Definition

Heart disease is a broad term used for a number of diseases, to describe touch your heart, and in some cases, the blood vessels. The various diseases that are born under the umbrella of heart disease include diseases of the blood vessels, such as coronary heart disease, heart rhythm disturbances (arrhythmias) and cardiac defects are you with (congenital heart defect).

The term “heart disease” is often synonymous involved with “cardiovascular disease” – a term that refers generally to conditions, the narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke connected. Other heart diseases, such as infections and conditions that your heart muscle, valves or rhythm against forms also affect views of heart disease.

Heart disease is No. 1 worldwide killer of men and women, including in the United States. For example, heart disease is responsible for 40 percent of all deaths in the United States, more than all cancers combined. Many forms of heart disease can be prevented or treated with a healthy lifestyle and diet and exercise.
Symptoms

Heart disease symptoms vary on what kind of heart disease you have ever.

The symptoms of heart disease in your blood vessels (cardiovascular disease)
Cardiovascular disease is caused by narrowed or blocked blood vessels stiffen that it received so your heart, brain or other parts of the body not making enough blood. Cardiovascular disease symptoms may include:

* Chest pain (angina pectoris)
* Shortness of breath
* Pain, numbness, weakness, or coldness in the legs or arms when the blood vessels may be reduced in those parts of the body

They could not be diagnosed with cardiovascular disease, until your condition deteriorates to the point that you have a heart attack, chest pain (angina pectoris), stroke, heart failure or sudden cardiac death. It is important for cardiovascular symptoms to observe and discuss any concerns with your doctor. Cardiovascular disease can sometimes be found with regular visit to your doctor.

Heart disease symptoms caused by abnormal heart beats (arrhythmias)
A heart arrhythmia is an abnormal heartbeat. Her heart was beating so fast, too slow or irregular, if you have an arrhythmia. Arrhythmia symptoms may include:

* A flutter in the chest
* Rapid heart beat (tachycardia)
* A slow heartbeat (bradycardia)
* Chest pain
* Shortness of breath
* Dizziness
* Dizziness
* Fainting spells (syncope) or near fainting

Heart disease symptoms caused by heart defects
Serious congenital heart defect – a defect you were born – are usually during the first few hours of clear days, weeks and months of life. Heart Defects Symptoms may include:

* Pale gray or blue skin color (cyanosis)
* Swelling in the legs, belly or areas around the eyes
* Shortness of breath during feeding, leading to poor weight gain

Less serious congenital heart defects often only later in childhood or even adulthood diagnosed. Signs and symptoms of congenital heart defects, and are generally not immediately life-threatening include:

* Easily short of breath during exercise or activity
* Tiring easily during exercise or activity
* Built-up fluid in the heart or lungs
* Swelling of the hands, ankles or feet

Heart disease symptoms by thick heart muscle (cardiomyopathy) causes
Cardiomyopathy is the thickening and stiffening of the heart muscle. In the early stages of cardiomyopathy, you may have no symptoms. As the condition worsens, symptoms of cardiomyopathy include:

* Dyspnea on exertion or even at rest
* Swelling of the legs, ankles and feet
* Flatulence (expansion) of the abdomen with fluid
* Fatigue
* Irregular heart beats, feel that the rapid, pounding or fluttering
* Dizziness, lightheadedness and fainting

Heart disease symptoms caused by infections, heart
There are three types of infections, heart: pericarditis, which affects the tissue around the heart (pericardium), myocarditis, which affects the muscular middle layer of the walls of the heart (myocardium), and endocarditis, which separates the inner membrane, that the impact chambers and valves of the heart (the endocardium). Slightly different with each type of infection, heart infection symptoms may include:

* Fever
* Shortness of breath
* Weakness or tiredness
* Swelling in the legs or abdomen
* Changes in your heart rhythm
* Dry or persistent cough
* Skin rash or unusual places

Heart disease symptoms caused by heart valve disease
The heart has four valves – the aortic, mitral, pulmonary and tricuspid valve – the opening and closing direct blood flow through the heart. The valves can leak through a variety of conditions that have been challenged to narrowing (stenosis), (regurgitation or insufficiency) or improper closing (prolapse). Depending on which valve is not working properly, valvular heart disease symptoms in the rule:

* Fatigue
* Shortness of breath
* Irregular heart beat or heart murmur
* Swollen feet or ankles
Chest pain *
* Fainting (syncope)

When the doctor
Are you looking for emergency medical care if you have the symptoms heart disease:

* Chest pain
* Shortness of breath
* Fainting

Heart disease is easier to treat if it is detected early, so your doctor about any concerns you have to talk about your heart health. If you do not have heart disease, but are concerned about the development of heart disease, talk to your doctor about the steps you to reduce your heart disease risk. This is especially true if you have a family history of heart disease.

If you suspect heart disease based on new signs or symptoms you already have, I think you make an appointment to see your doctor.
Causes
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Illustration showing chambers and valves of the heart chambers and heart valves
Illustration shows the development of atherosclerosis development of atherosclerosis

To understand, heart disease, it helps to know how your heart works. Your heart is a pump. It is a muscular organ the size of your fist and is easily accessible from the middle of the chest on the left. Their heart is divided into the right and the left side. The Division protects oxygen-rich blood from mixing with oxygen-poor blood. Oxygen-poor blood “blue blood”, returns to the heart after circulating through your body.

The right side of the heart, along the right atrium and ventricle, collects and pumps blood into the lungs through the pulmonary artery. The lungs replace the blood with a new supply of oxygen, making it red. Oxygen-rich blood then passes into the left side of the heart, consisting of the left atrium and ventricle and is pumped through the aorta, the body is to supply tissues throughout the body with oxygen and nutrients.

Four valves within your heart keep your blood moving in the right way. The tricuspid valve, mitral valve, pulmonary and aortic work like gates to a fence. You only open one way, and only when pressed. Each valve opens and closes once per heartbeat – or about once per second while you are in peace.

A beating heart contraction and relaxation. The contraction is called systole, and relaxation is called diastole. During systole, you force your ventricles contract, blood vessels go into your lungs and body – like ketchup being forced out a spray bottle. The right ventricle contracts a little work before the left ventricle. Your ventricles then relax during diastole and are filled with blood from the upper chambers, the left and right atrium. The cycle then starts over again.

Your heart also has electrical wiring, they keeps playing. Electrical impulses begin high in the right atrium and travel through specialized channels to the chambers and delivers the signal to the pump. The conduction system keeps your heart beating in a coordinated and normal rhythm, which in turn keeps blood circulating. The continuous exchange of oxygen-rich blood with oxygen-poor blood is what keeps you alive.

The causes of heart disease vary depending on the type of heart disease.

Causes of cardiovascular diseases
While cardiovascular disease can refer to many different types of heart or blood vessel problems, the term often used to damage to the heart or blood vessels by atherosclerosis (ath-ur-o-skluh-RO-SIS), an accumulation of middle fatty plaques in arteries. This is a disease that affects your arteries. Arteries are blood vessels that carry oxygen and nutrients you from your heart to the rest of your body. Healthy arteries are flexible and strong.

