tricyclic antidepressants. Compared to those treated with antidepressants, people treated with cognitive-behavioral therapy demonstrated similar, or better, results and lower relapse rates.

Other therapeutic approaches that may be applied by a psychiatrist, psychologist, or social worker include:

Psychodynamic psychotherapy -- based on Freud's theories about unresolved conflicts in childhood and depression as a grief process
Interpersonal therapy -- acknowledges childhood roots of depression, but focuses on current problems contributing to depression and is considered very effective treatment for depression
Supportive psychotherapy -- nonjudgmental advice, attention, and sympathy, and this approach may improve compliance with taking medication

Relaxation

One study suggests that relaxation techniques, such as yoga and tai chi, may improve symptoms of depression in people with mild depression.

Meditation

Some researchers believe that mindfulness meditation may prevent depression from recurring in people who once had the condition.

Other Considerations

Pregnancy

Postpartum depression is experienced by 8 - 20% of women following delivery.
The safety of SSRIs and tricyclic antidepressant medications during pregnancy remains uncertain. The physician will provide guidance regarding use or avoidance of antidepressants during pregnancy. The risks and benefits to the mother and the fetus must be weighed in each individual case in order to determine the most appropriate regimen during pregnancy. MAOIs cause birth defects and should be avoided during pregnancy.
Many of the dietary supplements and herbs mentioned here have not been tested for safety during pregnancy. Talk with your doctor or pharmacist.

Warnings and Precautions

People with Parkinson's disease should avoid SSRIs.
People with coronary artery disease should avoid tricyclic antidepressants.
Several herbal remedies and supplements should not be combined with antidepressant medications. Be sure to inform your health care provider of all herbs and supplements you take to avoid adverse interactions.

Prognosis and Complications

Depression is a serious condition that can have a devastating effect on people's lives. It can directly and indirectly contribute to chronic medical conditions, such as heart disease and stroke, because depressed people with these conditions are less likely to engage in healthy behaviors (such as exercise) and more likely to engage in unhealthy behaviors (such as smoking). Suicide is a significant factor in depression. About 15 % of people with a major depressive disorder commit suicide. Depression also significantly shortens the lifespan of the elderly and is associated with the development of memory impairment and dementia.

When left untreated, depression can last up to 2 years. Rates of recurrence are variable: 50% of people who have had one depressive episode will have a second major depressive disorder, 70% will have a third, and 90% will have a fourth. Symptoms of depression usually disappear after menopause in women with premenstrual dysphoric disorder or seasonal affective disorder. Fortunately, there are several treatment options available for people with depression, and the prognosis improves tremendously for those who seek treatment and comply with their regimen.

Supporting Research

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Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate. Nutrition. 2000;16:544-581.

Anonymous. SAMe for depression. Med Lett Drugs Ther. 1999;41(1065):107-108.

Babyak M, Blumenthal JA, Herman S, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62(5):633-638.

Beniamini Y, Rubenstein JJ, Zaichkowsky LD, Crim MC. Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients. Am J Cardiol. 1997;80(7):841-846.

Benjamin J, Agam G, Levine J, Bersudsky Y, Kofman O, Belmaker RH. Inositol treatment in psychiatry. Psychopharmacol Bull. 1995;31(1):167-175.

Benton D, Cook R. The impact of selenium supplementation on mood. Biol Psychiatry. 1991;29(11):1092-1098.

Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998;3(4):271-280.

Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutrition Rev. 1996;54(12):382-390.

Bottiglieri T, Laundy M, Crellin R, Toone BK, Carney MW, Reynolds EH. Homocysteine, folate, methylation, and monoamine metabolism in depression. J Neurol Neurosurg Psychiatry. 2000;69(2):228-232.

Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs. 1994;48(2):137-152.

Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clin Ther. 2000;22(4):411-419.

Briggs CJ, Briggs GL. Herbal products in depression therapy. CPJ/RPC. November 1998;40-44.

Bruinsma KA, Taren DL. Dieting, essential fatty acid intake, and depression. Nutrition Rev. 2000;58(4):98-108.

Cauffield JS, Forbes HJ. Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincotts Prim Care Pract. 1999;3(3):290-304.

Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol Psychiatr. 2000;68(3):137-144.

Einat H, Karbovski H, Korik J, Tsalah D, Belmaker RH. Inositol reduces depressive-like behaviors in two different animal models of depression. Psychopharmacology. 1999;144:158-162.

Ernst E, Rand JI, Stevinson C. Complementary therapies for depression. Arch Gen Psychiatry. 1998;55:1026-1032.

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Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence. 1996;31(124):903-911.

Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic agents. Psychosom Med. 1999;61:712-728.

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Review Date:
11/6/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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Syncope

FitSugar — Wed, 08 Oct 2008 17:34:56 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Syncope, or fainting, is a sudden loss of consciousness caused by decreased blood flow to the brain. Recovery occurs within seconds or minutes for many causes of fainting. About 3 - 4% of people, mostly the elderly, experience episodes of fainting.

Signs and Symptoms

You may experience the following signs and symptoms before you faint:

Lightheadedness
Blurred vision
Sweating
Heaviness in your lower limbs
Giddiness
Confusion
Yawning
Nausea, and sometimes vomiting

During a fainting episode, in addition to loss of consciousness, you may experience the following symptoms:

Abnormal paleness
Falling down if standing, slumping if seated
Spasmodic jerks of your body
Weak pulse
Drop in blood pressure

What Causes It?

Fainting often occurs from a simple, non-medical cause, but may be the result of a serious health condition, such as heart disease (decreased blood flow to the heart or irregular heart rhythm), low blood sugar (often related to diabetes), seizures, panic attacks, and problems regulating blood pressure.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for fainting:

Over 65 years of age
Preexisting heart disease
Recreational drug use
Taking certain medications such as antihypertensives, insulin, oral hypoglycemics, diuretics, antiarrhythmics, or anticoagulants
Pregnancy

What to Expect at Your Provider's Office

If you have fainted, you should see your health care provider. Your health care provider will ask questions, do a physical examination, and perform diagnostic tests. Tests may include blood tests, electrocardiogram (ECG), and imaging of the brain, such as magnetic resonance imaging (MRI). Your provider will focus on symptoms associated with the current fainting episode, medications you take, preexisting medical conditions, and your description of any similar episodes you may have experienced in the past. This will help your health care provider pinpoint the cause of the fainting episodes and identify or rule out particular health conditions. If seizures are suspected, your health care provider may also perform a test called an electroencephalogram (EEG).

Treatment Options

Prevention

Some cases of fainting may be preventable, depending on the cause.

Avoid fatigue, hunger, and stress.
Avoid changing positions quickly, especially rising from a sitting or lying-down position.
Sleep with the head of your bed elevated.
Avoid standing for long periods of time.
You may wear elastic stockings.
Diuretics and other prescription and non-prescription medicines can contribute to the problem, so check with your health care provider.
Avoid tight clothing around the neck.
Turn the whole body and not just the head when looking around.
To prevent injuries, cover floors with thick carpeting and avoid driving or operating mechanical equipment.
Avoid caffeine and alcohol.

Treatment Plan

Any serious underlying health condition must be treated. At the time of the fainting episode, make sure the person is in a position that increases blood flow to the brain, such as with the legs elevated. Loosen all tight clothing, apply cold water to the person's face, and turn the person's head to the side to prevent vomiting or choking. A pregnant woman should lie on her left side to relieve pressure on the heart.

Drug Therapies

When irregular heart rhythm causes fainting, your health care provider may prescribe medications such as beta-blockers or antiarrhythmics. Mineralocorticoids (such as fludrocortisone) or salt tablets may also be prescribed.

Surgical and Other Procedures

A cardiac pacemaker may be necessary in some cases where fainting is caused by an underlying heart condition, such as a slow or rapid heartbeat.

Complementary and Alternative Therapies

A wide variety of alternative therapies help protect the heart and vascular systems. Taking these supplements may help decrease episodes of fainting. Fainting may be caused by a serious underlying health condition, so check with your health care provider before taking any herbs or supplements. Always tell your health care provider about the herbs and supplements you are using or considering using.

You may experience warning signs before fainting. Hypnosis, deep breathing, relaxation techniques, and biofeedback may help you avoid fainting. These techniques may also help you control fainting related to nervous system regulation of your blood pressure.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
Avoid refined foods such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, excess sugar, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to two times daily, to help decrease inflammation and improve heart health. Cold-water fish, such as salmon or halibut, are good sources.
A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, heart, and muscular support.
Acetyl-L-carnitine, 500 mg daily, for antioxidant and heart protective activity.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
L-arginine, 1 - 2 grams one to two times daily, for vascular support.
L-theanine, 200 mg one to three times daily, for stress and nervous system support.
Adrenal hormonal extract, 100 - 200 mg daily, for adrenal stress. Laboratory tests may confirm the need for adrenal hormonal. Ask your health care provider.

Herbs

Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Bilberry (Vaccinium myrtillus) standardized extract, 80 mg two to three times daily, for antioxidant and vascular system support.
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for antioxidant and heart health support.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced and certified homeopath will assess your individual constitution and symptoms, and then recommend remedies. Below are common remedies used for fainting or pre-fainting symptoms:

Carbo vegetabilis, used for fainting or lightheadedness after rising in the morning, from loss of fluids, or from becoming overheated.
Opium, used for fainting due to excitement or fright.
Sepia, used for fainting following prolonged standing, exercise, or fluid loss due to fever.

Acupuncture

Acupuncture may be helpful in treating syncope. A clinical analysis of 102 serious cases of loss of consciousness reported that acupuncture helped in a large percentage of these cases.

Acupuncture is known for rarely causing side effects or complications. However, some patients faint during acupuncture treatments although it is not considered a serious complication.

Prognosis/Possible Complications

In most people, simple fainting is not a sign of a life-threatening disease, particularly if it only happens once. The elderly are at increased risk for injury after a fainting episode, especially from fractures.

Following Up

Many people with syncope, especially the elderly and those with preexisting heart disease, may be hospitalized to look for a cause. Continuous ECG monitoring can identify irregular heartbeat as a cause of fainting, especially in people who have recurring fainting episodes.

Supporting Research

Adams RD, Victor M. Principles of Neurology. 6th ed. New York, NY: McGraw-Hill; 1997:902–912.

Ahlemeyer B, Krieglstein J. Neuroprotective effects of Ginkgo biloba extract. Cell Mol Life Sci. 2003;60(9):1779-92.

Basu HN, Liepa GU. Arginine: a clinical perspective. Nutr Clin Pract. 2002;17(4):218-25.

Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors. 2003;17(1-4):207-13.

Beers MH, et al. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:1651-1654.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Newton, Mass: Integrative Medicine Communications; 1998:161-162, 333-335.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Carillo-Vico A, Reiter RJ, Lardone PJ, et al., The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs. 2006;7(5):423-31.

Castro M. The Complete Homeopathy Handbook: A Guide to Everyday Health Care. New York, NY: St. Martin's Press; 1990:67-68, 127, 148.

Castro V, Nacht R. Cocaine-induced bradyarrhythmia: an unsuspected cause of syncope. Chest. 2000;117:275-277.

Fang-Pey C, Hwang SJ, Lee HP, Yang HY, Chung C. Clinical study of syncope during acupuncture treatment. Int J Acupunct Electrother Res. 1990;15:107-119.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:100-107.

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest. 2005;35(11):691-9.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev. 1996; 1(1):11-17.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:779,1204-1205.

Guha S, Dawn B, Dutta G, Chakraborty T, Pain S. Bradycardia, reversible panconduction defect and syncope following self-medication with a homeopathic medicine. Cardiology. 1999;91(4):268-271.

Guize L, Iliou MC, Bayet G, Lavergne T, Le Heuzey JY. [Torsades de pointes.] Arch Mal Coeur Vaiss. 1993;86(5 suppl):769-776.

Hirschmann JV, Raugi GJ. Adult scurvy. J Am Acad Dermatol. 1999;41(6):895-906.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books; 1995:215.

Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med. 1995;122(4):286-295.

Kelley WN, et al. Textbook of Internal Medicine. Vol. 1. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1997:343–350.

Kerr D, Sherwin R, Pavalkis F, et al. Effect of caffeine on the recognition of and response to hypoglycemia in humans. Ann Intern Med. 1993;119(:799-804.

Kimura K, Ozeki M, Juneja LR, Ohira H. l-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2006 Aug 21.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

McGrady AV, Bush EG, Grubb BP. Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series. Appl Psychophysiol Biofeedback. 1997;22(1):63-72.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:296-308.

[No authors listed]. L-theanine . Monograph. Altern Med Rev. 2005;10(2):136-8.

Olshansky B. Evaluating syncope: how to do it efficiently and safely. J Crit Illn. 1999;14(:423-430.

Pandi-Perumal SR, Srinivasan V, Maestroni GJ, et al., Melatonin. FEBS J. 2006;273(13):2813-38.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.

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Salins PC, Kuriakose M, Sharma SM, Tauro DP. Hypoglycemia as a possible factor in the induction of vasovagal syncope. Oral Surg Oral Med Oral Pathol. 1992;74(5):544-9.

Schlant RC, et al. Hurst's The Heart. 8th ed. New York, NY: McGraw-Hill; 1994:927-945.

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Review Date:
9/5/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Tension headache

FitSugar — Wed, 08 Oct 2008 17:34:54 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Tension headaches are very common, affecting as many as 40% of teenagers and adults. Pain is caused by tightness (contraction) of your neck and scalp muscles. With a tension headache, the pain often starts at the back of your head and moves forward, so that it eventually includes your neck, scalp, and head. It’s often described as feeling like you have a tight band across your head. It may be caused by stress, but sometimes there is no obvious cause. If your headaches happen 15 or more days in a month for several months, they are considered chronic tension headaches. If they occur less frequently, they are called episodic tension headaches.

Although tension headaches can be painful, they are rarely a sign of a more serious illness. A combination of lifestyle changes, relaxation techniques, and traditional and complementary therapies can help reduce the number of tension headaches you have.

Signs and Symptoms

Headache starts at the back of your head and spreads forward
Dull pressure or a squeezing pain, often described as a tight band around the head
Muscles in your neck, shoulders, and jaw can feel tight and sore
Affects both sides of your head equally
May have difficulty sleeping or eating

Causes

Exactly what causes a tension headache isn’t clear. For years, researchers thought that it was caused by tightening the muscles in your shoulders, neck, scalp, and jaw when you are tense. But new tests that measure muscle tension have shown that the muscles of people with tension headaches aren’t any tighter. Newer theories suggest tension headaches are caused by changes in brain chemicals (neurotransmitters, including serotonin), similar to what happens with a migraine. Scientists don’t know why the levels of neurotransmitters go up and down, but they think it activates pain pathways in the brain. Tight muscles may help trigger the changes in neurotransmitters, or muscle tightness may be a result of fluctuating levels of brain chemicals.

