GENERAL NERVOUS SYSTEM DISORDERS

Pain in General

AGLG (Age/gender/lifestyle/genetics)

• We tend to feel pain more sharply at an earlier age, but this may be because of alarm.
• Women get more headaches than men, but this may be due to lifestyle factors.
• Mood and personality affect pain; fear or anxiety will make pain worse, while relaxation will reduce it to some extent. Those using recreational drugs that have pain killing effects should remember that you are on painkillers and be aware that minor injuries or infections may go unnoticed as your warning system is down.
• Genetically inherited disorders factor in pain.

Pain is the body’s warning system and response to any injury or disease that results in tissue damage. It’s great as a biological warning system to let you know there’s a problem in the short term, but a side effect of not solving the problem leads to chronic pain, which serves no useful function. Prolonged pain makes you release chemicals that can lead to depression, loss of weight as a result of decreased appetite, and disturbed sleep.

What Are the Causes?

Tissue [inside or outside] may be damaged by trauma, infection, or a problem with blood supply. Pain receptors send signals to the brain, and the damaged tissues release chemicals called Prostaglandins, which cause inflammation and swelling.

Throbbing pain is often due to increased blood flow, either as a result of a widening of the blood vessels [as in migraine] or because of an increase in blood flow through injured tissues. Shooting pain such as sciatica can be caused by pressure or irritation of a nerve, usually at a point where it emerges from the spinal cord. Colicky internal pain is causes by the contraction and stretching of muscles in the walls of the intestine.

The location of pain may not be a guide to the source! –Overlapping nerveways can result in a confused message, causing pain to be felt in a different area of the body from the site where it originates. This is called ‘referred pain’ or 'referrent' pain, and because of it, hip pain may be felt as knee pain, toothache might be felt as earache, and heart problems can cause pain in the chest, neck, and one or both arms. Internal pain tends to be referred to the centre of the abdomen, as sometimes in appendicitis.

What Might Be Done?

The brain and spinal cord produce their own painkillers, called Endorphins, in response to pain.

You can usually establish the source of pain through a physical exam, if you can’t, you’ll need to get further investigation, such as blood tests or ultrasound scanning .

The most obvious and sensible way to get rid of pain is treatment of the underlying cause, if possible. However, pain relief is also important until treatment of the cause takes effect. There are many different ways to relieve pain, including drugs and physical methods [see other tutorials]. The form of pain relief chosen might depend on the cause and the type of pain.

What Is the Prognosis?

Almost all pain can be relieved to some degree, even if the underlying cause of the pain cannot be definitively treated.

Headache

AGLG

• More common over the age of 20
• More common in females
• Anxiety is a risk factor. A noisy environment is a risk factor. Strong light or fluorescent light is a risk factor. Over exposure to sun or extreme heat is a risk factor. Lack of sleep or food, a junk food diet or drugs are a risk factor, including prescription drugs, tobacco, alcohol, sugar and caffeine.
• Genetically inherited disorders factor in pain

The majority of headaches last only for a short time, but headache can persist for weeks. Pain may only occur in one part of the head, for example above the eyes, or it may be spread across the entire head. The type of pain varies; it may be sharp and sudden or dull and constant. Sometimes other symptoms such as nausea or hypersensitivity to light, occur at the same time.

What Are the Causes?

About 3 in 4 headaches are caused by posture causing tension in the scalp or neck muscles!

Tight-fitting glasses, hats, shades, earphones, headphones and headsets, headbands, hair clips, hair ties, tight plaits or cornrows, badly-fitted hearing aids and dentures can also cause headaches, as can restrictive clothing around the neck.

Most viral infections cause headaches. Very few headaches have a serious underlying cause, but those that do require immediate medical attention. For example, a severe headache may be a sign of meningitis or subarachnoid hemorrhage.

In an elderly person who hasn't taken care of themselves, headache with tenderness of the scalp or temple may be due to temporal arteritis.

Occasionally, headache results from prolonged use [overuse] of some painkillers or other types of drugs [see drugs section].

If a headache is severe, lasts more than 24 hours, or is accompanied by other symptoms, you should find out more without delay.

What Might Be Done?

If a physical exam does not reveal an underlying disorder, you may have tests such as a CAT scan or MRI. Treatment will depend on the cause of the headache. A tension headache will usually clear up with rest and painkillers. Cluster headaches and migraine headaches can be treated with a specific drug [see drugs section].

Tension Headaches

AGLG

• More common over age 20
• More common in females
• Anxiety is a risk factor. Overusing computers and indoor sedentary lifestyles are a risk factor. Being overweight is a risk factor.
• Genetics largely irrelevant

What Are the Causes?

Tension headaches are usually the result of bad posture, which causes a tightening of the muscles in the neck and scalp. Recurrent tension headaches often affect people with depression, or those suffering constant anxiety. Tension headaches are often made worse by noise, light, and stuffy, hot environments.

Symptoms: Pain is usually constant and may be throbbing. Generally felt above the eyes or more generally over the head. There may be a feeling of pressure behind the eyes, a tightening of neck muscles, and/or a feeling of tightness around the head.

What Might Be Done?