Over time, however, too much pressure in the arteries, the walls thick and stiff – sometimes restricting blood flow to your organs and tissues. This process is called atherosclerosis or hardening of the arteries. Atherosclerosis is the most common form of the disease. Atherosclerosis is the leading cause of cardiovascular disease, and it is caused by an unhealthy diet, lack of exercise, obesity and smoking. These are important risk factors for the development of atherosclerosis and, in turn, cardiovascular disease.

Causes of cardiac arrhythmias
Common causes of heart rhythm disturbances (arrhythmias), or conditions that can lead to heart rhythm problems include:

* Heart defects are born with (congenital heart defect)
* Coronary heart disease
* High blood pressure
* Diabetes
* Smoking
* Excessive consumption of alcohol or caffeine
* Drug Abuse
* Stress
* Some over-the-counter drugs, prescription drugs, dietary supplements and herbal remedies
* Valvular

In a healthy person with a normal, healthy heart, it is unlikely for a fatal arrhythmias that develop without some outside trigger, like an electric shock or the use of illegal drugs. This is primarily because a healthy person’s heart free of any abnormal conditions that cause arrhythmia, such as an area of scar tissue.

However, in a heart that’s sick or deformed, the heart of the electrical impulses do not start properly, or travel through the heart, making frequent arrhythmias to develop.

Causes of heart defects
Heart disease to develop most, while still a baby in the womb. About a month after conception the heart begins to develop. It is at this point that heart disease can begin to form. Researchers are not sure what causes defects to begin, but they believe that some medical conditions, medications and genetics can play a role.

Causes of cardiomyopathy
The exact cause of cardiomyopathy, a thickening or enlargement of the heart muscle is unknown. There are three types of cardiomyopathy:

* Dilated cardiomyopathy. This is the most common form of cardiomyopathy. In this disorder, so your heart main chamber – the left ventricle – enlarged (dilated), its pumping capacity will be less severe and the blood does not flow as easily through the heart.
* The hypertrophic cardiomyopathy. This species includes abnormal growth or thickening of the heart muscle you, especially in the muscle of your heart’s main chamber. When thickening occurs, tends to stiffen the heart and shrink the size of the pump chamber can provide interfering with your heart’s ability to blood to your body.
* Restrictive cardiomyopathy. The heart muscle in patients with restrictive cardiomyopathy becomes rigid and less elastic, which means the heart can not expand properly and fill with blood between heartbeats. It is the least common type of cardiomyopathy and may occur without known cause.

Causes of heart infection
Heart infections such as pericarditis, endocarditis and myocarditis, occur when an irritant, such as bacteria, viruses or chemicals, your heart muscle gets. The most common causes of heart infections include:

* Bacteria. Endocarditis can be caused by a number of bacteria entering your bloodstream. The bacteria can enter your bloodstream through everyday activities like eating or brushing teeth, especially if you have poor oral health. Myocarditis can also be a tick-borne bacteria that are responsible for causing Lyme disease.
* Viruses. Heart infections can be caused by viruses, including some that influenza causes (Coxsackie B and adenoviruses), called a rash Fifth disease (human parvovirus B19), gastro-intestinal infections (echo virus), mononucleosis (Epstein-Barr virus) and measles (rubella). Viruses with sexually transmitted infections can also travel to the heart muscle and cause an infection.
* Parasites. Among the parasites that are heart-infection Trypanosoma cruzi, Toxoplasma can, and some that are transmitted by insects and can lead to a condition called Chagas disease.
* Drugs that cause an allergic or toxic reactions. These include antibiotics such as penicillin and sulfonamide drugs, and some banned substances such as cocaine. The needles used to administer medications or illegal drugs can also viruses or bacteria that cause infections can transmit heart.
* Other diseases. These include lupus, and connective tissue disorders, inflammation of blood vessels (vasculitis), and rare inflammatory diseases such as Wegener’s granulomatosis.

Causes of heart valve diseases diseases
There are many causes of diseases of the heart valves. Four valves within your heart keep blood flowing in the right direction. You can with heart valve disease, or the valves may be born damaged, infections (infectious endocarditis), connective tissue disease through such conditions as rheumatic fever, and certain medications or radiation therapy for cancer.
Risk Factors

Risk factors for heart disease are:

* Your age. Simply increasing the risk of damaged older thickened and narrowed arteries and the heart muscle is weakened or which contribute to heart disease.
* Your sex. Men are generally at greater risk for heart disease. But increases the risk of a woman after the menopause.
* Family history. A family history of heart disease increases the risk of coronary heart disease, particularly if one parent has developed at an early age (55 years ago for a male relative, like your brother or father and 65 for female relatives, like your mother or sister).
* Smoking. Nicotine constricts the blood vessels, and carbon monoxide can damage its lining, so that they more susceptible to atherosclerosis. Heart attacks are more common in smokers than in nonsmokers.
* Poor nutrition. A diet high in fat, salt and cholesterol can contribute to the development of heart disease.
* High blood pressure. Uncontrolled hypertension can result in hardening and thickening of the arteries, narrowing of the vessels through which blood can flow.
* High cholesterol levels in the blood. High concentrations of cholesterol in your blood may increase the risk of the formation of plaques and atherosclerosis. Plaques can be characterized by a high degree of low-density lipoproteins (LDL) “bad” cholesterol, or low levels of high-density lipoproteins (HDL) caused a “good” cholesterol known known.
* Diabetes. Diabetes increases the risk of heart disease. Both conditions have similar risk factors as obesity and hypertension.
* Obesity. Overweight typically worsens other risk factors.
* Physical inactivity. Lack of exercise is also with many forms of heart disease and some of their other risk factors, such as well-connected.
* High stress. Unrelieved stress in your life can damage the arteries and worsen other risk factors for heart disease.
* Poor hygiene. Do not regularly wash your hands and other habits to prevent, viral or bacterial infections can make the risk of heart infections, especially if you already have an underlying heart disease. The researchers also believe poor dental health can contribute to heart disease. Germs on teeth and gums can travel from your mouth and heart, possibly worsening coronary artery disease.

Complications

One of the most common complications of heart disease is heart failure.

* Heart failure. Heart failure occurs when your heart does not pump enough blood to meet your body needs. Over time, the heart can no longer keep up with the normal demands placed on them. The chambers can be stiff and not fill properly between beats. Nor can weaken the heart muscle and the heart chambers stretch (dilation) to the point that the heart can not efficiently pump blood through your body. Heart failure can result from many forms of heart disease, including heart disease, cardiovascular disease, heart valve diseases, heart infections or cardiomyopathy.

Other complications of heart disease include:

* Heart attack. Coronary heart disease can cause a heart attack. Heart attacks usually occur when a blood clot blocks the blood flow through a coronary artery – a blood vessel that feeds blood, part of the heart muscle. Interrupted blood flow to the heart can damage or destruction of part of the heart muscle.
* Stroke. Cardiovascular disease may lead to ischemic stroke, which, if the narrowed arteries to your brain or not enough blood gets blocked and your brain happens. A stroke is a medical emergency – brain tissue begins to die within minutes of a stroke.
* Aneurysm. Cardiovascular disease can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of the artery. If an aneurysm bursts, you can face life-threatening internal bleeding. Although this is possible is usually a sudden, catastrophic event, a leak is. If a blood clot in an aneurysm displaced, it can block an artery elsewhere.
* Peripheral arterial occlusive disease. The same atherosclerosis that can lead to coronary heart disease, may also lead to peripheral arterial occlusive disease. If you develop peripheral arterial disease (PAD), get to keep the extremities – usually the legs were not enough – blood flow with demand. This leads to symptoms, especially leg pain when walking (claudication).
* Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action, causing blood to stop flowing to the rest of your body. Sudden cardiac arrest occurs almost always in the context of other underlying heart disease, especially coronary heart disease. Sudden cardiac arrest is a medical emergency. If not treated immediately, it is fatal in sudden cardiac death.