Triggers may include:

Stress
Depression
Anxiety
Holding your head in one position for a long time (like using a computer)
Sleeping in an awkward position or in a cold room
Eye strain
Fatigue
Overexertion
Skipping meals
Head or neck injury, even years after the injury
Clenching your jaw or grinding your teeth (bruxism)
Medications, including some headache medications (leading to rebound headaches)
Arthritis

Certain foods or food additives may also be a trigger for some people (see Nutrition and Dietary Supplements section)

Pain that originates from other areas, such as your sinuses, can also trigger tension headaches or a combined sinus/tension headache

Risk Factors

Gender – women tend to have more headaches than men
Changes in estrogen levels (during a woman’s period or at menopause)
Premenstrual syndrome
Stress
Chronic overwork
Too much or too little sleep
Missing meals
Alcohol or drug use

Diagnosis

Your doctor will take a detailed history in order to distinguish tension headaches from headaches of other causes, such as migraines. He or she will ask questions about when your headaches occur, how long they last, how frequently they come on, the location of the pain, and any symptoms that accompany the headaches. Sometimes it helps to keep a diary about your headaches before seeing the doctor; this way, you'll have an accurate recording of how often they happen.

Your doctor will examine your head, neck, eyes, and sinuses and do a neurologic examination. Don't be surprised if the doctor asks you some questions to test your short term memory. On exam, the physician is likely to find musculoskeletal tenderness around your neck and scalp.

If you have unusual symptoms, you doctor may order these tests:

Computed tomography (CT) scan or magnetic resonance imaging (MRI), to rule out a tumor or aneurysm, or to check for sinusitis
X-ray of the neck to look for arthritis or spinal problems; x-ray of the sinuses to look for sinusitis
Electroencephalogram (EEG), a brain wave study, to look for any seizure activity

Treatment Approach

A comprehensive treatment plan including relaxation (see Mind/Body Medicine), exercise and other lifestyle changes, and occasional medication can be very effective in reducing the frequency and intensity of tension headaches.

Biofeedback, yoga, and relaxation techniques, for example, can help relieve pain and lower the number of headaches you have. Regular exercise helps, too.

Lifestyle

Keeping a headache diary can help identify the source of your tension headaches and how you can change your environment and habits to avoid them. When a headache starts, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.

Good health habits are important for helping to lessen stress and tension headaches:

Get adequate sleep
Eat a healthy diet
Get regular exercise
Quit smoking
Use relaxation techniques (see Mind/Body Medicine section)

Medications

Medications are used both to relieve pain and to prevent headaches if you have chronic tension headaches.

To relieve pain:

Over-the-counter (OTC) analgesics – are usually effective. Don’t take these medications more than two days per week, and take only the amount recommended on the package. Talk to your doctor about which of these is best for you.

Acetaminophen (Tylenol) – can cause liver damage if used in high doses or over a long period of time
Aspirin – can cause stomach upset and bleeding
Ibuprofen (Advil, Motrin) – can cause stomach upset and bleeding, and raise risk of heart problems
Naproxen (Aleve) – can cause stomach upset and bleeding, and raise risk of heart problems

Prescription analgesics – may be needed if your headaches don’t respond to OTC medications. They include

Naproxen (Naprosyn) – can cause stomach upset and bleeding, and raise risk of heart problems
Indomethacin (Indocin) – can cause stomach upset and bleeding, and raise risk of heart problems
Ketoprofen (Orudis) – can cause stomach upset and bleeding, and raise risk of heart problems

Rarely, if your headaches are very severe and nothing else relieves the pain, your physician may consider prescribing narcotics such as codeine plus acetaminophen (Tylenol with Codeine No. 3) or hydrocodone with acetaminophen (Vicodin).

To prevent chronic tension headaches:

Tricyclic antidepressants - Tricyclic antidepressants are helpful in preventing all kinds of headaches, including migraines and tension headaches. Tricyclic antidepressants include:

Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Doxepin (Sinequan)
Imipramine (Tofranil)

Selective serotonin reuptake inhibitors (SSRIs) – another type of antidepressant that may not be as effective as tricyclics in preventing headaches, but tend to have fewer side effects. They include:

Fluoxetine (Prozac)
Paroxetine (Paxil)
Citalopram (Celexa)
Sertraline (Zoloft)

Anticonvulsants - Some anti-seizure drugs help prevent migraines and tension headaches, although researchers aren't sure why:

Divalproex sodium (Depakote)
Topiramate (Topamax)

Surgery and Other Procedures

If an injury or problem in the cervical spine is contributing to tension headaches, a nerve block, using a steroid to reduce inflammation and muscle contraction, may be considered to lessen the head pain.

Nutrition and Dietary Supplements

Diet

Certain foods can trigger tension headaches, including:

Chocolate
Cheese
Monosodium glutamate (MSG), a flavor enhancer found often in food from Chinese restaurants
Foods containing the amino acid tyramine (found in red wine, aged cheese, smoked fish, chicken livers, figs, and some beans)
Nuts
Peanut butter
Some fruits (like avocado, banana, and citrus)
Onions
Dairy products
Meats containing nitrates (bacon, hot dogs, salami, cured meats)
Fermented or pickled foods

If you suspect that any of these foods cause your headaches, you could follow an elimination diet, eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to when the number of headaches increases after eating particular foods. Then you know which trigger foods to avoid.

The amino acid 5-hydroxytryptophan (5-HTP, 400 to 600 mg per day) is made by the body from tryptophan (another amino acid you get from certain foods) and converted into serotonin, a neurotransmitter. Because researchers think changes in neurotransmitters are related to tension headaches, and some of the drugs used to treat headaches work by affecting serotonin, 5-HTP has been proposed as a treatment for tension headaches. Several studies indicate that 5-HTP may be effective for migraines, but the evidence is mixed for tension headaches. One study found that 5-HTP did not reduce the number of headaches people experienced, but it did allow them to reduce their use of other painkillers. More studies are needed to tell whether 5-HTP is helpful in treating tension headaches. If you take an antidepressant, or supplements such as St. John's wort or SAMe, you should not take 5-HTP.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

Peppermint (Mentha x piperita) - Peppermint oil, applied topically to the forehead, has shown some promise in very early studies. In one study, applying a 10% peppermint oil solution to the temples relieved pain about as well as acetaminophen (Tylenol). But more research I needed to know for sure if peppermint oil is effective.
Tiger Balm (contains various oils including camphor, menthol, cassia oil, and clove oil) -Tiger Balm is an over-the-counter ointment used for muscle pain. One study found that applying Tiger Balm to the forehead helped relieve headache pain better than placebo and about as well as acetaminophen.
Butterbur (Petasites hybridus, 50 to 75 mg of a standardized extract two times per day) - A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks, and it has been proposed as a treatment for tension headaches, too. However, so far no studies have been done to see whether it works for tension headaches. If you want to try butterbur for your headaches, ask your doctor about a safe extract and dose. Women who are pregnant or breastfeeding should not take butterbur.
Feverfew (Tanacetum parthenium, standardized leaf extract to 250 mcg parthenolide per day) - Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines (not all studies agree, however). However, it has not been studied specifically to see if it can prevent or treat tension headaches. Feverfew can increase the risk of bleeding, and should not be taken with anticoagulants (blood-thinners). Women who are pregnant or breastfeeding should not take feverfew.

Although there is a lack of scientific studies showing that these herbs work, they are sometimes suggested to treat headaches:

Dong quai (Angelica sinensis)
Devil's claw (Harpagophytum procumbens)
Ginkgo biloba (Ginkgo biloba)
Willow bark (Salix spp.)

Acupuncture

Scientific studies using acupuncture to treat tension headaches have found mixed results; however, researchers do agree that acupuncture appears safe and that it may be effective for some people. Acupuncturists diagnose tension headaches by paying careful attention to the kidney and its associated meridians (energy pathways in the body), as well as liver and gallbladder meridians. The physical location of the headache also helps the acupuncturist create a treatment plan, which (in addition to placing needles in acupuncture points) may include lifestyle/dietary changes or herbal remedies.

Chiropractic

Several clinical trials indicate that spinal manipulation therapy may help in the treatment of tension headaches, especially ones that start in the neck. One study compared spinal manipulation to Elavil and found that people in both groups improved, while those in the spinal manipulation group had less side effects. The benefits if spinal manipulation lasted longer: One month after treatment, the spinal manipulation group still showed improvement, while the Elavil group did not. However, another study comparing spinal manipulation plus massage to a sham laser treatment plus massage found no benefit.

Massage and Physical Therapy

Regular massage may help relieve stress and decrease pain in people with chronic tension headaches, according to one preliminary study. Doing stretches for your head and neck (taught by a physical therapist) may also help. Practicing proper posture is another important factor in reducing your number of headaches; a physical therapist can teach you.

Reflexology, a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body, has been proposed as a treatment for headaches. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication. However, more research is needed. Practitioners believe reflexology helps you become more aware of you own body signals, which might help you sense the subtle signals that indicate a migraine is about to occur (before pain starts). They also believe reflexology helps improve general well-being and energy level.

Homeopathy

Studies indicate that homeopathy may be no more effective than placebo in relieving tension headaches. Interestingly, however, one of the most common reasons people seek homeopathic care is to relieve the pain associated with chronic headaches. Many homeopaths report that homeopathy helps treat and prevent recurrent tension headaches. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following remedies are commonly prescribed for tension headaches:

Belladonna - for throbbing headaches that come on suddenly; symptoms tend to worsen with motion and light, but are partially relieved by pressure, standing, sitting, or leaning backwards.
Bryonia - for headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation.
Gelsemium - for pain that extends around the head and feels like a tight band of constriction; pain usually originates in the back of the head and may be relieved following urination; this remedy is most appropriate for individuals who feel extremely weak and have difficulty keeping their eyes open.
Ignatia - for pain that may be described as a feeling of something being driven into the skull; these types of headaches tend to be triggered by emotion, including grief or anxiety, and the treatment is appropriate for both children and adults
Iris versicolor - for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting.
Lachesis - for headaches that tend to occur on the left side of the head; symptoms are typically worse in the mornings, before menstruation, and with exposure to warmth and sunlight; symptoms tend to improve with open air and firm pressure.
Nux vomica - for headaches associated with hangovers, overindulgence in foods or alcohol, and overwork; these types of headaches are often accompanied by nausea and/or dizziness; this remedy is most appropriate for individuals who tend to be constipated and irritable.
Pulsatilla - for headaches triggered by eating rich, fatty foods, particularly ice cream; pain tends to move but may be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; children for whom this remedy is appropriate often develop these symptoms while at school.
Sanguinaria- for right-sided headaches that begin in the neck and move upwards, recur in a predictable pattern (such as every seven days); pain is aggravated by motion, light, or sun exposure, odors, and noise; this remedy is appropriate for children who may have a craving for spicy or acidic foods, despite having a general aversion to eating due to the headache.
Spigelia - for stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up.

Mind/Body Medicine

You can do many things to avoid tension headaches or relieve the pain:

Biofeedback to control muscle tension.
Learn to meditate, breathe deeply, or try other relaxation exercises, such as yoga or hypnotherapy.

Other relaxation techniques that may be helpful include:

Guided imagery
Hypnosis

Other Considerations

Pregnancy

Some women who are prone to headaches will get them more often when they are pregnant. Other women, however, may have fewer headaches during pregnancy, especially during the second trimester.

Warnings and Precautions

Use medications only as directed. Using some medications on a regular basis can cause rebound headaches.

Call your doctor if you experience a new headache, a change in quality of a previous headache or headache pattern, or if a medication that usually takes away the pain no longer works.

Prognosis and Complications

Serious underlying conditions due to headaches, like a tumor or a stroke, are extremely rare. You should seek emergency medical attention if you experience the following:

Sudden and severe headache that persists or increases in intensity over 24 hours
A sudden, severe headache that you describe as "your worst ever," even if you are prone to headaches
Chronic or severe headaches that begin after age 50
Headaches accompanied by memory loss, confusion, loss of balance, change in speech or vision, or loss of strength in or numbness/tingling in any one of your limbs
Headaches after a head injury, especially if you are also drowsy or feel nauseated
Headaches accompanied by fever, stiff neck, nausea and vomiting (may indicate meningitis)
Severe headache localized to one eye, accompanied by redness of the eye (may indicate acute glaucoma)

The good news is that more than 90% of people with tension headaches can get significant relief from a combination of lifestyle changes, relaxation, and medication.

Supporting Research

Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-631.

Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(:617-623

Baghdikian B, Lanhers M, Fleurentin J, et al. An analytical study, anti-inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri. Planta Med. 1997;63:171–176.

Barrows KA, Jacobs BP. Mind-body medicine: an introduction and review of the literature. Med Clin North Am. 2002;86(1):11-31.

Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Alt Med Review. 1998;3(4):271-280.

Blumenthal M. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council. Boston: Integrative Medicine Communications; 1998.

Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18(3):148-154.

Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA. 1998;280(18): 1576-1579.

Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-466.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 217-220.

Dagenais S. Haldeman S. Chiropractic. Prim Care. 2002;29(2):419-437.

Endres HG, Böwing G, Diener HC, Lange S, Maier C, Molsberger A, et al. Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain. 2007 Oct;8(5):306-14.

Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14(3):228-234.

Hammill JM, Cook TM, Rosecrance JC. Effectiveness of a physical therapy regimen in the treatment of tension-type headache. Headache. 1996;36(3):149-153.

Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285(17):2208-2215.

Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine. 1996;21(15):1746-1759.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 238-239.

Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 27(17):1835-1843; discussion 1843.

Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med. 2002;136(5):374-383.

Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalagia. 2001;21(6):637-642.

Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. Review.

Launso L, Brendstrup E, Arnberg S. An exploratory study of reflexological treatment for headache. Altern Ther Health Med. 1999;5(3):57-65.

Linde K, Melchart D, Fisher P et al. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.

Lipchik GL, Nash JM. Cognitive-behavioral issues in the treatment and management of chronic daily headache. Curr Pain Headache Rep. 2002;6(6):473-479.

Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complement Ther Med. 2001;9(3):178-185.

Lundeberg T. Acupuncture in headache. Cephalagia. 1999;19 Suppl 25:65-68.

Manias P, Tagaris G, Karageorgiou K. Acupuncture in headache: a critical review. Clin J Pain. 2000;16(4):334-339.

Marcus DA. Estrogen and tension-type headache. Curr Pain Headache Rep. 2001;5(5):449-453.

Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am. 2001;85(4):1077-1084.

McCrory DC, Penzien DB, Hasselblad V, Gray RN. Evidence report: behavioral and physical treatments for tension-type and cervicogenic headache. Des Moines (IA): Foundation for Chiropractic Education and Research; 2001. Product No. 2085.

McGrady AV, Bush EG, Grubbs BP. Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series. Appl Psychophysiol Biofeedback. 1997;22(1):63-72.

Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev. 2001;(1):CD001218.

Melchart D, Linde K, Fischer P, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia. 1999;19(9):779-786;discussion 765.

Mueller L. Tension-type, the forgotten headache. How to recognize this common but undertreated condition. Postgrad Med. 2002;111(4):25-26, 31-32, 37-38.

Nilsson N, Christensen HW, Harvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1997;20(5):326-330.

Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophysiol Biofeedback. 2002;27(20:163-181.