Ordinary painkillers should help, but shouldn’t be used regularly. Look for signs of anxiety. If depression is a cause you may need anti-depressants or other treatment. Pay attention to your posture and make sure chairs, etc are comfortable, especially when using computers or driving for long stints. You can buy air cushions and massage cushions and stuff to keep you comfy. Don’t wear tight collars or uncomfortable headphones!

You can try yoga or relaxation exercises or martial arts to permanently improve your posture and circulation.

Some people find masturbation gets rid of a tension headache.

If immediate cause cannot be ascertained you may want an MRI or CT scan to check for an underlying cause.

Migraine 

AGLG

• Can occur as young as age 2. First time usually occurs under age 30; attacks decrease in frequency as you age. Onset rare overage 50.
• More common in females
• Sometimes runs in families
• Anxiety and certain foods/food additives can trigger an attack.

There are two major types of migraine: migraine with ‘aura’ and migraine without.

‘Aura’ is a group of symptoms including visual disturbances that develop before the onset of the main headache. Some people have attacks of both kinds.

What Are the Causes?

Increased blood flow is correlative with migraine, as are problems associated with tyrosine/phenylalanine metabolism [chemicals found in red wine, cheese and chocolate]. It may be inherited [it is in about 8 out of 10 cases]. Anxiety, depression, missed meals, lack of sleep, and certain foods [e.g., cheese, chocolate] or additives [MSG, Aspartame, food dyes] can all trigger migraine. Some women experience migraines with hormonal change during menstruation.

Symptoms

Sometimes preceded by a group of symptoms known as a ‘prodrome’. This includes: Anxiety or mood changes, an altered sense of taste or smell, an excess or lack of energy.

People who experience migraine with aura then experience: Visual disturbances, such as blurred vision or bright flashes, and pins & needles, numbness, or a sensation of weakness on the face or on one side of the body.

The main symptoms, common to all sufferers, are: Headache that is severe, throbbing, made worse by movement and usually felt on one side of the head, over one eye, or around one temple; nausea or vomiting; and a dislike of bright lights/loud noises.

What Might Be Done?

You can usually diagnose a migraine from your symptoms. There are antimigraine drugs [see drugs section]. Discovering the trigger factors is your best course of action, and avoiding the troublesome foods may be all it takes [however, you might want to find out why you have a problem metabolising these chemicals because they are involved in the production of neurotransmitters, and important ones at that [see chemicals section].

Cluster Headaches

AGLG

• Rare under age 30
• More common in males
• Smoking and drinking alcohol are risk factors
• Genetics not relevant

Severe short-lived headaches in one specific area or areas that recur in a characteristic pattern, usually between one and four times a day, and there may be gaps of months or years between each group of headaches.

What Are the Causes?

Like migraines, they correlate with increased blood flow due to widening of blood vessels in the brain.

 Symptoms: Often develop early in the morning, with severe pain around one eye or temple, watering and redness of the eye, drooping of the eyelid, stuffiness of the nostril and sometimes a runny nose on that side, and/or flushing of one side of the face. Average attack lasts 15-30 minutes.

What Might Be Done?

Anti migraine drugs are sometimes used for cluster headaches. In a sudden, severe attack, oxygen inhaled through a mask may bring relief. If the attacks continue, other medications can be tried [see drugs section].

If you are prone to cluster headaches you should take care with tobacco or alcohol because both increase the risk of an attack.

Chronic Fatigue Syndrome [CFS]

AGLG

• Most common between the ages of 25 and 45
• More common in females
• Lifestyle not a significant factor
• Genetics not a significant factor

Extreme fatigue over a prolonged period is called Chronic Fatigue Syndrome. It is also sometimes called Post-Viral Fatigue Syndrome, ME [myalgic encephalomyelitis] or Chronic Fatigue & Immune Dysfunction Syndrome. It can continue for months or years.

What Are the Causes?

CFS develops after recovery from a viral infection or after an emotional trauma, such as bereavement. Sometimes it is associated with depression [although whether it causes depression or depression causes it is a matter of current debate].

Symptoms

May vary, but major symptoms are: Extreme tiredness lasting at least 6 months, impairment of short-term memory or concentration, sore throat, tender lymph nodes, muscle and joint pain without swelling or redness, unrefreshing sleep, headaches, prolonged muscle fatigue and feeling ill after even mild exertion.

Conditions involving an allergic reaction [e.g., asthma, eczema], may become worse.

What Might Be Done?

It’s important to be sure of your diagnosis because other disorders [e.g., thyroid disorders, anemia, narcolepsy], present some of the same symptoms. A blood test might be necessary to eliminate suspects.

There is no specific drug for CFS and a combination is often used [see drugs section]. Techniques such as cognitive therapy or behavior therapy or even physiotherapy may help [see techniques section]. Slowly increasing exercise can help increase vitality. You may find adjusting your diet helps, try avoiding alcohol and caffeine. Try to avoid anxiety; relaxation exercises may be useful.

If you are stuck with it long term you may wish to use stimulants, but this could make the problem take a longer time to resolve in the long run.

What Is the Prognosis?

This is a long-term disorder, but there may be periods of relief from symptoms. In more than 50% of cases the problem clears up itself after a few years.