Preparing for your appointment

Some types of heart disease, is able to find a date – for example, if a child is born with serious heart defects, it will soon be recognized after birth. In other cases, your heart disease are diagnosed in an emergency situation, such as a heart attack.

If you think you may have heart disease or are concerned about your risk for heart disease because of a strong family history, make an appointment with your doctor. If heart disease is detected early, your treatment can easily and effectively. Finally, it can sometimes be related to a heart specialist (cardiologist).

Because appointments can be brief, and because it often cover much ground, it is a good idea to be prepared for your appointment. Here is some information to help you, ready for your appointment, and what they expect from your doctor.

What can you do

* Pay attention to pre-appointment restrictions. In the time that you make the appointment, to be sure to ask whether there is anything you need in advance, not, as you restrict your diet. For a cholesterol test, for example, you can quickly have for a certain period in advance.
* You can write down all the symptoms you experience, including any that seem unrelated to coronary heart disease.
* Write down key personal information, including a family history of heart disease, stroke, explains, high blood pressure or diabetes, and any major changes or life so far.
* Make a list of all medications and any vitamins or supplements that you take.
* A family member or friend to take, if possible. Sometimes it can be difficult to fill up all the information you during an appointment. Someone who accompanies you can, something that you missed, or remember your password.
* Are ready to discuss your diet and exercise habits. If you are not a diet or exercise routine, be ready with your doctor about any challenges you might be talking in the face “First Steps.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions to help you make the most of your time together. List Your questions are most important to least important in case time runs out. For heart disease, some basic questions are ask your doctor:

* What is likely causing my symptoms or condition?
* What are other possible causes for my symptoms or condition?
* What kinds of tests do I need?
* What is the best approach?
* What foods should I eat or avoid?
* What is a reasonable level of physical activity?
* How often should I be tested for heart disease? For example, knows how often I need a cholesterol test?
* What are the alternatives to the primary approach that you do?
* I have other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* I want a specialist? What will it cost and will my insurance cover seeing a specialist? (You may need to ask your insurance directly for information about coverage.)
* Is there an alternative to the generic drug you prescribe are to me?
* Are there any brochures or other printed materials that I can take home with me? Which websites do you recommend visiting?
* In addition to the questions asked have you prepared your doctor, do not hesitate to questions during your appointment at any time that you do not ask to know something.

What do you expect from your doctor
Your doctor will probably ask a series of questions. Willing to be, they answer might be going to the time on all the items you want to spend more time reserve. Your doctor may ask:

* When did you first experience symptoms?
* Have your symptoms been continuous, or occasional services?
* How strong are your symptoms?
* What, if anything, seems to improve your symptoms?
* What, if anything, seems to worsen your symptoms?

What can you do in the meantime
There is never too early to change to healthy lifestyle, how to make smoking, eat healthy foods and more and more physically active. These are primary lines of defense against heart disease and its complications, including heart attack and stroke.
Tests and diagnosis

The tests you need your heart disease diagnosed depend on what condition your doctor thinks you might have. No matter what kind of heart disease you have, your doctor will probably lead a physical examination and ask your personal and family medical history before any other tests. Diagnostic tests for heart disease may include:

* Blood tests. You may have to decrease your blood and tested for substances that show in your blood, that you might be heart disease. Your doctor may check your levels of cholesterol and triglycerides, blood cells or other blood tests show that it could damage your heart.
* Chest X-ray. An image is created through the line X-rays on his chest and positioning a large piece of photographic film or a digital recording plate against your back. The X-ray machine produces a small burst of radiation that passes through your body and draw a picture on the film or digital plate. A chest X-ray shows a picture of your heart, lungs and blood vessels. He can tell if your heart is enlarged, a sign of some forms of heart disease.
* Electrocardiogram (ECG). In this non-invasive tests, a technician probes on your chest space, recording the electrical impulses that make your heart beat faster. An ECG records these electrical signals and can help your doctor detect irregularities in your heart rhythm and structure. You may have an EKG while at rest, you or during exercise (exercise ECG).
* Holter monitoring. A Holter monitor is a portable device that you wear to a continuous ECG recording, usually for 24-72 hours. Holter monitoring is used for occasional irregular heartbeat irregularities, which are in a regular audit to identify ECG found.
*

Echocardiogram. These non-invasive investigation, which includes an ultrasound scan of the chest shows detailed images of your heart’s structure and function. Ultrasound waves are transmitted, and their echoes with a device called a transducer that recorded place outside of the body. A computer uses the information to create moving images from the converter on a video monitor.

In some cases where the images of a regular echocardiogram are unclear, your doctor may recommend transesophageal ultrasound. During this test, you swallow a tube with a small sensor, about the size of the index finger that is held in the neck. The transducer is to transfer images from your heart to a computer monitor.
* Cardiac catheterization. In this test, a short tube (sheath) in a vein or artery in the leg (groin inserted) or arm. A hollow, flexible and longer tube (guide catheter) is then inserted into the vagina. With the help of X-ray images on a monitor, your doctor threads the guide catheter through the artery until it is reached your heart. The pressure in your heart chambers can be measured, and dye can be injected. The dye on an X-ray, which helps your doctor, you see the blood flow can be seen through the heart to check the blood vessels and valves for abnormalities.
* Heart biopsy. Sometimes, a heart biopsy will be performed as part of cardiac catheterization, especially if your doctor suspects you have inflammation of the heart muscle and not in a position to confirm that, with other tests. In a heart biopsy is a tiny sample of your heart tissue is removed through the catheter and is sent to a laboratory for testing.
* Cardiac computed tomography (CT). This test is often used to check for heart failure or heart rhythm disturbances. In a cardiac CT scan, you lie on a table in a donut-shaped machine. An X-ray tube inside the machine rotates around your body, and collects images of the heart and chest. Some may advertise walk-in clinics heart scans for calcium deposits in the arteries that show, look to the risk of a heart attack can. However, these scans are not recommended for most people because the information they provide is often not useful.
* Cardiac magnetic resonance imaging (MRI). In cardiac MRI, you lie on a table in a long tube machine, which generates a magnetic field. The magnetic field aligns atomic particles in certain your cells. When radio waves are broadcast on these aligned particles, they produce signals that are different depending on the type of tissue it. Images of your heart are created from these signals that your doctor will help determine the cause of your heart disease look.

Treatment and medication

Heart disease treatments vary. You may need lifestyle changes, medication, surgery or other medical procedures as part of your treatment.

Treatments for cardiovascular diseases
The goal in the treatment of diseases of the arteries (cardiovascular disease) is often the case that narrows your arteries open cause symptoms. Depending on how serious the blockages in the arteries, treatment may include:

* Changes in lifestyle.

Schizophrenia

Definition

Schizophrenia is a group of serious brain disorders in which reality is interpreted abnormally. Schizophrenia results in hallucinations, delusions, and disordered thinking and behavior. People with schizophrenia withdraw from the people and activities in the world around them, retreating into an inner world marked by psychosis.