Powers SW, Mitchell MJ, Byars KC, Bentti AL, LeCates SL, Hershey AD. A pilot study of one-session biofeedback training in pediatric headache. Neurology. 2001;56(1):133.

Quinn C, Chandler C, Moraska A. massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657-1661.

Ribeiro CA. L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. Headache. 2000;40:451-6.

Savi L, Rainero I, Valfre W, Gentile S, Lo Giudice R, Pinessi L. A comparison of patients with migraine and tension-type headache. Panminerva Med. 2002;44(1):27-31.

Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology. 2000;54(:1553.

Silver N. Headache (chronic tension-type). Am Fam Physician. 2007 Jul 1;76(1):114-6. Review.

Solomon GD. Chronic tension-type headache: advice for the viselike-headache patient. Cleve Clin J Med. 2002;69(2):167-172.

Solomon S. Posttraumatic headache. Med Clin North Am. 2001;85(4):987-996.

Tavola T, Gala C, Conte G, Invernizzi G. Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain. 1992;48:325-329.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 89-94.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 236-239.

Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med. 1999;7:142-155.

Vithoulkas G. Homeopathic treatment of chronic headache: a critique. Homeopathy. 2002;91(1):32-34.

Walach H, Haeusler W, Lowes T et al. Classical homeopathic treatment of chronic headaches. Cephalalgia. 1997;17:119-126.

Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: 1 year follow up. Cephalalgia. 2000;20:835-837.

Walach H, Lowes T, Mussbach D et al. The long-term effects of homeopathic treatment of chronic headaches: one year follow-up and single case time series analysis. Br Homeopath J. 2001;90(2):63-72.

Wang K, Svensson P, Arendt-Nielsen L. Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial. Clin J Pain. 2007 May;23(4):316-22.

White AR, Resch K-L, Chan JCK et al. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632-637.

Yucal B, Kora K, Ozyalcin S, Alcalar N, Ozdemir O, Yucel A. Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache. Headache. 2002;69(2):167-172.

Review Date:
12/18/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Herpes simplex virus

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 (usually known as a cold sore) is transmitted through kissing or sharing drinking utensils, and HSV-2 (usually known as genital herpes) through sexual contact. You may be infected and not show symptoms for a long time. Often symptoms are triggered by exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness.

There is not cure for herpes, and once you have it, it is likely to recur; however, some people may have one outbreak and then never have another one. In between herpes outbreaks, the virus lies dormant (as if it is hibernating or sleeping) in nerve cells.

While exposure to HSV-1 is extremely common – as many as 90% of American adults have been exposed to the virus – and there is no stigma to having a cold sore, HSV-2 or genital herpes can cause embarrassment. Although there is no cure for genital herpes, an infected person can take steps to preventing spreading the disease and can continue to have a sex life.

While most herpes infections do not cause serious complications, infections in infants and in people with weakened immune systems or herpes infections that affect the eyes can be life-threatening.

Signs and Symptoms

HSV-1

Small, painful blisters filled with fluid around the lips or edge of the mouth
Tingling or burning around the mouth or nose (often a few days before blisters appear)
Fever
Sore throat
Swollen lymph nodes in neck

HSV-2

Small red blisters or open sores on genitals or inner thighs; in women, often occur inside the vagina
May be painful or not
In women, vaginal discharge
Fever, muscle aches
Headache Painful urination
Swollen lymph glands in the groin

Causes

HSV-1 is transmitted through saliva. Kissing, using the same eating utensils, sharing personal items (such as a razor), and receiving oral sex from someone who has HSV-1 can cause you to contract the virus.

HSV-2 is a sexually transmitted disease.

Both herpes viruses can be contagious even if the infected person does not have active symptoms or visible blisters.

Also, a mother can pass the infection to her baby during vaginal birth, especially if there are active blisters around the vagina at the time of delivery.

Risk Factors

Oral herpes (cold sores)

Everyone is at risk for oral herpes from HSV-1. In fact, studies suggest that by adolescence 62% of Americans are infected with HSV-1 and by the time people are in their 40s, 90% have been infected.

Genital herpes

All sexually active people are at risk for genital herpes. Having multiple sexual partners puts you at even greater risk. Women have a greater risk of being infected after sex with an unprotected partner than men do. Estimates of how many Americans are infected range from 20% to 30%.

Other factors

People with weakened immune systems, such as people with HIV/AIDS or those who take immunosuppressant drugs to treat an autoimmune disease or because of organ transplant, are at increased risk for severe cases of herpes.

Diagnosis

In many instances, your doctor is able to make the diagnosis of herpes from examining you and no tests are required. If your doctor is not 100% certain, however, then he or she make take a sample from the blisters to test for the virus. Finally, there is a blood test that may be helpful for making a diagnosis, especially if your doctor suspects herpes but you don't have an active infection.

Preventive Care

HSV-1

Avoiding kissing people with visible core sores
Don't share personal items
Wash your hands frequently
If you have HSV-1, be careful touching your eyes and genitals; don't perform oral sex on your partner
Use sunscreen
Reduce stress

HSV-2

Avoid having sex if you or your partner has an outbreak (active infection) of herpes. Herpes outbreaks are not always obvious and your partner may be contagious without you knowing it. Anyone involved in an ongoing sexual relationship with a partner infected with HSV-2 should get counseling from a healthcare practitioner on how to best keep yourself safe.
Avoid touching the sores
Use or have your partner use a latex condom (even when sores are not visible)
Limit the number of sex partners

Treatment Approach

Herpes cannot be cured, so the goals of treatment are to reduce the number of outbreaks and to lessen symptoms when you do have an outbreak.

Cold sores usually go away by themselves in no more than 1 to 2 weeks. Using medications may shorten the outbreak and decrease discomfort.

Antiviral medications for genital herpes can reduce outbreaks and help speed recovery when an outbreak does occur. They can also lessen the chances of spreading the virus.

Coping with the emotional and social aspects of having genital herpes is part of treatment. Relaxation techniques and support groups can help.

Lifestyle

For cold sores, applying either heat or cold to blisters may help relieve pain. Try ice or warm compresses.

For genital herpes, wear cotton underwear and avoid tight fitting clothes as they can restrict air circulation and slow the healing of lesions.

Be sure to tell your partner or potential partner that you have herpes.

Medications

Antiviral medicines - may help shorten the duration of a herpes outbreak and suppress recurring outbreaks. For genital herpes, there are two types of therapy: episodic and suppressive. With episodic therapy, you take medication at the first sign of an outbreak and for several days to shorten the duration or prevent a full outbreak. With suppressive therapy, you may take medication daily to keep outbreaks from occurring. Antiviral medications include:

Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)

Topical medications (for oral herpes) - include the antiviral cream Penciclovir (Denavir) and an over-the-counter cream, docosanol (Abreva).

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

Lysine (1 to 3 g per day) - Although not all studies agree, several studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores and possibly genital herpes. Most of the studies have involved people with cold sores or with both cold sores and genital herpes. A few studies also suggest that lysine may help shorten the duration of an outbreak. The evidence is somewhat stronger for cold sores: the research to date is not entirely conclusive, lysine supplements have been used to help treat or prevent mouth and genital lesions caused by herpes. Taking lysine supplements or increasing lysine in your diet (from foods like fish, chicken, eggs, and potatoes) may speed recovery time and reduce the chance of recurrent breakouts of the herpes infection. If you have high cholesterol, heart disease, or high triglycerides (type of fatty material in the blood, generally measured when you have your cholesterol checked), it is best, at this point, not to use lysine because animal studies suggest that this supplement may raise cholesterol and triglyceride levels.
Propolis - A resin made by bees, propolis is loaded with flavonoids (antioxidants that help fight infection and boost immune function). Test tube studies show it can stop HSV-1 and HSV-2 from reproducing. One small study of people with genital herpes compared an ointment made from propolis to Zovirax ointment. People using propolis saw the lesions heal faster than those using topical Zovirax. More studies are needed to say for sure whether propolis works.
Zinc - In test tubes, zinc is effective against HSV-1 and HSV-2. In one small study in people, those who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream.

Herbs

Lemon balm (Melissa officinalis) - Several studies suggest that topical ointments containing lemon balm may help heal cold sores. In one study, for example, those who applied lemon balm cream to their lip sores saw a reduction in redness and swelling after two days.
Aloe (Aloe vera) - Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men. In two studies, men who used the aloe vera cream (0.5% aloe) saw lesions heal faster than those who used a placebo cream. It isn't know whether aloe vera would also help heal cold sores.
Rhubarb cream (Rheum palmatum) - In one Swiss study, a cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores. Sage by itself was not beneficial. More research is needed.
Eleutherococcus or Siberian ginseng (Eleutherococcus senticosus/Acanthopanax senticosus) -Although not all studies agree, one 6-month study of 93 people with genital herpes found that Siberian ginseng reduced the frequency, severity, and duration of outbreaks. This herb should not be taken if you have high blood pressure, obstructive sleep apnea (repeated, prolonged periods when breathing stops while sleeping), narcolepsy (frequent day time sleeping), are pregnant or breastfeeding.
Peppermint oil (Mentha x piperita ) - In test tubes, peppermint oil has stopped a number of viruses from reproducing, including herpes. However, it isn't known whether peppermint oil would have any effect on the herpes virus in humans.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the remedies described below for the treatment of herpes based on their knowledge and experience. One study of 53 people with genital herpes did show that the majority had improvement in their symptoms and were less likely to have recurrent outbreaks when treated with homeopathy. Participants in this study were followed for up to 4 years.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

For cold sores:

Natrum muriaticum - for eruptions at the corners of the mouth that occur during periods of emotional stress and tend to worsen in the daytime
Rhus toxicodendron - for eruptions consisting of many small blisters that itch intensely at night
Mercurius - for children who drool and may have a fever
Sepia - for outbreaks that do not improve with other homeopathic remedies; this remedy is most appropriate for individuals who tend to have a lack of energy and don't tolerate cold weather

For genital lesions:

Graphites - for large, itchy lesions in individuals who are overweight
Natrum muriaticum - for eruptions that occur during periods of emotional stress and symptoms that tend to worsen in the daytime
Petroleum - for lesions that spread to anus and thighs; symptoms tend to worsen in winter and improve in summer
Sepia - for outbreaks that do not improve with other homeopathic remedies; this remedy is most appropriate for individuals who tend to have a lack of energy and don't tolerate cold weather

Mind/Body Medicine

Support groups - Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is quite common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom you are hoping to become intimate is also typical. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. If you are in a committed relationship, seeing a couples' therapist with your partner may also be helpful.
Relaxation techniques - Using relaxation techniques, such as yoga, guided imagery, and meditation, on a daily basis may help you feel better overall and cope with stresses related to having herpes.
Self-hypnosis - Self-hypnosis using guided imagery may also help relieve stress. In one 6-week training program, participants with frequently recurring genital herpes were able to reduce outbreaks by nearly 50% and improve their mood, including reducing feelings of depression and anxiety.
Other - Individual therapy with a psychiatrist, psychologist, or social worker; and techniques such as biofeedback can help reduce emotional symptoms associated with herpes.

Other Considerations

Pregnancy

Herpes viruses can be transmitted to a newborn during vaginal delivery, especially if the mother has active lesions in the vagina at the time of delivery. Herpes infections in newborns can be life-threatening or cause disability. Delivery by cesarean section (C-section) will be recommended to avoid infecting the baby.

Special Populations

Newborns – herpes infections contracted during delivery from the mother can lead to meningitis, herpes infection in the blood, chronic skin infection, and may even be fatal.

You are more likely to have severe, frequent outbreaks and to experience complications from herpes if your immune system is suppressed from:

HIV or AIDS
Chemotherapy for cancer
Long-term use of high doses of corticosteroids
Medications that intentionally suppress the immune system

Warnings and Precautions

If you are diagnosed with genital herpes, you should be tested for other sexually transmitted diseases such as chlamydia and gonorrhea.

Prognosis and Complications

Herpes is a chronic, recurrent infection. The initial symptoms usually appear within 1 to 3 weeks of exposure to the virus and last 7 to 10 days (for cold sores) or 7 to 14 days (for genital lesions). Usually the number of outbreaks is greatest in the first year and higher for HSV-2 genital lesions than HSV-1 cold sores. Each year after that, the number of outbreaks usually goes down and they become less severe. But you can never completely get rid of the virus.

Complications of herpes include:

Herpetic keratitis – herpes infection of the eye leading to scaring within the cornea and possible blindness
Persistent herpes infection, without lesion-free periods
Herpes infection in the esophagus
Herpes infection of the liver which can lead to cirrhosis (liver failure)
Encephalitis and/or meningitis (serious brain infections)
Lung infection
Eczema herpetiform – widespread herpes across the skin

Supporting Research

Allen P. Tea tree oil: the science behind the antimicrobial hype. Lancet. 2001;358(9289):1245.

Ames M. Herpes: Comprehensive treatment strategy. Int J Integra Med. 2000;2(5):6-9.

Beauman JG. Genital herpes: a review. Am Fam Physician. 2005 Oct 15;72(:1527-34. Review.

Binns SE, Hudson J, Merali S, Arnason JT. Antiviral activity of chacterized extracts from Echinacea spp. (Heliantheae: Asteraceae) against herpes simplex virus (HSV-I). Planta Med. 2002;68(9):780-783.

Brennan P. Homeopathic remedies in prenatal care. J Nurse Midwifery. 1999;44(3):291-299.

Carson CF, Ashton L, Dry L, Smith DW, Riley TV. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J Antimicrob Chemother. 2001;48(3):450-451.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 259-260.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1080-1086.

Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, Bielenberg J. Antiviral effects of Glycyrrhiza species. Phytother Res. 2007 Sep 20; [Epub ahead of print]

Fox PA, Henderson DC, Barton SE, et al. Immunological markers of frequently recurrent genital herpes simplex virus and their response to hypnotherapy: a pilot study. Int J STD AIDS. 1999;10(11);730-734.

Fried RG. Nonpharmacologic treatments in psychodermatology. Dermatol Clinics. 2002;20910;177-185.

Gaby AR. Natural remedies for Herpes simplex. Altern Med Rev. 2006 Jun;11(2):93-101. Review.

Godfrey HR, Godfrey NJ, Godfrey JC, Riley D. A randomized clinical trial on the treatment of oral herpes with topical zinc oxide/glycine. Altern Ther Health Med. 2001;7(3):49-56.

Griffith RS, Walsh DE, Myrmel KH, Thmpson RW, Behforooz A. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica. 1987;175(4):183-190.

Gruzelier JH. A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress. 2002;5(2):147-163.

Hijikata Y, Tsukamoto Y. Effect of herbal therapy on herpes labialis and herpes genitalis. Biotherapy. 1998;11(4):235-240.

Huleihel M, Isanu V. Anti-herpes simplex virus effect of an aqueous extract of propolis. Isr Med Assoc J. 2002;4(11 Suppl):923-927.

Jenaer M, Henry MF, Garcia A, Marichal B. Evaluation of 2LHERP in preventing recurrences of genital herpes. Institut International 3IDI. Br Homeopath J. 2000;89(4):174-177.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 234.

Koch C, Reichling J, Schneele J, Schnitzler P. Inhibitory effect of essential oils against herpes simplex virus type 2. Phytomedicine. 2007 Oct 30; [Epub ahead of print]

Koytchev R, Alken RG, Dundarov S. Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine. 1999;6(4):225-230.

L-lysine. Monograph. Altern Med Rev. 2007 Jun;12(2):169-72.

Marcason W. Will taking the amino acid supplement lysine prevent or treat the herpes simplex virus? J Am Diet Assoc. 2003;103(3):351.

McCaleb R. Melissa relief for herpes sufferers. HerbalGram. 1995;34.

Milman N, Scheibel J, Jessen O, et al. Lysine prophylaxis in recurrent herpes simplex labialis: a double-blind, controlled crossover study. Acta Derm Venereol. 1980;60:85-87.

Robbers JE, Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: The Haworth Herbal Press; 1999:67-68, 246-247.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:249-251.

Saller R, Buechi S, Meyrat R, Schmidhauser C. Combined herbal preparation for topical treatment of Herpes labialis. Forsch Komplementarmed Klass Naturheilkd. 2001;8(6):373-382.

Schnitzler P, Nolkemper S, Stintzing FC, Reichling J. Comparative in vitro study on the anti-herpetic effect of phytochemically characterized aqueous and ethanolic extracts of Salvia officinalis grown at two different locations. Phytomedicine. 2007 Dec 7; [Epub ahead of print]

Schnitzler P, Schon K, Reichling J. Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Pharmazie. 2001;56(4):343-347.

Shenefelt PD. Hypnosis in dermatology. Arch Dermatol. 2000;136(3):393-399.

Tomblin FA Jr, Lucas KH. Lysine for management of herpes labialis. Am J Health Syst Pharm. 2001;58(4):298-300, 304.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 60.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 277-278.

Vogler BK, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J GenPract. 1999;49:823-828.

Vogler BK, Pittler MH, Ernst E. The efficacy of ginseng. A systematic review of randomized clinical trials. Eur J Clin Pharmacol. 1999;55(:567-575.

Vynograd N, Vynograd I, Sosnowski Z. A comparative multi-centre study of the efficacy of propolis, acyclovir, and placebo in the treatment of genital herpes (HSV). Phytomedicine. 2000;7(1):1-6.

Review Date:
12/23/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Migraine headache

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Migraines are severely painful, recurrent headaches that are sometimes accompanied by other symptoms such as visual disturbances (aura) or nausea. There are two types of migraine – migraine with aura (formerly called common migraines) and migraine without aura (formerly called classic migraines). If you have a migraine with aura, you may experience a visual disturbance (like seeing stars or zigzag lines or a temporary blind spot) about 30 minutes before the headache starts. Even if you don't experience an aura, you may have other warning signs in the period before the headaches starts (called prodrome), such as a craving for sweets, thirst, sleepiness, or depression. Although there is no cure for migraines, you can manage the condition by reducing the frequency of attacks and lessening pain once an attack starts.

Signs and Symptoms

The headache from a migraine, with or without aura, has the following characteristics:

Throbbing, pounding, or pulsating pain
Often begins on one side of your head and may spread to both or stay localized
Most intense pain is often concentrated around the temple(s) (side of the forehead)
Can last from 4 to 72 hours

These symptoms may occur at the same time or before the headache:

Nausea and vomiting
Dizziness, lightheadedness or even vertigo (feeling like the room is spinning)
Loss of appetite
Fatigue
Visual disturbances, like seeing flashing lights or zigzag lines, temporary blind spots (for example, loss of your peripheral vision), or blurred vision
Parts of your body may feel numb, weak, or tingly
Light, noise, and movement – especially bending over – make your head hurt worse; you want to lie down in a dark, quiet room
Irritability

Symptoms that may linger even after the headache is gone:

Feeling mentally dull, like your thinking is not clear or sharp
Sleepiness
Neck pain

Causes

Researchers aren't sure what causes a migraine, although they know it involves changes in the blood flow in the brain. Initially, blood vessels constrict (narrow), reducing blood flow and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. Later, the blood vessels dilate (enlarge) leading to increased blood flow and a severe headache. Migraine triggers can include the following:

Alcohol, especially beer and red wine
Certain foods, such as aged cheeses, chocolate, nuts, peanut butter, some fruits (like avocado, banana, and citrus), foods with monosodium glutamate (MSG), onions, dairy products, meats containing nitrates (bacon, hot dogs, salami, cured meats) fermented or pickled foods
Skipping meals
Fluctuations in hormones (for example, during pregnancy, before and during your period, and menopause)
Certain odors, such as perfume or smoke
Bright lights
Loud noises
Stress, physical or emotional (often, the headache occurs during a period of relaxation after a particularly stressful time)
Sleeping too little or too much
Caffeine
Smoking or exposure to tobacco smoke
Some medications

Risk Factors

Gender (women are more likely to get migraines than men)
Having other family members with migraine headaches
Being under age 40; migraines tend to diminish as you age
Taking birth control pills (if your migraines are affected by fluctuations in estrogen levels)
Exposure and sensitivity to any of the potential triggers listed above

Diagnosis

Your doctor will take a detailed medical history in order to distinguish migraine headaches from other types of headaches, such as tension or sinus. He or she will ask questions about when your headaches occur, how long they last, how frequently they come on, the location of the pain, and any symptoms that accompany or precede the headaches. Sometimes it helps to keep a diary about your headaches prior to seeing the doctor, so you'll have an accurate recording of how often they happen. (See Lifestyle section for what information to include in a diary.)

Tests your doctor may order, depending on your symptoms and exam, include:

Computerized tomography (CT) scan, to look for other problems that could be causing your headache
Magnetic resonance imaging (MRI), to look for brain abnormalities, and to look closely at the blood vessels in the brain
Lumbar puncture (spinal tap), if your doctor suspects meningitis or other conditions

You should seek emergency help if you experience the following symptoms:

You have unusual neurologic symptoms you have not experienced before, such as speech problems, change in vision, loss of balance, or difficulty moving a limb.
Your headache pattern or intensity is different
You are experiencing "the worst headache of your life"
Your headache worsens when you are lying down

These may indicate a stroke, a bleed in the brain, or other serious condition.

Treatment Approach

Treatment for migraines is aimed at preventing them from occuring and lesseneing pain once an attack starts.

You can control your migraines with a combination of medications, lifestyle changes, and complementary therapies. Biofeedback (see Mind/Body Medicine) may help you control the initial contraction of blood vessels, while relaxation techniques may reduce both the frequency and intensity of attacks.

Lifestyle

Keeping a migraine diary, particularly when you first begin to experience migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine occurs, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before the headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.

Other lifestyle measures that may reduce the number of migraines include:

Avoiding cigarettes, caffeine, and alcohol
Exercising regularly
Getting enough sleep each night
Relaxing and reducing stress in your life (see Mind/Body Medicine section)

Once a headache or associated migraine symptoms begin, it helps to:

Rest in a quiet, darkened room
Drink fluids to avoid dehydration (especially if you have vomited)

Medications

Medications for migraines can be classified in two major categories: those designed to prevent attacks, and those designed to relieve pain.

Drugs for Prevention

Your doctor may prescribe preventive medications if you have two or more migraines per month, use pain relievers more than twice a week, or if your symptoms are especially debilitating. Depending on your condition and medication, your doctor may recommend taking the medication daily or when a known trigger is about to occur (such as having your period).

Beta-blockers - also used to treat heart disease; researchers aren't sure why they also work for migraines, although they may help keep blood vessels in the brain from constricting and dilating. Beta-blockers include
- Atenolol (Tenormin)
- Metoprolol (Lopressor, Toprol-XL)
- Propranolol (Inderal, Inderal LA)
Calcium-channel blockers - another type of cardiovascular drug that can help prevent migraines, including
- Verapamil (Calan, Isoptin)
- Diltiazem (Cardizem, Dilacor)
Anti-depressants - Tricyclic antidepressants are helpful in preventing all kinds of headaches, including migraines. Tricyclic antidepressants include:
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
Anticonvulsants - Some anti-seizure drugs help prevent migraines, although researchers aren't sure why:
- Divalproex sodium (Depakote)
- Topiramate (Topamax)

Drugs for Treatment

To be effective, these medications should be taken as soon as you feel a migraine coming on.

Triptans - This class of medications tends to be the front-line treatment for severe migraines and relieve pain, nausea, and sensitivity to light and sound. They work by constricting the blood vessels in the brain. Triptans include
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
Ergots - Ergots also work by constricting blood vessels, but tend to have more side effects than triptans. Ergots include
- Ergotamine (Ergomar, Cafergot)
- Dihydroergotamine (Migranal)
Isometheptene, dichloralphenazone, and acetaminophen (Midrin) - Midrin combines a pain reliever (acetaminophen) and sedative (dichloralphenazone) with a medication that constricts blood vessels (isometheptene) to prevent migraines.

Other medications used to treat the headache pain or associated symptoms:

Anti-nausea drugs
Acetaminophen (Tylenol) for pain
Ibuprofen (Advil, Motrin) or other nonsteroidal anti-inflammatory drugs (NSAIDs)
Narcotics, such as codeine, are sometimes used for people who can't take triptans or ergots; however, they can cause dependency and rebound headaches

Nutrition and Dietary Supplements

Diet

Certain foods may trigger migraine headaches. Some of the include:

Chocolate
Cheese
Monosodium glutamate (MSG), a flavor enhancer found often in food from Chinese restaurants
Foods containing the amino acid tyramine (found in red wine, aged cheese, smoked fish, chicken livers, figs, and some beans)
Nuts
Peanut butter
Some fruits (like avocado, banana, and citrus)
Onions
Dairy products
Meats containing nitrates (bacon, hot dogs, salami, cured meats)
Fermented or pickled foods

If you suspect that any of these foods cause your migraines, you could follow an elimination diet, eliminating all the items on this list from your diet and then reintroducing them one at a time. Pay close attention to when the number of headaches increases after eating particular foods. Then you know which trigger foods to avoid.

5-hydroxytryptophan (5-HTP, 400 to 600 mg per day) - This amino acid is made by the body from tryptophan (another amino acid you get from certain foods) and converted into serotonin, an important brain chemical. Researchers think abnormal serotonin function in blood vessels is related to migraines, and some of the drugs used to treat migraines work by affecting serotonin. Several studies indicate that 5-HTP may be about as effective as some prescription migraine medications, reducing the intensity and frequency of attacks. But not all studies have been so positive – one study found that 5-HTP was less effective than the beta-blocker Inderal. More studies are needed to be sure that 5-HTP is helpful in treating migraines. If you take an antidepressant, or supplements such as St. John's wort or SAMe, you should not take 5-HTP.
Magnesium (200 to 600 mg per day) - People with migraines often have lower levels of magnesium compared to people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks. In one study, people who took magnesium reduce the frequency of attacks by 41.6 percent, compared to 15.8 percent in those who took placebo. Some studies also suggest that magnesium may be helpful for women whose migraines are triggered by their periods.Side effects from magnesium can include lower blood pressure and diarrhea.
Vitamin B2 (riboflavin, 400 mg per day) - A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50 percent decrease in the number of attacks. Not all studies have found riboflavin to be effective, however. More research is needed.

Preliminary research indicates that these supplements may also help prevent migraines, although much more research is needed to say for sure:

Coenzyme Q10 (100 mg three times per day)
Melatonin (5 mg per day, taken before bedtime)

Herbs

Butterbur (Petasites hybridus, 50 to 75 mg of a standardized extract two times per day) - A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks. The studies used a standardized extract that lowered the amount of alkaloids in the herb, which might potentially be harmful to the liver. If you want to try butterbur for your migraines, ask your doctor about a safe extract and dose. Women who are pregnant or breastfeeding should not take butterbur.
Feverfew (Tanacetum parthenium, standardized leaf extract to 250 mcg parthenolide per day) - Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines (not all studies agree, however). In one study of people with migraines, those who took feverfew capsules every day for 4 months saw a substantial drop in the number of attacks as well as far fewer symptoms, such as nausea and vomiting, compared to those who received placebo. Feverfew can increase the risk of bleeding, and should not be taken with anticoagulants (blood-thinners). Women who are pregnant or breastfeeding should not take feverfew.

Although there are no scientific studies showing that these herbs work, they are sometimes suggested to treat migraines and other types of headaches:

Dong quai (Angelica sinensis)
Devil's claw (Harpagophytum procumbens)
Ginger (Zingiber officinale)
Ginkgo biloba (Ginkgo biloba)
Willow bark (Salix spp.)

Acupuncture

Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown benefit with acupuncture, researchers do agree that acupuncture appears safe and that it may be effective for some people. Results from a study published in 2003 suggest that receiving an acupuncture treatment when migraine symptoms first begin is as effective as taking the drug Imitrex; as symptoms continue, however, the medication works better than acupuncture.

In addition to needling treatment, acupuncturists may recommend lifestyle changes, such as suggestions for specific breathing techniques, qi gong exercise, and dietary modifications.

Chiropractic

Several clinical trials indicate that spinal manipulation therapy may help in the treatment of migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks and 49% reported a significant reduction of the intensity of each migraine.

In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation was as effective as Elavil in reducing migraines and had fewer side effects. There was no added benefit to combining the two therapies.

In addition, researchers reviewed nine studies that tested spinal manipulative therapy for tension or migraine headaches and found that it was as effective as medications in preventing these headaches.

However, not all these studies were of good quality, and they varied in the techniques used. More research is needed to say for sure whether chiropractic is effective for preventing migraines.

Massage and Physical Therapy

Reflexology, a technique that places pressure on specific "reflex points" on the hands and feet that are believed to correspond to areas throughout the body, has been proposed as a treatment for migraines. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication. However, more research is needed. Practitioners believe reflexology helps you become more aware of you own body signals, which might help you sense the subtle signals that indicate a migraine is about to occur (before pain starts). They also believe reflexology helps improve general well-being and energy level.