Contrary to popular belief, schizophrenia isn’t the same as a split personality or multiple personality. While the word “schizophrenia” does means “split-mind,” it refers to a disruption of the usual balance of emotions and thinking.

Schizophrenia is a chronic condition, requiring lifelong treatment. But thanks to new medications, schizophrenia symptoms can often be successfully managed, allowing people with the condition to lead productive, enjoyable lives.

Symptoms

There are several types of schizophrenia, so signs and symptoms vary. In general, schizophrenia symptoms include:

• Beliefs not based on reality (delusions), such as the belief that there’s a conspiracy against you
• Seeing or hearing things that don’t exist (hallucinations), especially voices
• Incoherent speech
• Neglect of personal hygiene
• Lack of emotions
• Emotions inappropriate to the situation
• Angry outbursts
• Catatonic behavior
• A persistent feeling of being watched
• Trouble functioning at school and work
• Social isolation
• Clumsy, uncoordinated movements

Schizophrenia ranges from mild to severe. Some people may be able to function well in daily life, while others need specialized, intensive care. In some cases, schizophrenia symptoms seem to appear suddenly. Other times, schizophrenia symptoms seem to develop gradually over months, and they may not be noticeable at first.

Over time, it becomes difficult to function in daily life. You may not be able to go to work or school. You may have troubled relationships, partly because of difficulty reading social cues or others’ emotions. You may lose interest in activities you once enjoyed. You may be distressed or agitated or fall into a trance-like state, becoming unresponsive to others.

In addition to the general schizophrenia symptoms, symptoms are often categorized in three ways to help with diagnosis and treatment:

Negative signs and symptoms
Negative signs and symptoms represent a loss or decrease in emotions or behavioral abilities. They may include:

• Loss of interest in everyday activities
• Appearing to lack emotion
• Reduced ability to plan or carry out activities
• Neglecting hygiene
• Social withdrawal
• Loss of motivation

Positive signs and symptoms
Positive signs and symptoms are unusual thoughts and perceptions that often involve a loss of contact with reality. These symptoms may come and go. They may include:

• Hallucinations, or sensing things that aren’t real. In schizophrenia, hearing voices is a common hallucination. These voices may seem to give you instructions on how to act, and they sometimes may include harming others.
• Delusions, or beliefs that have no basis in reality. For example, you may believe that the television is directing your behavior or that outside forces are controlling your thoughts.
• Thought disorders, or difficulty speaking and organizing thoughts, such as stopping in midsentence or jumbling together meaningless words, sometimes known as “word salad.”
• Movement disorders, such as repeating movements, clumsiness or involuntary movements.

Cognitive signs and symptoms
Cognitive symptoms involve problems with memory and attention. These symptoms may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. They include:

• Problems making sense of information
• Difficulty paying attention
• Memory problems

Causes

It’s not known what causes schizophrenia. However, researchers believe that an interaction of genetics and environment may cause schizophrenia. Problems with certain naturally occurring brain chemicals, including the neurotransmitters dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren’t fully certain about the significance of these changes, they support evidence that schizophrenia is a brain disease.

Risk factors

Schizophrenia affects about 1 percent of the general population. In people who have close relatives with schizophrenia, the illness is much more common — about 10 percent. In men, schizophrenia symptoms typically start in the teens or 20s. In women, schizophrenia symptoms typically begin in the 20s or early 30s.

Although the precise cause of schizophrenia isn’t known, researchers have identified certain factors that seem to increase the risk of developing or triggering schizophrenia, including:

• Having a family history of schizophrenia
• Exposure to viruses while in the womb
• Malnutrition while in the womb
• Stressful life circumstances
• Older paternal age
• Taking psychoactive drugs during adolescence

When to seek medical advice

If you have any symptoms of schizophrenia, seek medical help as soon as possible. Schizophrenia doesn’t get better on its own, and in fact, usually worsens without treatment. However, if you’re like some people with schizophrenia, you may not recognize that you need help or that you even have symptoms. Family and friends, or people at work or school, may be the ones who initially suggest you seek help. Try to listen to them, as they have your best interests at heart.

Getting treatment from a mental health provider with experience in schizophrenia can help you learn ways to manage your symptoms so that you have the best chance to continue on with a productive and happy life. If you’re reluctant to seek treatment, try to work up the courage to confide in someone, whether it’s a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.

Helping someone who may have schizophrenia
If you have a loved one you think may have symptoms of schizophrenia, have an open and honest discussion about your concerns. Many people with schizophrenia don’t think they need help because to them, delusions and hallucinations are real. You may not be able to force someone to seek professional help, but you can offer encouragement and support and help your loved one find a qualified doctor or mental health provider.

If your loved one poses a danger to himself or herself or to someone else, you may need to call the police or other emergency responders for help. In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state.

Suicidal thoughts
Suicidal thoughts and behavior are common among people with schizophrenia. If you’re considering suicide right now and have the means available, talk to someone now. The best choice is to call 911 or your local emergency services number. If you simply don’t want to do that, for whatever reason, you have other choices for reaching out to someone:

• Contact a family member or friend
• Contact a doctor, mental health provider or other health care professional
• Contact a minister, spiritual leader or someone in your faith community
• Go to your local hospital emergency room
• Call a crisis center or hot line

Tests and diagnosis

When doctors suspect someone has schizophrenia, they typically run a battery of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and imaging studies, such as an MRI or CT scan.
• Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about delusions or hallucinations and check for signs of psychosis. You may also fill out psychological self-assessments and questionnaires. You may be asked about substance or alcohol abuse. And with your permission, family members or close friends may be asked to provide information about your symptoms.

Diagnostic criteria for schizophrenia
To be diagnosed with schizophrenia, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for schizophrenia are:

• Presence of at least two of these: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms
• Significant impairment in the ability to work, attend school or perform normal daily tasks
• Signs last for at least six months
• Other mental health disorders have been ruled out

You may be diagnosed with one of the five subtypes of schizophrenia, although not all people easily fit into a specific category. The five subtypes are:

• Paranoid
• Catatonic
• Disorganized
• Undifferentiated
• Residual

Talk to your doctor about which type of schizophrenia you have so that you can learn more about your specific situation and its treatments.

Complications

Left untreated, schizophrenia can result in severe emotional, behavioral, health, and even legal and financial problems that affect every area of your life. Complications that schizophrenia may cause or be associated with include:

• Suicide
• Self-destructive behavior, such as self-injury
• Depression
• Abuse of alcohol, drugs or prescription medications
• Poverty
• Homelessness
• Family conflicts
• Inability to work or attend school
• Health problems from antipsychotic medications
• Being a victim or perpetrator of violent crime
• Heart disease, often related to heavy smoking

Treatments and drugs

Schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have subsided. Treatment with medications and psychosocial therapy can help you take control of your condition and become an active and informed participant in your own care. During crisis periods or times of severe symptoms, hospitalization may be necessary for your safety and to make sure you’re getting proper nutrition, sleep and hygiene.

Schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well, including psychologists, social workers and psychiatric nurses, because the condition can affect so many areas of your life. You may also have a case manager to make sure that you’re getting all of the treatment you need and that your care is coordinated among all of your health care providers.