Homeopathy

One of the most common reasons people seek homeopathic care is to treat chronic headaches. However, only one out of four studies included in a scientific review found that individually prescribed homeopathic remedies significantly reduced the frequency, severity, and duration of migraines. Some of these effective remedies are listed below. Professional homeopaths may also recommend various treatments based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account the individual's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are some of the remedies found to be effective:

Belladonna - for throbbing headaches that come on suddenly; these types of headaches tend to worsen with motion and light, but are partially relieved by pressure, standing, sitting, or leaning backwards
Bryonia - for headaches with a steady, sharp pain in the forehead that may radiate to the back of the head; these types of headaches worsen with movement and light touch, but improve with firm pressure; this remedy is most appropriate for individuals who are irritable and may also experience nausea, vomiting, and constipation
Gelsemium - for pain that extends around the head and feels like a tight band of constriction; pain usually originates in the back of the head and may be relieved following urination; this remedy is most appropriate for individuals who feel extremely weak and have difficulty keeping their eyes open
Ignatia - for pain that may be described as a feeling of something being driven into the skull; these types of headaches tend to be triggered by emotion, including grief or anxiety, and the treatment is appropriate for both children and adults
Iris versicolor - for periodic migraines that begin with blurred vision, especially after eating sweets; pain usually occurs on one side of the head and may be partially relieved by gentle movement and/or fresh air
Kali bichromicum - for aching and pressing pains on the forehead (particularly between and behind the eyes); may be accompanied by sinus congestion or nausea and vomiting; this remedy is most appropriate for individuals who prefer to lie down in a dark room and who experience relief from warmth and eating
Lachesis - for migraines on the left side of the head that are typically worse in the mornings and before menstruation; this type of headache is aggravated by warmth and sunlight and relieved by open air and firm pressure
Natrum muriaticum - one of the most common remedies used for migraine headaches, particularly those that are described as "hammers beating the head;" pain is relieved when the individual is lying down, alone, in a quiet dark room; these migraines may be associated with either menstruation or a grieving experience and are worse in the middle of the day; this remedy is most appropriate for children who look pale and feel nauseated, nervous, and emotional
Nux vomica - for headaches that are described as a "nail being driving into the head;" often accompanied by nausea and/or dizziness; this remedy is most appropriate for individuals who are constipated and irritable
Sanguinaria - for right-sided headaches that begin in the neck and move upwards, recur in a predictable pattern (such as every seven days), and are accompanied by nausea and vomiting; pain is aggravated by motion, light or sun exposure, odors, and noise; this remedy is appropriate for children who may have a craving for spicy or acidic foods, despite having a general aversion to eating due to the headache
Sepia - for migraines that are accompanied by nausea and are relieved when the individual is lying down; light and movement tend to worsen symptoms; this remedy is most appropriate for individuals who are moody and don't like being alone, but worry about being with others

Homeopaths may also prescribe the following remedies based on their knowledge and clinical experience:

Pulsatilla - for headaches triggered by eating rich, fatty foods, particularly ice cream; pain tends to move but may be concentrated in the forehead or on one side of the head; may be accompanied by digestive problems or occur around the time of menstruation; children for whom this remedy is appropriate often develop these symptoms while at school
Spigelia - for migraines described as a stinging, burning, or throbbing pain, often on the left side of the head; symptoms tend to worsen with exposure to cold weather and with motion, but are temporarily relieved by cold compresses and when the individual is lying on the right side with the head propped up

Mind/Body Medicine

Reducing and learning to cope with stress may help reduce the number and intensity of your headaches. Techniques that can help include:

Self-hypnosis
Biofeedback
Joining a support group
Relaxation techniques such as progressive muscle relaxation (alternately contracting and releasing muscles throughout your body), meditation, and guided imagery

Other Considerations

Pregnancy

Many of the medications, herbs, and supplements used to prevent or treat migraines should not be used if you are pregnant. Talk to your doctor before using any medication (over the counter or prescription) or any complementary therapy available prior to becoming pregnant.

Warnings and Precautions

Use medications only as directed. using some medications on a regular basis can cause rebound headaches.

Call your doctor if you experience a new headache, a change in quality of a previous headache or headache pattern, or if a medication that usually takes away the pain no longer works.

Prognosis and Complications

Migraine headaches generally don't pose a threat to your overall health, although they can be chronic, recurrent, frustrating, and interfere with your day to day life. Stroke is an extremely rare complication from severe migraines, possibly due to prolonged constriction (narrowing) of blood vessels, reducing the blood flow to parts of the brain.

Many people find that migraines into remission (meaning that they stop for a long time and happen only very infrequently) or even disappear altogether, especially as you get older. For women, this may be related to lower levels of estrogen after menopause.

Supporting Research

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Review Date:
12/18/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Sleep apnea

FitSugar — Wed, 08 Oct 2008 17:35:25 -0700

Overview

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Special Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

People with sleep apnea stop breathing for short periods of time while they are asleep. You generally don't wake up fully when this happens, but in the morning you don't feel rested, and you feel sleepy during the day. Sleep apnea can be caused by a blocked upper airway (called obstructive apnea), by your brain not signaling your lungs to breathe (central apnea), or by a combination of these two problems. Obstructive sleep apnea is the most common form.

Signs and Symptoms

The symptoms of sleep apnea include the following.

Loud, irregular snoring, then quiet periods of at least 10 seconds when breathing stops. These episodes can happen up to 100 times or more each hour.
Daytime sleepiness, always feeling tired
Morning headaches, sore throat, dry mouth, cough
Feeling depressed, moody, irritable
Unable to concentrate or remember
Possible impotence or high blood pressure

What Causes It?

Many physical conditions (such as obesity, or large tonsils and adenoids) can cause sleep apnea. The typical person with sleep apnea is an overweight, middle-aged man who has allergies, but apnea can occur at any age and in women as well as men. Sometimes drugs such as alcohol, sleeping pills, or heart medications can trigger apnea. It can also be inherited.

What to Expect at Your Provider's Office

People who have sleep apnea often seek medical help because they feel tired all the time or because their partner complains of loud snoring. Your health care provider will check your weight and blood pressure and ask about allergies. Your healthy care provider may send you home with a device to check your oxygen levels while you sleep. They may also refer you to a sleep clinic for overnight testing.

Treatment Options

The most effective treatment is called Continuous Positive Airway Pressure (CPAP), which uses a machine and mask to blow air through the airway at a pressure high enough to make sure the airway stays open.
A few drugs hold promise, but most have some undesirable side effects.
Some dental appliances, worn in your mouth, are available. They work by pushing the lower jaw forward, by keeping the tongue from obstructing the airway, or by a combination of both. These may be uncomfortable at first.
Sometimes surgery is needed, but your health care provider will most likely recommend that you try devices or drugs first.

Making the following lifestyle changes can help obstructive apnea:

Lose weight. Often this will cause obstructive apnea to go away completely.
Minimize your use of alcohol, antihistamines, or tranquilizers.
Get treatment for allergies and colds or sinus problems.
Gargle with salt water (without swallowing) to shrink your tonsils.
Develop regular sleep habits, and especially make sure you get enough sleep at night.
Sleep on your side rather than on your back or with your body elevated from the waist up. You can use foam wedges (rather than soft pillows, which tend to make apnea worse by pushing the chin toward the chest) to raise your upper body.
Use an air humidifier at night.
Don't smoke or expose yourself to other irritants (such as dust or perfumes).
Raise the head of your bed by placing bricks under the headboard.

Drug Therapies

There is no drug that completely treats sleep apnea. Some of the drugs used in combination with CPAP include:

Medications used to treat central apnea:

Acetazolamide
Clomipramine -- side effects may include impotence

Medications used to treat obstructive apnea:

Medroxyprogesterone -- side effects may include nausea, depression, excess hair growth, breast tenderness, and fluid retention.
Protriptyline -- this medication is used rarely. Side effects may include dry mouth, constipation, frequent urination, impotence, and confusion (in the elderly).
Modafinil -- sometimes prescribed in combination with CPAP to treat excessive daytime sleepiness.

Complementary and Alternative Therapies

Alternative therapies may be useful in treating sleep apnea caused by allergies. Homeopathy and nutrition are most likely to have a positive effect. While many supplements are touted as good for weight loss, none have proved to be as effective as eating less and exercising more.

Nutrition and Supplements

Diet: Try eliminating mucus-producing foods (dairy and bananas) for 2 weeks, then reintroducing them and noticing any difference.
Essential fatty acids (EFAs) moderate inflammatory response and decrease allergic response. EFAs are found to be low in obese people. Fish oil, evening primrose oil, flaxseed oil, and borage oil all contains essential fatty acids.
Chromium helps regulate insulin and decrease insulin resistance. Chromium may not be effective at burning fat, but it is effective at stabilizing blood sugar and decreasing sugar cravings. The adequate intake is 45 mcg per day. Studies suggest amounts of 200 mcg per day for up to 6 months are safe. Do not take chromium if you are pregnant. If you have diabetes, do not take chromium without your doctor's supervision.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies, though it may be helpful as a supportive therapy. Professional homeopaths, however, may recommend one or more of the following treatments for sleep apnea based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Arsenicum album -- for respiratory disorders that worsen at night and are accompanied by fear, agitation, restlessness, weakness, and exhaustion.
Lachesis -- for conditions that get worse while trying to sleep. This remedy is most appropriate for those who are intense, talkative, jealous, and may feel depressed (particularly in the morning). It is may help people who may be frightened of going to sleep.
Opium -- this remedy may be prescribed for individuals with sleep apnea and narcolepsy (inability to control falling asleep during the daytime). This remedy is appropriate for individuals who may be somewhat confused due to the sleep disorder.
Sambucus -- for difficulty breathing at night. This remedy is most appropriate for individuals who may have nasal obstruction or asthma and actually jump up out of bed with a feeling of suffocation.
Spongia -- for respiratory symptoms that are worsened by cold air and lying down. This remedy is appropriate for individuals often feel a tightness in the chest area.
Sulphur -- for chronic conditions accompanied by sleep disturbances and nightmares, especially if the individual also has skin rashes that become worse with heat. This remedy is most appropriate for individuals who prefer cold temperatures and strongly dislike any kind of restriction.

Acupuncture

Some evidence suggests that a type of acupuncture called auriculotherapy acupoint pressure may help treat sleep apnea.

Following Up

Sleep apnea is a serious condition that can cause fatal heart problems, so it's crucial to stick with your treatment plan. If you are using a mask and ventilator equipment, be sure to take care of them. Keep in contact with your health care provider or sleep clinic to make sure your treatment is working.

Special Considerations

If you are pregnant, you may have nasal congestion that makes you snore in a way that people with apnea do, but this is not apnea. If you have apnea and become pregnant, be sure to continue your treatment so that your condition will not affect your baby.

Supporting Research

Caldwell JP. Sleep: Everything You Need to Know. Buffalo, NY: Firefly Books; 1997.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 237-239, 306, 320-321, 331-332.

Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163(2):344-8

Flemons WW. Clinical practice: obstructive sleep apnea. N Engl J Med 2002;347(7):498-504

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 260-264.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Pascualy RA, Soest SW. Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment. 2nd ed. New York, NY: Demos Vermande; 1996.

Smolley LA, Bruce DF. Breathe Right Now: A Comprehensive Guide to Understanding and Treating the Most Common Breathing Disorders. New York, NY: WW Norton & Co; 1998.

Wang XH, Yuan YD, Wang BF. Clinical observation of effect of auricular acupoint pressing in treating sleep apnea syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003 Oct;23(10):747-9.

Review Date:
6/30/2006
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Premenstrual syndrome

FitSugar — Wed, 08 Oct 2008 17:34:56 -0700

Overview

Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Prognosis/Possible Complications
Following Up
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Women who have premenstrual syndrome (PMS) experience a variety of physical and emotional symptoms that occur each month from 2 to 14 days before their menstrual cycle. The symptoms usually disappear once the cycle begins. PMS may begin at any age and ends after menopause. Approximately 75% of women experience PMS to some degree, with 20 - 50% finding that symptoms disrupt their daily activities, and 3 - 5% becoming incapacitated.

Signs and Symptoms

PMS is often accompanied by the following signs and symptoms:

Abnormal bloating and weight gain
Breast swelling, tenderness
Mood swings
Depression and anxiety
Skin disorders
Changes in appetite, food cravings
Changes in interest in sex
Headaches, backaches, cramps
Inability to concentrate, loss of interest in usual activities, confusion

What Causes It?

While the exact cause of PMS is unknown, the most popular theories include hormonal changes (estrogen excess or progesterone deficiency), hypoglycemia (low blood sugar), vitamin B₆ deficiency, abnormal metabolism of prostaglandin (hormone-like substances), excessive fluid retention, and endorphin (a substance in the brain that provides pain relief) withdrawal.

Who's Most At Risk?

Women with a history of the following conditions are at a higher-than-average risk for having PMS.

Dysmenorrhea (painful menstruation)
Depressive, mood, anxiety, or bipolar disorders (including a family history of these problems)
Postpartum depression or psychotic episodes
High stress

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with PMS, you should see your health care provider. Your health care provider can help make a diagnosis and guide you in determining a treatment or combination of therapies that may work best for you.

You'll need to chart your symptoms and their severity daily for 1 - 2 months. Your provider will take a detailed history of symptoms, do a physical and gynecologic examination to rule out other medical conditions, and conduct a psychosocial evaluation. Certain laboratory and imaging studies may be used, such as a Pap smear, complete blood count, chemistry screen, fasting blood glucose test, and thyroid studies.

Treatment Options

Prevention

Reducing stress, increasing exercise, and making dietary changes around the time of menstruation can prevent PMS symptoms from worsening.

Treatment Plan

Preventive measures and, in some cases, drug therapy, are most often used for treating PMS.

Drug Therapies

Your provider may prescribe the following medications.

Diuretics, for bloating and water retention
Analgesics, for headaches and cramps
Beta-blockers and calcium-channel blockers, to prevent the onset of migraine headaches
Prostaglandin inhibitors for painful menstruation
Spironolactone for skin conditions
Medications that block ovulation
Bromocriptine for breast soreness
Anti-anxiety medications
Antidepressants
Progesterone, for relief of symptoms

Women who are planning to become pregnant should avoid medications such as prostaglandin inhibitors, diuretics, spironolactone, and danazol.

Surgical and Other Procedures

Women whose symptoms are severe and do not respond to treatment may need to undergo a hysterectomy, including removal of the ovaries, followed by estrogen replacement therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for PMS may include a range of complementary and alternative therapies.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

Eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives and food additives. Your health care provider may want to test for food sensitivities.
Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy), or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Drink calcium-enriched soy milk, for bone health and symptoms of PMS.
Exercise moderately at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
Calcium citrate, 500 - 1,000 mg daily, for bone support and symptoms of PMS.
Vitamin D, 400 IU daily, for bone support and symptoms of PMS.
Ipriflavone (soy isoflavones) standardized extract, 200 mg three times a day, for bone loss and symptoms of PMS.
Progesterone cream, 1/8 - 1/4 teaspoonful (depending upon extract strength) applied topically daily on days 7 - 28 of cycle, for symptoms of PMS. Talk to your doctor. Although available as an over-the-counter product, progesterone cream may interfere with prescription and non-prescription medications, such as oral contraceptives.
Omega-3 fatty acids, such as fish oils, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
Melatonin, 2 - 5mg before bed, for sleep regulation.

Herbs

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures or liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with your favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls per cup of water ,steeped for 10 - 15 minutes (roots need longer).