Medications
Medications are the cornerstone of schizophrenia treatment. But because medications for schizophrenia can cause serious but rare side effects, you may be reluctant to take them. Work with your psychiatrist and other health care providers to find a medication regimen that works for you, with the fewest side effects.

Antipsychotic medications are the most commonly prescribed medications to treat schizophrenia. They’re thought to control symptoms by affecting the brain neurotransmitters dopamine and serotonin. There are two main types of antipsychotic medications:

• Conventional, or typical, antipsychotics. These medications have traditionally been very effective in managing the positive symptoms of schizophrenia. These medications have frequent and potentially severe neurological side effects, including the possibility of tardive dyskinesia, or involuntary jerking movements. This group of medications includes:
• Haloperidol (Haldol)
• Thioridazine
• Fluphenazine

These typical antipsychotics are often cheaper than newer counterparts, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

• New generation, also called atypical antipsychotics. These newer antipsychotic medications are effective at managing both positive and negative symptoms. They include:

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)
• Paliperidone (Invega)

Risperidone (Risperdal) is the only atypical antipsychotic medication that’s been approved by the Food and Drug Administration (FDA) to treat schizophrenia in children ages 13 to 17. Atypical antipsychotic medications pose a risk of metabolic side effects, including weight gain, diabetes and high cholesterol.

Which medication is best for you depends on your own individual situation. It can take several weeks after first starting a medication to notice an improvement in your symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. Other medications also may be helpful, such as antidepressants or anti-anxiety medications.

If one medication doesn’t work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don’t stop taking your medications without talking to your doctor, even if you’re feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, antipsychotic medication needs to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Be aware that all antipsychotic medications have side effects and possible health risks. Certain antipsychotic medications, for instance, may increase the risk of diabetes, weight gain, high cholesterol and high blood pressure. Clozaril can cause dangerous changes in your white blood cell count. Certain antipsychotic medications can cause serious health problems in some older adults and should be avoided.

Be sure to talk to your doctor about all of the possible side effects and being monitored for health problems while you take these medications. Antipsychotic medications can also have dangerous interactions with other substances. Your doctors should know about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Psychosocial treatments
Although medications are the cornerstone of schizophrenia treatment, psychotherapy and other psychosocial treatments also are important. These treatments may include:

• Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the daily life challenges brought on by schizophrenia. Therapy can help you improve communications skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about schizophrenia can help you understand it better, cope with lingering symptoms, and understand the importance of taking your medications. Therapy can also help you cope with stigma surrounding schizophrenia.
• Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy can also help family members cope and reduce their distress about your condition.
• Rehabilitation. Training in social and vocational skills to live independently is an important part of recovery from schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. If you don’t have a case manager to help you with these services, ask your doctors about getting one. Today, fewer people with schizophrenia require long-term hospitalization because effective treatments are available.

Treatment challenges
When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.

For one thing, it’s often difficult for people with schizophrenia to stick to their treatment plans. You may believe that you don’t need medications or other treatment. Also, if you’re not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan, such as taking a medication that’s available in a long-lasting injectable form. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.

Many people with schizophrenia smoke, often heavily. If you smoke, you may need a higher dose of antipsychotic medication because nicotine interferes with these medications.

Similarly, using alcohol and drugs can make schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.

Prevention

There’s no sure way to prevent schizophrenia. However, early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook. Sticking with your treatment plan can help prevent relapses or worsening of schizophrenia symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and earlier treatment.

For people at increased risk of schizophrenia, taking proactive steps such as avoiding illicit drug use, reducing stress, getting enough sleep and starting antipsychotic medications as soon as it’s necessary may help minimize symptoms or prevent them from worsening.

Lifestyle and home remedies

Schizophrenia isn’t an illness that you can treat on your own. But you can do some things for yourself that will reinforce your treatment plan:

• Take your medications as directed. Even if you’re feeling well, resist any temptation to skip your medications. If you stop, schizophrenia symptoms are likely to come back.
• Pay attention to warning signs. You and your caregivers may have identified things that may trigger schizophrenia symptoms, cause a relapse or prevent you from carrying out your daily activities. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Involve family members or friends in watching for warning signs. Addressing schizophrenia symptoms early on can prevent the situation from worsening.
• Avoid drugs and alcohol. Alcohol and illicit drugs can worsen schizophrenia symptoms and interfere with the effectiveness of medications.
• Check first before taking other medications. Contact the doctor who’s treating you for schizophrenia before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals or supplements. These can interact with your schizophrenia medications.

Coping and support

Coping with an illness as serious as schizophrenia can be challenging. Medications can have unwanted side effects, and you may feel angry or resentful about having a condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment, which can trigger a relapse. Here are some ways to cope with schizophrenia:

• Learn about schizophrenia. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Join a support group. Support groups for people with schizophrenia can help you reach out to others facing similar challenges.
• Stay focused on your goals. Recovery from schizophrenia is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you’re responsible for managing your illness and working toward your goals.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn relaxation and stress management. Try such stress reduction techniques as meditation, yoga or tai-chi.
• Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks.

Heart failure

Definition

Heart failure, also known as congestive heart failure (CHF), means your heart can’t pump enough blood to meet your body’s needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can’t reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.

The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Symptoms

Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term “congestive heart failure” comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.

Some of the signs and symptoms for chronic and acute heart failure are:

In addition to characterizing whether your condition is chronic or acute, your doctor will need to know whether your heart fails to pump, or fills with blood, or a combination of both. Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart’s main pumping chamber.

While systolic heart failure was once thought to be more common and less serious, recent studies have shown this to be incorrect. Isolated diastolic heart failure, now also termed “heart failure with normal ejection fraction,” is just as common as systolic heart failure and has a similar prognosis. Identifying the type of heart failure, whether systolic, diastolic, or a combination, is important because the drug treatments for each type may differ.

Causes

Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart’s pumping ability.
• High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
• Faulty heart valves. The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
• Damage to the heart muscle (cardiomyopathy). Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can’t be found, it’s referred to as idiopathic dilated cardiomyopathy.
• Myocarditis. Myocarditis is an inflammation of the heart muscle. It’s most commonly caused by a virus and can lead to left-sided heart failure.
• Heart defects present at birth (congenital heart defects). If your heart and its chambers or valves haven’t formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
• Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Risk factors

A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk.

Risk factors include:

• High blood pressure. Your heart works harder than it has to if your blood pressure is high.
• Coronary artery disease. Narrowed arteries may limit your heart’s supply of oxygen-rich blood, resulting in weakened heart muscle.
• Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
• Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.
• Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
• Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don’t stop taking these medications on your own, though. If you’re taking them, discuss with your doctor whether you need to make any changes.
• Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
• Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
• Viruses. A viral infection may have damaged your heart muscle.
• Alcohol use. Alcohol can weaken heart muscle and lead to heart failure.
• Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

When to seek medical advice

See your doctor if you experience any of the signs or symptoms associated with heart failure. These include:

• Fatigue and weakness
• Rapid or irregular heartbeat
• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Swelling in your abdomen, legs, ankles and feet
• Difficulty concentrating or decreased alertness

You may first find out you have heart failure from an emergency room visit after worsening signs and symptoms. Other heart and lung problems can cause signs and symptoms that are similar to heart failure.

If you have a diagnosis of heart failure, and if any of the signs or symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

Tests and diagnosis

To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination. Your doctor will also check for the presence of risk factors such as high blood pressure. Using a stethoscope, your doctor can listen to your lungs for signs of congestion. The stethoscope also picks up abnormal heart sounds that may suggest heart failure. After the physical exam, your doctor may do blood tests and a chest X-ray followed by an echocardiogram.

• Blood tests. Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it’s injured or overworked.
• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
• Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
• Echocardiogram. An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can’t fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart’s main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
• Ejection fraction. Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.Other imaging tests may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).

Other tests
In addition to the physical examination, blood tests, chest X-ray and echocardiogram, your doctor may recommend one or more tests to help diagnose heart failure, determine its underlying cause and guide treatment decisions. You may have tests such as:

• Stress test. You may have one of a variety of stress tests either using an exercise bike or treadmill or medications that stress the heart. In some stress tests, pictures are taken of your heart with either nuclear medicine or echocardiographic techniques to try and determine if you have blockages in your heart arteries as a cause for your heart failure. You may also have an oxygen uptake stress test which helps your doctor know how well your body is compensating for your condition.
• Cardiac CT or MRI scan. These tests are now being used with increased frequency for people with heart failure, not only to measure ejection fraction but to check the heart arteries and valves, determine if you have had a heart attack, and look for unusual causes of heart failure.
• Coronary catheterization (angiogram). In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray. This test helps doctors identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure. The test may include a ventriculogram — a procedure to determine the strength of the left ventricle (the heart’s main pumping chamber) and the health of the heart valves.

Classifying heart failure
Results of these tests help doctors determine the cause of your signs and symptoms and develop a program to treat your heart. To determine the best course of treatment, doctors may classify heart failure using two scales:

• New York Heart Association scale. This scale classifies heart failure in categories from one to four. In Class I heart failure, the mildest form, you can perform everyday activities and not feel winded or fatigued. Class IV is the most severe, and you’re short of breath even at rest.
• American College of Cardiology scale. This newer classification system uses letters A to D. The system includes a category for people who are at risk of developing heart failure. For example, a person who has several risk factors for heart failure is Stage A, but a person with end-stage heart failure requiring hospice care is Stage D. Doctors use this classification system to identify your risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.

Ask your doctor about your score if you’re interested in determining the severity of your heart failure. Your doctor can help you interpret your score and plan your treatment based on your condition.

Complications

In systolic heart failure, your heart pumps with less force. To make up for the weak pumping, your ventricle enlarges in an attempt to stretch and contract with more strength, allowing it to pump more blood. This can initially stabilize the situation but, eventually the more the heart dilates, the more inefficient it becomes. The heart muscle may thicken to help increase pumping strength. More muscle means the heart needs more blood, and your coronary arteries may not be able to supply it. Your heart may also beat faster in an attempt to pump more often. In addition, levels of heart-stimulating hormones go up.

At first, these means of compensating help a weakened heart pump harder. However, eventually these changes make matters worse by weakening your heart muscle.

If you have heart failure, your outlook depends on the cause and the severity, overall health and other factors such as age. Many people’s symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. It can lead to sudden death. People with severe heart failure have debilitating symptoms, and some may require heart transplantation or support with an artificial heart device.

Treatments and drugs

Heart failure is a chronic disease needing lifelong management. However, with treatment, a failing heart can become stronger and signs and symptoms of heart failure can improve. Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, the treatment of heart failure involves a balance of the right medications, and in some cases, devices that help the heart beat properly.

Medications
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:

• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten). ACE inhibitors also blunt some of the effects of hormones that promote salt and water retention. ACE inhibitors can cause an irritating cough in some people. It may be best to put up with the cough, if you can, to gain the medication’s benefits. But be sure to discuss this with your doctor. Switching to another ACE inhibitor or an angiotensin II receptor blocker (ARB) may relieve the problem.
• Angiotensin II (A-II) receptor blockers (ARBs). These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don’t cause a persistent cough. They may be an alternative for people who can’t tolerate ACE inhibitors.
• Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
• Beta blockers. This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms. Beta blockers may reduce signs and symptoms of heart failure and improve heart function.
• Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Commonly prescribed diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix). The drugs also decrease fluid in your lungs, so you can breathe more easily. Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you’re taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
• Aldosterone antagonists. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They’re primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer. Unlike some other diuretics, spironolactone can raise the level of potassium in your blood to dangerous levels.

A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure. This is the first drug studied and approved for a specific racial group. Further studies will be necessary to determine if this combination medicine will be helpful for others with heart failure.

You’ll probably need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications as well — such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots – along with heart failure medications.

You may be hospitalized for a few days if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long term.

Surgery and medical devices
In some cases, doctors recommend surgery to treat the underlying problem that led to heart failure. For example, a damaged heart valve may be repaired or, if necessary, replaced with a new one. Doctors recommend coronary bypass surgery to treat severely narrowed coronary arteries that are contributing to heart failure.

Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:

• Implantable cardioverter-defibrillators (ICDs). An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
• Cardiac resynchronization therapy (CRT) or biventricular pacing. A biventricular pacemaker sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart’s electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart’s limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
• Heart pumps. These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart.

Some people have such severe heart failure that surgery or medications don’t help. They may need to have their diseased heart replaced with a healthy donor heart. Heart transplants have dramatically improved the survival and quality of life of people with severe heart failure. However, candidates for transplantation often have to wait years before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.

Experimental treatments

• Cardiac wrap surgery. Researchers are studying a technique that wraps a failing heart in a mesh bag, helping to prevent further failure. A surgeon pulls the mesh wrap over the base of the heart and attaches it with stitches. The goal is to prevent a weakened heart from enlarging (dilating) and failing further. Studies are ongoing.
• Ventricular restoration surgery. This surgery is being used experimentally to treat some people with heart failure caused by a heart attack. During the surgery, doctors remove scar tissue in the ventricular muscle caused by a heart attack and reshape the remaining healthy tissue to restore a more normal elliptical left ventricle shape. Reducing the size of and reshaping the left ventricle help restore normal function to the pumping mechanism.
• Enhanced external counterpulsation (EECP). This noninvasive technique has been used as a treatment for heart-related chest pain, and researchers are studying this treatment to see if it’s beneficial for people with heart failure. Inflatable pressure cuffs are placed on the calves, thighs and buttocks. These cuffs are inflated and deflated in sync with your heartbeat. The theory is that EECP increases blood flow back to the heart.

Prevention

The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.