The following herbal remedies may provide relief from symptoms:

Chaste tree (Vitex agnus castus) standardized extract, 400 mg daily before breakfast, for symptoms of PMS.
Black cohosh (Actaea racemosa) standardized extract, 20 - 40 mg two times a day, for symptoms of PMS.
Evening primrose oil (Oenothera biennis) standardized extract, 500 - 1,000 mg daily, as a source of gamma linolenic acid (GLA), for symptoms of PMS.
St. John's wort (Hypericum perforatum) standardized extract, 300 mg 2 - 3 times per day, for depression associated with PMS. Check with your health care provider if you are taking prescription medications, especially oral contraceptives.
St. John's wort (Hypericum perforatum) (300 mg 2- 3 times per day) for depression associated with PMS. Must be taken consistently throughout the month. Direct sun exposure may cause rashes in some people.
Kava kava (Piper methysticum) standardized extract, 100 - 250 mg 1 - 3 times a day, as needed for symptoms of stress and anxiety associated with PMS. Patients with a history of liver disorders should talk to their doctor about taking this supplement.
Dandelion (Taraxacum officinale) leaf tincture, 5 - 10 mL 2 - 3 times a day, for fluid buildup associated with PMS. You can also prepare teas from the leaf.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PMS based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

A low homeopathic dose, such as 30C, as often as every 15 - 30 minutes, may be used for symptoms of PMS, including bloating, pain, irritability and mood swings.

Chamomilla -- for intense menstrual pain. This remedy is most appropriate for women who are extremely irritable, angry, and have frequent mood swings.
Cimicifuga -- for feelings of hysteria, frustration, and being overwhelmed. This remedy is most appropriate for women who have labor-type pains that migrate from one side of the body to the other and may involve the back or even sciatic nerve (the largest nerve in the body; extends from the lower back down through the legs and knees).
Colocynthis -- for cramps that are relieved by bending forward, abdominal massage, and warmth (such as a heating pad). This remedy is most appropriate for women who are extremely irritable and restless.
Ignatia -- for emotional symptoms such as grief, panic, and mood swings. This remedy is most appropriate for individuals who feel particularly vulnerable.
Lachesis -- for women who tend to be annoyed, caustic, talkative, and envious, and whose pain and bloating is worse on the left side. Also for women whose symptoms tend to worsen upon awakening in the morning and with exposure to heat or light pressure. Also for women whose symptoms improve dramatically when menstruation begins.
Lycopodium -- for bloating with backaches and gas that are the worst during early evening and in warm weather.
Magnesia phos -- for sharp cramps that are relieved by bending forward, abdominal massage, and warmth (such as a heating pad), but are worsened by cold air.
Nux vomica -- for individuals who are extremely irritable, confrontational, and feel nauseous.
Pulsatilla -- for irregular periods with cramps, bloating, or mood swings as the predominant symptoms. An appropriate candidate for Pulsatilla is gentle and yielding but clingy and cries easily. Women who may benefit from pulsatilla may have nausea and water retention that is aggravated by heat.
Sepia -- for bloating, mood swings, constipation, drowsiness, and irritability.

Acupuncture

Although scientific evidence regarding the use of acupuncture for PMS is lacking, this condition is frequently treated by acupuncturists. Acupuncturists treat people with PMS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of PMS, a qi deficiency is usually detected in the liver and spleen meridians. Many treatments include moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points). Qualified practitioners may also recommend herbal treatment or dietary modifications.

Castor Oil Packs

For cramping and pain, dampen a cloth with castor oil and apply to the abdomen. Cover with saran wrap, and then apply a heating pad over this pack. Use for 1 - 3 hours, then remove.

Chiropractic

Some studies suggest that chiropractic spinal manipulation may be effective for women with PMS. Women with PMS have been found to have a higher rate of spine-related problems (such as tenderness and muscle weakness) than those who do not have PMS. In one study, researchers found that women with PMS experience a significant decrease in symptoms after receiving spinal manipulation and soft tissue therapy compared to those who do not receive the chiropractic treatment. The researchers note that these effects may be short-lived and that monthly chiropractic treatment would probably be needed to maintain these positive results.

Prognosis/Possible Complications

Severe PMS can disrupt a woman's life. Psychological and emotional support as well as treatment of the physical symptoms may help.

Following Up

Ongoing follow-up and regular evaluations are necessary.

Supporting Research

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994:715-718.

Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA 2001;285:1482–8.

Agnusdei D, Bufalino L. Efficacy of ipriflavone in established osteoporosis and long-term safety. Calcif Tissue Int 199:61:S23–7.

Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Human Psychopharmacol. 2003;18(3):191-5.

Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City, NY: Avery Publishing; 1997:443-445.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:352.

Beck WW. Obstetrics and Gynecology. 2nd ed. New York, NY: John Wiley; 1989: 216.

Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gynecol Obstet. 2000;264(3):150-3.

Bertone-Johnson ER, Hankinson SE, Bendich A, et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-52.

Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:119-20, 108, 90, 226-7.

Bowman MA. Ambulatory Care for the Adult. Madison, Conn: Fence Creek Publishing; 1998:121, 139, 140, 438.

Bryant M, Cassidy A, Hill C, et al. Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr. 2005;93(5):731-9.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 188-189.

Cunningham FG, et al. Williams Obstetrics. 19th ed, Norwalk, Conn: Appleton & Lange; 1993:97-99.

Danforth's Obstetrics and Gynecology. 7th ed. Philadelphia, Pa: J. B. Lippincott; 1994:599-600, 677-678.

Ernst E. Herbal remedies for anxiety - a systematic review of controlled clinical trials. Phytomedicine. 2006;13(3):205-8.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:290.

Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003;188(5 Suppl):S56-65.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:1222-3, 1175, 7476-8, 1204-6.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 185-186.

Keye WR Jr. The Premenstrual Syndrome. Philadelphia, PA: W. B. Saunders; 1988: 48, 55, 62, 74, 78, 114-118, 120, 147-149, 151-152, 180-183.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:112-118.

Lydeking-Olsen E. Beck-Jensen JE, Setchell KD, Holm-Jensen T. Soymilk or progesterone for prevention of bone loss--a 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004;43(4):246-57.

Mischoulon D, Fava M. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr. 2002;76(5):1158S-61S.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:58-62, 68-9, 82-6, 210-1, 274-6, 310-5, 343-7.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin, Calif: Prima Publishing; 1998:470-479.

North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004;11(1):11-33.

Rivlin ME, Martin RW. Manual of Clinical Problems in Obstetrics and Gynecology. 4th ed. Boston, Mass: Little, Brown; 1994:401-404.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 190-191.

Walsh MJ, Polus B. The frequency of positive common spinal clinical examination findings in a sample of premenstrual syndrome sufferers. J Manipulative Physiol Ther. 1999a;22(4):216-220.

Walsh MJ, Polus B. A randomized placebo controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome. J Manipulative Physiol Ther. 1999b;22(9):582-585.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc; 1987:364-369.

Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13(2):185-96.

Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus)--pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-57.

Review Date:
8/4/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Influenza

FitSugar — Wed, 08 Oct 2008 17:35:25 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Influenza, or "flu," is a caused by a virus infecting the respiratory system (nose, throat, bronchial tubes, lungs). Flu symptoms are usually more severe than those of the common cold and are more likely to affect other parts of your body. Flu also tends to come on suddenly, while colds can take a while to develop. Flu is very contagious, spreading easily from one person to the next. Most people with healthy immune systems will get over the flu in a week or two, but young children, senior adults, and people with chronic illnesses are more likely to develop complications such as pneumonia. About 36,000 people die of flu each year in the United States.

There are three types of flu viruses: A, B, and C. Type A viruses are the ones responsible for periodic pandemics (worldwide epidemics, such as the one in 1918 that killed as many as 50 million people worldwide). The avian or bird flu is a type A flu virus.

The best way to protect yourself from the flu is to get an annual vaccine (flu shot).

Signs and Symptoms

Fever that comes on suddenly (usually above 101 degrees Fahrenheit)
Chills and sweats
Headache
Muscle or body aches
Fatigue
Dry cough
Sore throat
Sneezing, runny nose, stuffy nose
Loss of appetite
Nausea, vomiting, or diarrhea, especially in children

Causes

Influenza is caused by viruses that are spread through the air by sneezes and coughs, or by touching a surface a person with the flu has touched and transmitting the virus to your mouth or nose. Some flu viruses cause a very mild illness, or none at all. Others cause serious, widespread illness.

Since there are many types of influenza virus, and because they change over time, a new flu vaccine is offered every fall. Getting vaccinated before the flu season starts reduces your chances of getting the flu, and helps you recover faster if you do get it. You should not take the vaccine if you have an allergy to eggs, because the viruses for the vaccines are grown in chick embryos. See Risk Factors for list of people who should get the vaccine every year.

Risk Factors

Infants and young children, as well as senior adults, are considered at highest risk of complications from flu. Other risks include:

Having a chronic illness, such as heart disease
Having a weakened immune system, from medications or HIV
Pregnant women
Peole who work in healthcare
People who work in childcare
Residents of nursing homes

If you are at risk for complications, you should get an annual flu shot (see Prevention).

Diagnosis

Your doctor will probably be able to diagnose flu from a physical exam and a description of your symptoms. He or she may take a chest X-ray if there is concern about complications such as pneumonia.

Preventive Care

The best way to prevent the flu is by getting a flu shot. Annual flu shots are recommended if you:

Are 50 or older
Have chronic heart, lung, or kidney disease
Live in an institution (such as a nursing home)
Have a weakened immune system
Have sickle cell anemia

You should not receive the vaccine if you are allergic to eggs.

You can also cut your risk of flu by washing your hands frequently during flu season.

Treatment Approach

Bed rest and drinking plenty of fluids are usually enough to treat flu. Mild over-the-counter pain relievers and fever reducers (such as acetaminophen or Tylenol, and ibuprofen or Advil), can help relieve fever and muscle aches.If you are at high risk for complications (see Risk Factors), then your doctor may prescribe antiviral medications (drugs that fight the virus). They must be started within two days to be effective. Certain herbs, supplements, and homeopathic remedies may help some of your symptoms.

Lifestyle

Drink lots of fluids
Rest to restore your energy and avoid complications like pneumonia.
Eat a diet rich in fresh fruits and vegetables. These foods provide lots of antioxidants (substances that may help boost your immune system), especially vitamins A and C.
Exercising regularly may cut your risk of flu and help your body respond better to a flu shot.
Minimize stress and your reaction to stress. Consider yoga, tai chi, or other forms of relaxation on an ongoing basis. Stress can put you at increased risk for viruses like influenza.

Medications

Pain and fever reducers - include ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) for fever reduction and relief of minor aches and pain. Children under 18 should not take aspirin due to the risk of a rare but serious illness called Reye's syndrome.
Decongestants - help open your nasal passages so you can breathe easier. If decongestant nasal sprays or drops are used for more than three days, however, they can cause rebound congestion. Decongestants are often combined in cold and flu medicines with antihistamines, cough suppressants, and pain relievers. People with heart disease, high blood pressure, diabetes, or glaucoma should not take decongestants. Popular brands of decongestants include Sudafed, Afrin, and Neo-Synephrine.
Cough medicines - cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucous) are available over the counter and by prescription.
Antiviral medications - Several antiviral medications have been approved by the Food and Drug Administration to treat flu, although a number of flu viruses have developed resistance to some of the medications. In addition, using these medications may help contribute to other strains of flu becoming resistant. These drugs must be started within 48 hours of becoming sick to be effective. Medications include
- Oseltamivir (Tamiflu): The FDA requires Tamiflu to carry a warning that people who have the flu, especially children, may be at increased risk of confusion and injuring themselves after taking Tamiflu.
- Zanamavir (Relenza)
- Amantadine (Symmetrel): Recently, most flu viruses in the U.S. have been resistant to Symmetrel
- Rimantadine (Flumadine): Recently, most flu viruses in the U.S. have been resistant to Flumadine

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Be sure to talk to your doctor about any supplements you are taking or considering taking.

Warm liquids - Chicken soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from the flu.
Probiotics (Lactobacillus) - So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent colds, too, although they have not been studied for the flu. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
Zinc - Your body needs zinc for its immune system to function properly, so it has long been thought that zinc could help protect against catching a cold or flu. But the evidence has been decidedly mixed, with some studies finding a benefit from zinc lozenges but others showing no effect. Recently, a review of studies that compared zinc to placebo found that most of them had flaws that made any positive results unreliable. Only four studies were deemed reliable, and three found no benefit from zinc lozenges. The remaining positive study suggested that zinc nasal sprays might help reduce nasal stuffiness. If you do decide to try zinc lozenges for a cold, remember that getting too much zinc (more than 50 mg per day over a long period of time) can be dangerous.
Spirulina - In test tubes, spirulina seems to be able to stop some flu viruses from reproducing. It isn't known whether it will have the same effect in humans, however.

Herbs

Andrographis (Andrographic paniculata) - One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero or Siberian ginseng (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce symptoms and shorten the duration of the flu. More studies are needed to say for sure whether it is effective.
Echinacea (Echinacea purpurea, 300 mg three times per day) - Although evidence on whether echinacea works to prevent or treat colds and flu has gone back and forth, recent evidence is encouraging. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58 percent and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. The analysis looked at colds, not flu, so the evidence may be more mixed as to whether Echinacea can help prevent flu. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
Garlic (Allium sativum) - Some studies suggest taking garlic may help reduce your risk of getting an upper respiratory infection, such as a cold or flu. More studies are needed to tell whether garlic has any true benefit for flu, however. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood-thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
Elder or elderberry (Sambucus nigra) - By lessening congestion and possibly increasing perspiration, elder may help reduce the symptoms of colds and flu. One study suggested that using a standardized elderberry extract, Sambucol™, could shorten the duration of flu by about three days. Sambucol™ also contains other herbs plus vitamin C, so it isn’t known whether elder by itself would have the same effect. Pregnant and breast-feeding women should not take elder.
Eucalyptus (Eucalyptus globulus) - Eucalyptus is used in many remedies to treat cold and flu symptoms, particularly cough. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. Fresh leaves can be used in teas and gargles to soothe sore throats. Ointments containing eucalyptus leaves are also applied to the nose and chest to relieve congestion and loosen phlegm.
Goldenseal (Hydrastis canadensis) - Goldenseal is often combined with echinacea in herbal cold and flu remedies, although scientific evidence that it works is lacking. Women who are pregnant or breast-feeding should talk to their doctor before taking goldenseal.
Licorice (Glycyrrhiza glabra) - Licorice root is a traditional treatment for sore throat, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure or heart disease, women who are pregnant or breast-feeding, and those who take anticoagulants (blood thinners) should not take licorice.
Marshmallow (Althea officinalis) - Although there isn’t any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough.
Peppermint (Mentha x piperita) - Like eucalyptus, peppermint is widely used to treat cold and flu symptoms. Its main active agent, menthol, is a good decongestants. Menthol also thins mucus and works as an expectorant, meaning that it helps loosen and break up phlegm. It is soothing and calming for sore throats and dry coughs as well.
Slippery elm (Ulmus fulva) - Slippery elm may help ease sore a sore throat and has been used traditionally for this purpose, although scientific evidence is lacking.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of the flu based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

A combination remedy including Aconite, Gelsemium, Eucalyptus, Ipecacuanha, Phosphorus, Bryonia, and Eupatorium perfoliatum
A mixture of Anas barbarice hepatis and Cordis extractum
Gelsemium - for chills, weakness, lack of energy, fever, and headaches in the back and top of the head; this is one of the most common homeopathic remedies for the flu
Eupatorium perfoliatum - for deep aches, sneezing and coughing
Nux vomica - for violent vomiting, irritability, dry cough, chills, and a stuffy nose that develops into a watery, irritating discharge

Other Considerations

Warnings and Precautions

If you are in any of the high-risk groups described in the Risk Factors section, be sure to call your doctor at the earliest signs of flu symptoms. The sooner you are treated, the less likely you are to develop complications.