Lifestyle and home remedies

Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make:

• Stop smoking. Smoking damages your blood vessels, reduces the amount of oxygen in your blood and makes your heart beat faster. If you smoke, ask your doctor to recommend a program to help you quit. You can’t be considered for a heart transplant if you continue to smoke.
• Weigh yourself daily. Do this each morning after you’ve urinated, but before you’ve had breakfast. Notify your doctor if you have a weight gain of 3 or more pounds in a day. It may mean that you’re retaining fluids and need a change in your treatment plan. Record your weight every morning and bring the record with you to your doctor’s visits.
• Restrict sodium. Sodium is a component of salt. Too much sodium contributes to water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet. For people with heart failure, the recommended sodium intake is no more than 2,000 milligrams a day. Keep in mind that most of this salt is already added to prepared foods, and be careful when using salt substitutes. Some substitutes or “lite” salts contain a mixture of salt and other compounds. To get that familiar salty taste, you may use too much of the substitute and actually not reduce your sodium intake. In addition, many salt substitutes contain potassium chloride. Too much potassium can be harmful if you have kidney problems or if you’re taking certain medications for treatment of heart failure. A dietitian can help you outline a healthy, low-salt diet, but it’s up to you to stick to it without exception.
• Maintain a healthy weight. If you’re overweight, your dietitian will help you work toward your ideal weight.
• Limit fats and cholesterol. In addition to avoiding high-sodium foods, limit your intake of saturated fat, trans fat and cholesterol. A diet high in fat and cholesterol is a risk factor for coronary artery disease, which often underlies or contributes to heart failure.
• Limit alcohol and fluids. Excessive use of alcohol can directly weaken your heart muscle or increase your risk of abnormal heart rhythms that may worsen existing heart failure. Alcohol may also interact with some medications used to treat heart conditions. Your doctor likely will advise you to abstain from alcohol if you have heart failure. If you have severe heart failure, your doctor may also suggest you limit your total intake of fluids.
• Exercise. Exercise was once forbidden for people with heart failure. But, moderate exercise helps keep the rest of your body healthy and conditioned, reducing the demands on your heart muscle. Before you start exercising though, talk to your doctor about an exercise program that’s right for you. Your doctor may suggest a walking program. Check with your local hospital to see if it offers a cardiac rehabilitation program; if it does, talk to your doctor about enrolling in the program.
• Reduce stress. When you’re anxious or upset, your heart beats faster and you breathe more heavily. This can make heart failure worse, since your heart is already having trouble meeting the body’s demands. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible.
• Sleep easy. If you’re having shortness of breath, especially at night, sleep with your head propped up at a 45-degree angle using a pillow or a wedge. If you snore or have had other symptoms of disordered sleep, make sure you get tested for sleep apnea.

Coping and support

Often people with congestive heart failure complain that they wake up tired because lying flat makes it harder to breathe, and their sleep is interrupted because of excess fluid or medications that increase the need to urinate.

To improve your sleep at night, prop up your head with pillows and avoid big meals right before bedtime. Also, discuss with your doctor changing the time for taking medications, especially diuretics. Taking diuretics earlier in the day may keep you from having to urinate as often during the night.

Although many cases of heart failure can’t be reversed, treatment can usually improve symptoms and help you live longer. You and your doctor can work together to help make your life more comfortable. Pay attention to your body and how you feel, and tell your doctor when you’re feeling better or feeling worse. This way, your doctor will know what treatment works best for you.

Don’t be afraid to ask your doctor questions about living with heart failure. These steps can help you work most effectively with your doctor:

• Keep track of the medications you take. Make a list and share it with any new doctors treating you. Carry the list with you all the time.
• Keep track of your weight and bring the record to visits with your doctor. An increase in weight can be a sign you’re accumulating fluid. Your doctor may instruct you to take extra diuretics if your weight has increased more than a pound or so in a day.
• Keep track of your blood pressure. Consider purchasing a high-quality home blood pressure monitor. Keep track of your blood pressure between doctor appointments and bring the record with you to visits.
• Write down your questions. Before a doctor appointment, prepare a list of any questions or concerns. For example, is it safe for you and your partner to have sex? Most people with heart failure can continue sexual activity once symptoms are under control.
• Ask for clarification. Make sure you understand what your doctor is saying.

Managing heart failure requires an open dialogue between you and your doctor. Be honest about whether you’re following recommendations concerning your diet, lifestyle and taking medications. Your doctor often can suggest strategies to help you get and stay on track.

Migraine

Definition

A migraine can be disabling — with symptoms so severe, all you can think about is finding a dark, quiet place to lie down. Up to 17 percent of women and 6 percent of men have experienced a migraine.

In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.

Fortunately, management of migraine pain has improved dramatically in the last decade. If you’ve seen a doctor in the past and had no success, it’s time to make another appointment. Although there’s still no cure, medications can help reduce the frequency of migraine and stop the pain once it has started. The right medicines combined with self-help remedies and changes in lifestyle may make a tremendous difference for you.

Symptoms

A typical migraine attack produces some or all of these signs and symptoms:

• Moderate to severe pain, which may be confined to one side of the head or may affect both sides
• Head pain with a pulsating or throbbing quality
• Pain that worsens with physical activity
• Pain that interferes with your regular activities
• Nausea with or without vomiting
• Sensitivity to light and sound

When left untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or just once or twice a year.

Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some, however, have migraines with auras, which were previously called classic migraines. If you’re in the second group, you’ll likely have an aura about 15 to 30 minutes before your headache begins. Auras may continue after your headache starts or even occur after your headache begins. When you’re experiencing an aura, you may:

• See sparkling flashes of light
• Perceive dazzling zigzag lines in your field of vision
• Experience slowly spreading blind spots in your vision
• Feel tingling, pins and needles sensations in one arm or leg
• Rarely, experience weakness or language and speech problems

Whether or not you have auras, you may have one or more sensations of premonition (prodrome) several hours or a day or so before your headache actually strikes, including:

• Feelings of elation or intense energy
• Cravings for sweets
• Thirst
• Drowsiness
• Irritability or depression

Migraine symptoms in children
Migraines typically begin in childhood, adolescence or early adulthood and may become less frequent and less intense as you grow older. In addition to physical suffering, severe headaches often mean missed school days and trips to the emergency department, as well as lost work time for anxious parents.

Children’s migraines tend to last for a shorter time. But the pain can be disabling and can be accompanied by nausea, vomiting, lightheadedness and increased sensitivity to light. A migraine tends to occur on both sides of the head in children.

Children may also have all of the signs and symptoms of a migraine — nausea, vomiting, increased sensitivity to light and sound — but no head pain. These “abdominal migraines” can be especially difficult to diagnose.

The good news is that some of the same medications that are effective for adults also work for children. Your child doesn’t have to go through the pain and disruption of migraines. If your child has headaches, talk to your pediatrician. He or she may want to refer your child to a pediatric neurologist.

Causes

Although much about headaches still isn’t understood, some researchers think migraines may be caused by functional changes in the trigeminal nerve system, a major pain pathway in your nervous system, and by imbalances in brain chemicals, including serotonin, which plays a regulatory role for pain messages going through this pathway.

During a headache, serotonin levels drop. Researchers believe this causes the trigeminal nerve to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). There they cause blood vessels to become dilated and inflamed. The result is headache pain.

Migraine triggers
Whatever the exact mechanism of headaches, a number of things may trigger them. Common migraine triggers include:

• Hormonal changes. Although the exact relationship between hormones and headaches isn’t clear, fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, and this corresponds to a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications, such as contraceptives and hormone replacement therapy, also may worsen migraines.
• Foods. Certain foods appear to trigger headaches in some people. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; fermented, pickled or marinated foods; aspartame; overuse of caffeine; monosodium glutamate — a key ingredient in some Asian foods; certain seasonings; and many canned and processed foods. Skipping meals or fasting also can trigger migraines.
• Stress. A hard week at work followed by relaxation may lead to a weekend migraine. Stress at work or home also can instigate migraines.
• Sensory stimuli. Bright lights and sun glare can produce head pain. So can unusual smells — including pleasant scents, such as perfume and flowers, and unpleasant odors, such as paint thinner and secondhand smoke.
• Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraine attacks in some individuals.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment. A change of weather, season, altitude level, barometric pressure or time zone can prompt a migraine.
• Medications. Certain medications can aggravate migraines.