Prognosis and Complications

Most healthy people get over the flu in one to two weeks. For those at high risk, certain serious, even life-threatening, complications can occur including:

Pneumonia
Encephalitis (an infection of the brain)
Secondary bacterial infection elsewhere in the body

Supporting Research

Alvarez-Olmos MI. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy. Clin Infect Dis. 2001;32(11):1567-1576.

Barak V, Birkenfeld S, Halperin T, Kalickman I. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002;4(11 Suppl):919-922.

Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-296.

Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D'Alessio D. Treatment of the common cold with unrefined Echinacea: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002;137:936-946.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:57-61, 233-239, 240-243, 244-248, 297-303.

Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine. 1999;6(1):1-6.

Cohen S, Hamrick N, Rodriquez MS, Feldman PJ, Rabin BS, Manuck SB. Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosom Med. 2002;64(2):302-310.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 57, 69.

de Vrese M, Winkler P, Rautenberg P, Harder T, Noah C, Laue C, et al. Probiotic bacteria reduced duration and severity but not the incidence of common cold episodes in a double blind, randomized, controlled trial. Vaccine. 2006 Nov 10;24(44-46):6670-4.

Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.

Eby GA. Zinc ion availability-the determinant of efficacy in zinc lozenge treatment of common colds. J Antimicrob Chemother. 1997;40:483-493.

Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, Bielenberg J. Antiviral effects of Glycyrrhiza species. Phytother Res. 2007 Sep 20; [Epub ahead of print]

Fortes C, Forastiere F, Agabiti N, et al. The effect of zinc and vitamin A supplementation on immune response in an older population. J Am Geriatr Soc. 1998;46:19–26.

Glatthaar-Saalmuller B, Sacher F, Esperester A. Antiviral activity of an extract derived from roots of Eleutherococcus senticosus. Antiviral Res. 2001;50(3):223-8.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. 2nd ed. Montvale, NJ: Medical Economics Company Inc; 2000:283-287, 477-479.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-929.e3. Review.

Guralnik M, Rosenbloom RA, Petteruti MP, Lefante C. Limitations of current prophylaxis against influenza virus infection. Am J Ther. 2007 Sep-Oct;14(5):449-54. Review.

Hatakka K, Savilahti, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centers: double-blind, randomized trial. BMJ. 2001;322(7298):1327.

Hayashi K, Hayashi T, Kojima I. A natural sulfated polysaccharide, calcium spirulan, isolated from Spirulina platensis: in vitro and ex vivo evaluation of anti-herpes simplex virus and anti-human immunodeficiency virus activities. AIDS Res Hum Retroviruses. 1996;12:1463–1471.

Hewson-Bower B, Drummond PD. Psychological treatment for recurrent symptoms of colds and flu in children. J Psychosom Res. 2001;51(1):369-377.

Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-780, 782

Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 2002;29(2):231-261.

Jackson JL, Lesho E, Peterson C. Zinc and the common cold: a meta-analysis revisited. J Nutr. 2000;130(5S Suppl):1512S-1515S.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 213.

Kligler B. Echinacea. Am Fam Physician. 2003;67(1):77-80.

Kohut ML, Cooper MM, Nickolaus MS, Russell DR, Cunnick JE. Exercise and psychosocial factors modulate immunity to influenza vaccine in elderly individuals. J Gerontol A Biol Sci Med Sci. 2002;57(9):M557-M562.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:190-196.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-334.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

McElroy BH, Miller SP. Effectiveness of zinc gluconate glycine lozenges against the common cold in school-aged subjects: a retrospective chart review. Am J Ther. 2002;9(6):472-475.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.

Melchart D, Walther E, Linde K, Brandmeier R, Lersch, C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med. 1998;7:541-545.

Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-252.

Reid MR, Mackinnon LT, Drummond PD. The effects of stress management on symptoms of upper respiratory tract infection, secretory immunoglobulin A, and mood in young adults. J Psycosom Res. 2001;51(6):721-728.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:166-169, 221-225, 252-258, 369-371.

Roettger B. Homeopathy as an effective treatment for colds and flus. Nutr Sci News Mag. August 1995.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Scaglione F, Cattaneo G, Alessandria M, Cogo R. Efficacy and safety of the standardized ginseng extract G115 for potentiating vaccination against common cold and/or influenza syndrome. Drugs Exp Clin Res. 1996;22:65-72.

Schulz V, Hansel R, Tyler V. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. 3rd ed. Berlin, Germany: Springer; 1998:150.

Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.

Takkouche B, Regueira-Mendez C, Garcia-Closas R, Figueiras A, Gestal-Otero JJ. Intake of vitamin C and zinc and risk of common cold: a cohort study. Epidemiology. 2002;13(1):38-44.

Turner RB. Ineffectiveness of intranasal zinc gluconate for prevention of experimental rhinovirus colds. Clin Infect Dis. 2001;33(11):1865-1870.

Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother. 2000;44:1708-1709.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 107.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 229.

Van Straten M, Josling P. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Adv Ther. 2002;19(3):151-159.

Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-369.

Review Date:
12/19/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Common cold

FitSugar — Wed, 08 Oct 2008 17:35:26 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

A cold is an upper respiratory infection caused by a virus. They tend to occur most often in winter, although scientists aren't sure why. In the United States, adults usually have between two and four colds per year, and children have as many 10.

There is no foolproof way to prevent a cold – and no way to cure it – but you can treat the symptoms. Colds tend to last about a week, and can be accompanied by sore throat and cough. Unlike the flu, colds don't usually cause you to run a high fever (above 102 degrees Fahrenheit).

Signs and Symptoms

Sneezing and runny nose from nasal congestion
Sore throat
Cough
Hoarseness
Low-grade fever (less than 102 degrees)
Headache
Fatigue

Causes

Colds are caused by more than 100 different viruses, although most colds are caused by rhinoviruses. You can get a cold by touching a person with a cold (for example, by shaking hands) and then touching your nose or eyes, or by touching a surface that a person with a cold has touched (such as telephone or keyboard). Colds are also transmitted through the air, when someone with a cold coughs or sneezes. Although you're more likely to get a cold in winter, exposure to cold outdoor air and fatigue do not increase your risk of getting sick (but stress may do so).

Risk Factors

People more likely to get colds include:

Children, especially those who attend day care or whose parents smoke
Smokers and those exposed to second hand smoke
Those exposed to industrial smoke, toxic fumes, or other air pollutants
People with immune system disorders, such as HIV, AIDS, or cancer, or who take medications that suppress the immune system, such as corticosteroids
People under a fair amount of stress

Diagnosis

Most people treat colds without seeing a doctor. If you do see your doctor, the diagnosis will be made based on your symptoms and exam. He or she may take a throat culture to rule out strep throat. If you have an underlying lung condition, such as asthma or emphysema, you should let your doctor know right away when you get a cold.

Preventive Care

Although anyone and everyone can get a cold, there are a few things that you can do that may help improve your immune system and make you less susceptible to getting colds:

Wash your hands frequently
Exercise regularly
Eat a diet rich in fruits and vegetables and low in fat
Get sufficient rest
Minimize your stress and your reaction to stress. Yoga, tai chi, or other forms of relaxation may help.

Treatment Approach

With a cold, the goal of treatment is to improve your symptoms as quickly as possible. But even if you do nothing, they should go away within a week to 10 days. Antibiotics cannot help your cold. However, there are medications, herbs, supplements, and homeopathic remedies that may make you feel better while you have a cold.

Lifestyle

Drink a lot of water to help loosen mucus.
Rest to restore your energy and avoid complications such as bronchitis or pneumonia.
Eat a diet rich in fresh fruits and vegetables. These foods provide lots of antioxidants (substances that may help boost your immune system), especially vitamins A and C.

Medications

A number of over-the-counter medications are available to help treat cold symptoms. Children under the age of six should not be given any over-the-counter cold or cough medicine.

Decongestants - help open your nasal passages so you can breathe easier. If decongestant nasal sprays or drops are used for more than three days, however, they can cause rebound congestion. Decongestants are often combined in cold medicines with antihistamines, cough suppressants, and pain relievers. People with heart disease, high blood pressure, diabetes, or glaucoma should not take decongestants. Popular brands of decongestants include Sudafed, Afrin, and Neo-Synephrine.

Antihistamines - can temporarily relieve a runny nose by drying up nasal secretions. Non-drowsy antihistamines available over the counter include loratadine (Claritin); others, such as fexofenadine (Allegra) and cetirizine (Zyrtec), are available by prescription.

Cough medicines - cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucous) are available over the counter and by prescription.

Pain relievers - such as aspirin, acetaminophen (Tylenol), and ibuprofen (Advil, Motrin) can be used for fever, body aches, and headaches. Children under the age of 16 should not take aspirin due to the risk of a rare but serious illness called Reye's syndrome.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

Chicken soup - It’s about as traditional a remedy for a cold as you can find (at least in modern history). In fact, chicken soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.
Probiotics (Lactobacillus) - So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent colds, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
Vitamin C - Despite the popular belief that vitamin C can cure the common cold, the scientific evidence hasn't found that to be true. Only a small reduction in the duration of a cold (about 1 day) has been found when some people take vitamin C supplements regularly (not just at the beginning of a cold). The only other piece of evidence supporting vitamin C for preventing colds comes from studies examining people exercising in extreme environments (athletes such as skiers and marathon runners, and soldiers in the Arctic). In these studies, vitamin C did seem to reduce the risk of getting a cold. Talk to your doctor about any pros and cons with regards to using vitamin C during cold and flu season. Some people believe that you have to take very high doses of vitamin C to get any benefit, and they suggest taking enough to cause diarrhea and then reducing the dose. You should only use such high doses of vitamin C under your doctor’s supervision.
Zinc - Your body needs zinc for its immune system to function properly, so it has long been thought that zinc could help protect against catching a cold. But the evidence has been decidedly mixed, with some studies finding a benefit from zinc lozenges but others showing no effect. Recently, a review of studies that compared zinc to placebo found that most of them had flaws that made any positive results unreliable. Only four studies were deemed reliable, and three found no benefit from zinc lozenges. The remaining positive study suggested that zinc nasal sprays might help reduce nasal stuffiness. If you do decide to try zinc lozenges for a cold, remember that getting too much zinc (more than 50 mg per day over a long period of time) can be dangerous.

Herbs

Echinacea (Echinacea purpurea, 300 mg three times per day) – Although evidence on whether echinacea works to prevent or treat colds has gone back and forth, recent evidence is encouraging. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58 percent and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).

Preventing colds

In addition to echinacea, several other herbs that are used to strengthen the immune system may also be beneficial in preventing you from catching a cold. As is true with echinacea, these herbs should be avoided by anyone taking drugs to suppress their immune system.

Andrographis (Andrographic paniculata) - One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero or Siberian ginseng (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms.
Garlic (Allium sativum) - In one study, people who took garlic for 12 weeks between November and February had 63 percent fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood-thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
Ginseng (Panax quinquefolius, 400 mg per day) - At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms.

Treating colds

Elder or elderberry (Sambucus nigra) - By lessening congestion and possibly helping you sweat, elder may help reduce the symptoms of colds and flu. One study suggested that using a standardized elderberry extract, Sambucol™, could shorten the duration of flu by about three days. Sambucol™ also contains other herbs plus vitamin C, so it isn’t known whether elder by itself would have the same effect. Pregnant and breast-feeding women should not take elder.
Eucalyptus (Eucalyptus globulus) - Eucalyptus is used in many remedies to treat cold symptoms, particularly cough. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. Fresh leaves can be used in teas and gargles to soothe sore throats. Ointments containing eucalyptus leaves are also applied to the nose and chest to relieve congestion and loosen phlegm.
Goldenseal (Hydrastis canadensis) - Goldenseal is often combined with echinacea in herbal cold remedies, although scientific evidence that it works is lacking. Women who are pregnant or breast-feeding should talk to their doctor before taking goldenseal.
Licorice (Glycyrrhiza glabra) - Licorice root is a traditional treatment for sore throat, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure or heart disease, women who are pregnant or breast-feeding, and those who take anticoagulants (blood thinners) should not take licorice.
Marshmallow (Althea officinalis) - Although there isn’t any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough.
Peppermint (Mentha x piperita) - Like eucalyptus, peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestants. Menthol also thins mucus and works as an expectorant, meaning that it helps loosen and break up phlegm. It is soothing and calming for sore throats and dry coughs as well.
Slippery elm (Ulmus fulva) - Slippery elm may help ease sore a sore throat and has been used traditionally for this purpose, although scientific evidence is lacking.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of the common cold based on their knowledge and experience. It is important to note, however, that cold symptoms are viewed in homeopathic medicine as the body's natural way of eliminating a virus. For this reason, homeopathic doctors may recommend no treatment at all. If a remedy is selected, usually it is intended to boost the body's natural immune response. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Aconitum - for symptoms including fever, anxiety, and thirst, that start abruptly, often following exposure to a cold climate or draft; most effective during the first 24 hours of the illness
Allium cepa - for colds with clear watery discharge that burns and/or irritates the nostrils; red, burning eyes; and symptoms that worsen in warm rooms and in the evening
Arsenicum album - for colds with watery, burning discharge from the eyes and nose, throbbing headache, nasal congestion that is not relieved by sneezing, dry mouth, sensitivity to cold, and a thirst for small sips of fluid
Belladonna - for colds with sudden onset of high fever, flushed face, watery nasal discharge, sore throat, throbbing headache, earache, and cough that tends to worsen at night; this remedy is most appropriate for individuals who are often agitated and sometimes delirious; these symptoms may cause children to cry
Bryonia - for chest colds with spastic cough that produces only a small amount of mucus and sharp chest pain that worsens with inhalation and while coughing; a dull headache, little to no nasal discharge, and sneezing may also be present
Euphrasia - for colds with excessive, non-irritating watery discharge that tends to worsen in the morning and when the person is lying down
Ferrum phosphoricum - for the early stages of a cold with slight fever, flushed face (redness may be patchy), and fatigue; may also be used in children with nosebleeds or bloody nasal discharge
Gelsemium - for colds that have gradual onset with watery nasal discharge that causes irritation, a feeling of fullness or tickling in the nose and/or the back of the throat, muscle aches, fatigue, lack of energy, lightheadedness or spaciness, and a headache with pain in the back of the head
Hepar sulphuricum - for late stages of a cold when nasal discharge turns from watery to thick, yellow, and foul smelling; symptoms tend to worsen in the evening and with cold and wind
Mercurius - for fluctuating body temperature and thick, yellow nasal discharge with a foul odor; symptoms may also include bad breath and a swollen tongue
Pulsatilla - for coughs and nasal congestion with thick, yellow-green mucus that does not burn the skin; symptoms tend to worsen in warm, stuffy rooms and when the person is lying on his or her back; this remedy is most appropriate for children (even newborns) and adults who are weepy, have mood swings, and are easily influenced by others

Mind-Body Medicine

A study of a small number of university students suggests that practicing relaxation techniques on a regular basis may help reduce the duration of a cold or the flu. A similar study of children reached the same conclusion. Some good stress reduction techniques include meditation, deep relaxation, yoga, tai chi, and breathing exercises.

Other Considerations

Pregnancy

Tell your healthcare provider if you are pregnant or think you are pregnant. Some medications, herbs, and supplements may be harmful to your baby and should not be taken if you are pregnant or trying to become pregnant.

Special Populations

If you have asthma, emphysema, or any other respiratory disease, you should talk to your doctor as soon as you develop cold symptoms.

Warnings and Precautions

If your symptoms aren’t better in 7 to 10 days, you should call your doctor. Other reasons to see your doctor include high fever (above 102° Fahrenheit), thick, green nasal discharge, or development of a productive cough (cough with phlegm), especially if it is thick and green as well.

Prognosis and Complications

Colds usually get better within 7 to 10 days. Some potential complications include:

Worsening of a pre-existing respiratory condition, such as asthma or emphysema
Bronchitis
Pneumonia
Ear infection
Sinusitis

Supporting Research

Alvarez-Olmos MI. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy. Clin Infect Dis. 2001;32(11):1567-1576.

Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001;175(7):359-362.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:57-61, 233-239, 240-243, 244-248 , 297-303.

Cohen S, Hamrick N, Rodriquez MS, Feldman PJ, Rabin BS, Manuck SB. Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosom Med. 2002;64(2):302-310.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 67-73.

Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.

Eby GA. Zinc ion availability-the determinant of efficacy in zinc lozenge treatment of common colds. J Antimicrob Chemother. 1997;40:483-493.

Farese RV, Biglieri EG, Shakelton CHL, et al. Licorice-induced hypermineralocorticolism. N Engl J Med. 1990;325(17):1223–1227.

Fortes C, Forastiere F, Agabiti N, et al. The effect of zinc and vitamin A supplementation on immune response in an older population. J Am Geriatr Soc. 1998;46:19–26.

Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacother. 1998;32:63-69.

Glatthaar-Saalmuller B, Sacher F, Esperester A. Antiviral activity of an extract derived from roots of Eleutherococcus senticosus. Antiviral Res. 2001;50(3):223-228.

Gruenwald J, Brendler T, Jaenicke C, et al, eds. PDR for Herbal Medicines. 2nd ed. Montvale, NJ: Medical Economics Company Inc; 2000:283-287, 477-479.

Hambridge M. Human zinc deficiency. J Nutr. 2000;130(5S suppl):1344S-1349S.

Hemilia H. Vitamin C intake and susceptibility to the common cold. Br J Nutr. 1997;77(1):59-72.

Hemilia H, Douglas RM. Vitamin C and acute respiratory infections. Int J Tuber Lung Dis. 1999;3(9):756-761.

Hewson-Bower B, Drummond PD. Psychological treatment for recurrent symptoms of colds and flu in children. J Psychosom Res. 2001;51(1):369-377.

Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-780, 782.

Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 2002;29(2):231-261.

Jackson JL, Lesho E, Peterson C. Zinc and the common cold: a meta-analysis revisited. J Nutr. 2000;130(5S Suppl):1512S-1515S.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 202-203.

Josling P. Preventing the common cold with a garlic supplement: a double blind, placebo-controlled survey. Adv Ther. 2001;18(4):189-193.

Kligler B. Echinacea. Am Fam Physician. 2003;67(1):77-80.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

McElroy BH, Miller SP. Effectiveness of zinc gluconate glycine lozenges against the common cold in school-aged subjects: a retrospective chart review. Am J Ther. 2002;9(6):472-475.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.

Norregaard J, Lykkegaard JJ, Mehlsen J, Danneskiold-Samsoe B. Zinc lozenges reduce the duration of common cold symptoms. Nutr Review. 1997;55(3):82-85.

Pittler MH, Ernst E. Clinical effectiveness of garlic (Allium sativum). Mol Nutr Food Res. 2007 Nov;51(11):1382-5.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:221-225, 252-258, 369-371.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Sazawal S, Black RE, Jalla S, et al. Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind, controlled trial. Pediatrics. 1998;102(part 1):1-5.

Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007 Feb 15;75(4):515-20. Review.

Takkouche B, Regueira-Mendez C, Garcia-Closas R, Figueiras A, Gestal-Otero JJ. Intake of vitamin C and zinc and risk of common cold: a cohort study. Epidemiology. 2002;13(1):38-44.

Turner RB. Ineffectiveness of intranasal zinc gluconate for prevention of experimental rhinovirus colds. Clin Infect Dis. 2001;33(11):1865-1870.

Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother. 2000;44:1708-1709.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 62-66.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 226.

Van Straten M, Josling P. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Adv Ther. 2002;19(3):151-159.

Review Date:
12/19/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Bronchitis

FitSugar — Wed, 08 Oct 2008 17:35:33 -0700

Overview

Signs and Symptoms
Causes
Diagnosis
Preventive Care
Treatment Approach
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Bronchitis occurs when the air passages in your lungs become inflamed. Bronchitis can be acute or chronic. Acute bronchitis is usually due to a viral infection – such as a cold – that starts in your nose or sinuses and spreads to the airways. Acute bronchitis usually lasts a few days, although you may have a cough for weeks afterward. Chronic bronchitis, on the other hand, occurs most often in people who smoke and, together with emphysema, is known as chronic obstructive pulmonary disease (COPD). Chronic bronchitis is characterized by a productive (wet) cough that is persistent. The mucus that’s produced by the inflamed airways eventually causes scar tissue to form in the lungs, making breathing difficult. For more information, see the article on Chronic Obstructive Pulmonary Disease.

Signs and Symptoms

Acute bronchitis:

Cough that produces yellow or green mucus
Burning sensation in the chest
Wheezing
Sore throat
Fever
Fatigue

Chronic bronchitis:

Chronic cough that produces mucus
Wheezing, shortness of breath
Blue-tinged lips
Ankle, feet, and leg swelling

Causes

Acute bronchitis is usually caused by the same viruses that cause colds. But exposure to cigarette smoke or pollution, a condition called gastroesophageal reflux disease (GERD), and bacterial infections can also cause bronchitis.

The main causes of chronic bronchitis are cigarette smoking and prolonged exposure to air pollution or dust.

Diagnosis

Your doctor will listen to your chest and back, look at your throat, and may draw blood and take a culture of the sputum from your lungs. If your doctor is concerned about possible pneumonia or COPD, a chest X-ray might be ordered or a lung function test (which measures the amount of air in your lungs) may be ordered.

Preventive Care

The best way to avoid chronic bronchitis is to not smoke and to stay away from air pollutants. For acute bronchitis, take steps to avoid colds and respiratory infections, such as washing your hands frequently, getting an annual flu shot, and (if you are over 65 or have a chronic illness) asking your doctor about the pneumococcal vaccine (Prevnar).

Treatment Approach

Acute bronchitis from a virus generally clears up on its own within 7 to 10 days. Using a humidifier, taking a cough medicine that contains an expectorant (something that helps you "bring up" mucus), and drinking plenty of fluids can help relieve symptoms. If a bacterial infection is the culprit, your doctor may prescribe antibiotics.

Lifestyle

Do not smoke, and avoid secondhand smoke.
Use a humidifier or inhale steam from a bowl.
Drink plenty of fluids.
Rest.
If you have low oxygen levels from chronic bronchitis, you may need home oxygen therapy.

Medications

For chronic bronchitis:

Bronchodilators - increase airflow by opening airways and help make it easier to breathe

Corticosteroids - reduce inflammation; either inhaled with an inhaler or taken by mouth, they are usually used to treat moderate to severe COPD

For acute bronchitis:

Antibiotics - for bacterial infection

Cough medicines - Two types of cough medicines, cough suppressants (for a dry cough) or expectorants (for a wet, productive cough that brings up mucus), are available over the counter and by prescription. Usually doctors recommend not suppressing a cough in cases of acute bronchitis, unless your cough is keeping you from sleeping at night.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

For chronic bronchitis:

N-acetylecysteine (NAC, 400 to 1,200 mg per day) - NAC is a modified form of a dietary amino acid that works as an antioxidant in the body. Several studies using it to treat COPD indicate that it may help relieve symptoms by acting as an antioxidant to reduce oxidative stress on the lungs (damage caused by free radicals, particles that harm cells and DNA). Although not all the studies agree, some suggest that taking NAC can reduce the number of attacks of severe bronchitis.

For acute bronchitis:

Because bronchitis often follows a cold, some of the same supplements used to prevent or treat a cold may be helpful.

Probiotics (Lactobacillus) - So-called “good” bacteria or probiotics help prevent infections in the intestines, and there is preliminary evidence that they might help prevent respirator infections, too. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit.
Chicken soup - It’s about as traditional a remedy for a cold as you can find (at least in modern history). In fact, chicken soup and warm liquids (broth, tea) can help soothe a sore throat and loosen mucus, which in turn helps ease congestion from a cold.

Herbs

For acute bronchitis/Preventing respiratory infections:

Echinacea (Echinacea purpurea, 300 mg three times per day) - Echinacea may help prevent colds, which can lead to bronchitis. An analysis of 14 scientific studies found that people who took echinacea reduced their risk of getting a cold by 58 percent and reduced the duration of a cold by an average of a day and a half. However, many of the studies used echinacea in combination with another herb or vitamin, so it’s impossible to say which one was responsible for the benefit. Echinacea should not be used by women who are pregnant or breastfeeding, or by anyone taking drugs that suppress the immune system (such as corticosteroids or methotrexate).
Andrographis (Andrographic paniculata) - Andrographis may also help lessen cold symptoms and possibly reduce your risk of getting bronchitis. One study found that andrographis, an herb used in Ayurvedic medicine, combined with eleuthero (Eleutherococcus senticosus) in a formula called Kan Jang, helped reduce cold symptoms.
Garlic (Allium sativum) - In one study, people who took garlic for 12 weeks between November and February had 63 percent fewer colds than people who took placebo. Those who did get a cold recovered about one day faster. Because garlic can increase the risk of bleeding, people who take anticoagulants (blood-thinners, such as aspirin or warfarin) should not take garlic. Women who are pregnant or breastfeeding should talk to their doctor before taking garlic supplements.
Ginseng (Panax quinquefolius, 400 mg per day) - At least two studies suggest that taking American ginseng may help prevent colds, as well as reduce the number of colds experienced and the severity of symptoms.

For acute and chronic bronchitis/Expectorants for cough:

Essential oil monoterpenes - A combination of essential oils, including eucalyptus (Eucalyptus globulus), a citrus oil, and an extract from pine, has been suggested for several respiratory illnesses, including both acute and chronic bronchitis. One study found that people with acute bronchitis treated with essential oil monoterpenes did better than people who took placebo. Another study found that people who took the herbal treatment did as well as those who took antibiotics. However, more studies are needed.
Lobelia (Lobelia inflata) - Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including bronchitis. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.
Mullein (Verbascum densiflorum, 3 g per day) - Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, it has not been studied for bronchitis.
Peppermint (Mentha x piperita) - Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, helping loosen and break up phlegm.

For acute bronchitis:

South African geranium (Pelargonium sidoides ) - Although scientific evidence is preliminary, a specific extract from South African geranium did show positive results in a few studies. In one study, people with acute bronchitis recovered faster when taking this extract than those who took placebo. In another study, people who took the extract did as well as those who took antibiotics, but without some side effects of the antibiotics. More studies are needed.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bronchitis in addition to standard medical care. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Aconitum - for early stages of bronchitis or other respiratory disorders; this remedy is most appropriate for people with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and being awakened by their own coughing; symptoms tend to worsen in cold air or when when lying on one's side

Antimonium tartaricum - for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when lying on one's back; this remedy is particularly good for children and the elderly and is generally used during the later stages of bronchitis

Bryonia - for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable

Hepar sulphuricum - for later stages of bronchitis, accompanied by wheezing, scant mucus production, and coughing that occurs when any part of the body gets cold

Ipecacuanha - for the earliest stages of bronchitis accompanied by a deep, wet cough, nausea and vomiting; this remedy is commonly prescribed for infants

Phosphorus - for several different types of cough but usually a dry, harsh cough accompanied by a persistent tickle in the chest and significant chest pain; this remedy is most appropriate for individuals who are often worn out and exhausted, tend to be anxious and fear death, and require a lot of reassurance

Massage and Physical Therapy

Aromatherapy

Running a humidifier with an essential oil such as cedarwoord, bergamot, eucalyptus, myrrh, sweet fennel, jasmine, lavender, tea tree, or marjoram at night may help thin mucus and ease cough. Talk to an experienced aromatherapist to learn which oil, alone or in combination, is best for you.

Prognosis and Complications

For acute bronchitis, symptoms usually resolve within 7 to 10 day; however, a dry, hacking cough can linger for a number of weeks.

The chance for recovery is poor for advanced chronic bronchitis. Early treatment, combined with stopping smoking, can stop lung damage from progressing and improve quality of life.

Supporting Research

Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract. 1999;48:628-635.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Blumenthal M, Goldberg A, Brinkman J, ed. Herbal Medicine. Expanded Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 2000:33-35, 297-303, 335-340.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 68.

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-334.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-929.e3. Review.

Jackson IM, et al. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res. 1984; 12(3): 198-206.

Hasani A, Pavia D, Toms N, Dilworth P, Agnew JE. Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction. J Altern Complement Med. 2003 Apr;9(2):243-9.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 210.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:40-43.

Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007 Nov-Dec;3(6):573-84.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin. 2007 Feb;23(2):323-31.

Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med. 1998;7:541–545.

Pittler MH, Ernst E. Clinical effectiveness of garlic (Allium sativum). Mol Nutr Food Res. 2007 Nov;51(11):1382-5.

Reichling J, Fitzi J, Furst-Jucker J, Bucher S, Saller R. Echinacea powder: treatment for canine chronic and seasonal upper respiratory tract infections. Schweiz Arch Tierheilkd. 2003;145(5):223-231.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:160-165, 252-256, 259-261, 337-338.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Schulz V. Liquid herbal drug preparation from the root of Pelargonium sidoides is effective against acute bronchitis: results of a double-blind study with 124 patients. Phytomedicine. 2007;14 Suppl 6:74-5.

Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.

Stead LF, Hughes JR. Lobeline for smoking cessation (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford: Update Software.

Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J. 2000 Aug;16(2):253-262.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 70-72.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 227-228.

Yildirim A, Mavi A, Oktay M, Kara AA, Algur OF, Bilaloglu V. Comparison of antioxidant and antimicrobial activities of tilia (Tilia argentea Desf ex DC), sage (Salvia triloba l.), and black tea (Camellia sinensis) extracts. J Agric Food Chem. 2000;48(10):5030-5034.

Review Date:
12/27/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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