Risk factors

Many people with migraines have a family history of migraine. If both your parents have migraines, there’s a good chance you will too. Even if only one of your parents has migraines, you’re still at increased risk of developing migraines.

You also have a relatively higher risk of migraines if you’re young and female. In fact, women are three times as likely to have migraines as men are. Headaches tend to affect boys and girls equally during childhood but increase in girls after puberty.

If you’re a woman with migraines, you may find that your headaches begin just before or shortly after onset of menstruation. They may also change during pregnancy or menopause. Many women report improvement in their migraines later in pregnancy, but others report that their migraines worsened during the first trimester. If pregnancy or menstruation affects your migraines, your headaches are also likely to worsen if you take birth control pills or hormone replacement therapy (HRT).

When to seek medical advice

Migraines are a chronic disorder, but they’re often undiagnosed and untreated. If you experience signs and symptoms of migraine, track and record your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache gets worse
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement
• New headache pain if you’re older than 50

Tests and diagnosis

If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain.

Computerized tomography (CT)
This imaging procedure uses a series of computer-directed X-rays that provides a cross-sectional view of your brain. This helps doctors diagnose tumors, infections and other possible medical problems that may be causing your headaches.

Magnetic resonance imaging (MRI)
MRIs use radio waves and a powerful magnet to produce very detailed cross-sectional views of your brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.

Spinal tap (lumbar puncture)
If your doctor suspects that an underlying condition, such as meningitis or subarachnoid hemorrhage, is the cause of your headaches, he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in your lower back to extract a sample of cerebrospinal fluid (CSF) for laboratory analysis. The procedure takes about 30 minutes. You may feel pressure while the fluid is extracted and have a headache afterward because of a drop in CSF pressure.

Complications

Sometimes your efforts to control your pain cause problems. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and aspirin, may cause abdominal pain, bleeding and ulcers — especially if taken in large doses or for a long period of time.

In addition, if you take over-the-counter or prescription headache medications more than two or three times a week or in excessive amounts, you may be setting yourself up for a serious complication known as rebound headaches. Rebound headaches occur when medications not only stop relieving pain, but actually begin to cause headaches. You then use more pain medication, which traps you in a vicious cycle.

Serotonin syndrome
A potentially life-threatening drug interaction — called serotonin syndrome — can occur if you take migraine medicines called triptans, such as sumatriptan (Imitrex) or zolmitriptan (Zomig), along with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Some common SSRIs include Zoloft, Prozac and Paxil. SNRIs include Cymbalta and Effexor. Fortunately, serotonin syndrome is exceedingly uncommon.

Treatments and drugs

A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and impaired movement on one side of your body.

Some medications aren’t recommended if you’re pregnant or breast-feeding. Some aren’t used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren’t effective alone for severe migraines. If over-the-counter medications don’t help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.
• Triptans. For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Related medications include rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness, muscle weakness and, rarely, stroke and heart attack. In recent studies, a single-tablet combination of sumatriptan and naproxen sodium relieved migraine symptoms more effectively than did either individual medication. This combination tablet will likely be marketed soon.
• Ergots. Ergotamine (Ergomar) has been in use for more than 60 years and was a common prescription for migraine before triptans were introduced. Ergotamine is much less expensive, but also less effective, than triptans. Dihydroergotamine is an ergot derivative that is more effective and has fewer side effects than ergotamine.
• Anti-nausea medications. Since migraine attacks are often accompanied by nausea with or without vomiting, medication for treatment of these symptoms is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or rectal suppository).
• Butalbital combinations. Medications that combine the sedative butalbital with aspirin or acetaminophen are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine. These medications, however, have a high risk of rebound headaches and withdrawal symptoms and accordingly should be used infrequently.
• Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine pain when people can’t take triptans or ergots. These drugs are habit-forming and are usually used only as a last resort.

Preventive medications
Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.

In most cases, preventive medications don’t eliminate headaches completely, and some can have serious side effects. For best results, take these medications as your doctor recommends:

• Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful migraine prevention medications. Researchers don’t understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness.
• Antidepressants. Certain antidepressants are good at helping prevent all types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. You don’t have to have depression to benefit from these drugs. Newer antidepressants, however, generally aren’t as effective for migraine prevention.
• Anti-seizure drugs. Although the reason is unclear, some anti-seizure drugs, such as divalproex sodium (Depakote) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss and dizziness.
• Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
• Botulinum toxin type A (Botox). Some people receiving Botox injections for their facial wrinkles have noted improvement of their headaches. The mechanism by which Botox might prevent migraines is unclear, although the drug may cause changes in your nervous system that modify your tendency to develop migraines. Studies using Botox injections for migraines have had mixed results. Additional research is necessary. Still, if several other preventive medications have failed to control your headaches, you might talk to your doctor about trying Botox.

Prevention

Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:

• Avoid triggers. If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
• Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.
• Reduce the effects of estrogen. If you’re a woman with migraines and estrogen seems to trigger or make your headaches worse, you may want to avoid or reduce the amount of medications you take that contain estrogen. These medications include birth control pills and hormone replacement therapy. Talk with your doctor about the best alternatives or dosages for you.

Lifestyle and home remedies

Self-care measures can help ease the pain of a migraine. Try these headache helpers:

• Keep a diary. A diary can help you determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also pay special attention to foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike. If you’re under stress, tell your doctor.
• Try muscle relaxation exercises. Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home using books or tapes. Or spend at least a half-hour each day doing something you find relaxing — listening to music, gardening, taking a hot bath or reading.
• Get enough sleep, but don’t oversleep. The average adult needs seven to nine hours of sleep a night.
• Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.

Alternative medicine

Nontraditional therapies may be helpful if you have chronic headache pain:

• Acupuncture. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin. The penetration is so shallow and the needles are so thin that acupuncture generally causes little or no pain or discomfort. A number of clinical trials have found acupuncture may be helpful for headache pain, but evidence from these trials isn’t strong enough for experts to routinely recommend this treatment.
• Biofeedback. Biofeedback appears to be especially effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses, such as muscle tension. This technique can be combined with preventive medications.
• Massage. Although massage is a wonderful way to reduce stress and relieve tension, its value in treating headaches hasn’t been fully determined. For people who have tight, tender muscles in the back of the head, neck and shoulders, massage may help relieve headache pain.
• Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur may prevent migraines or reduce their severity. A high dose of riboflavin (vitamin B-2) also may prevent migraines by correcting tiny deficiencies in the brain cells. There is also some evidence that coenzyme Q10 supplements may be helpful in some individuals. Oral magnesium sulfate supplements may reduce the frequency of headaches in some people, although studies don’t all agree on this issue. In addition, infusions of magnesium sulfate seem to help some people during an acute headache, and they seem to relieve migraine pain in people with magnesium deficiencies. Ask your doctor if these treatments are right for you. Don’t use feverfew or butterbur if you’re pregnant.
• Cervical manipulation. There are no scientifically valid studies that prove that chiropractic or other spine-manipulation treatments are effective in the treatment of migraine.