Mental Health

Memory – Harvard Health

What is Memory?

As we age, it’s common to worry about losing our memories (That’s partly because a certain amount of age-related memory loss is perfectly normal). In order to preserve your memory as you age, it’s important to understand how memory functions. So, what is memory? Where in the brain are memories stored, and how does the brain retrieve them?

Quite simply, memory is our ability to recall information. Scientists talk about different types of memories based either on their content or on how we use the information. For example, remembering the layout of your grandmother’s kitchen is different in both content and purpose than remembering the middle three digits of a plumber’s phone number while looking at his business card as you dial the phone. The main two categories for memories are short-term and long-term.

Short-term memories involve information that you only need to recall for a few seconds or minutes. If you’re turning at an intersection, the fact that there were no cars coming when you looked to the left is important, but once you’ve made your turn you will quickly discard the information because it is no longer relevant. Keeping it around would unnecessarily clutter your brain.

Long-term memories contain the information that makes you you—not just facts (like the capital of Kansas) or events (like your senior prom) but also skills and processes (like typing or dancing the Macarena). Long-term memory is durable yet changeable; a memory can evolve based on retelling a story or on new information learned after the event.

Memories are not stored in a single location in the brain. Instead, the sensory components of a memory—sight, smell, sound, etc.—are distributed to different areas of the brain, and the act of remembering occurs as the brain pieces those bits back together. Each time a memory is created, its constituent parts are catalogued in the deep-brain structure known as the hippocampus. Next to the hippocampus sits the amygdala, the brain’s emotional center. It flags certain memories as being important or emotionally powerful. The different components of the memory are then distributed mostly to sections of the cerebral cortex, which is the outer layer of the brain.

When it’s time to retrieve a memory, you rely on the part of the brain known as the frontal lobes, which are involved in attention and focus. The pieces of the memory are then pulled from the areas of the cerebral cortex where they’re stored. For example, to remember a scene from your favorite movie might involve pulling in data from the brain’s visual region to recall the backdrop and the actors’ faces, but also information from the language region to remember the dialogue—and perhaps even the auditory region to remember the soundtrack or sound effects. Together, these components form a unique neuronal pattern that lies dormant until you set about remembering it, at which point it is reactivated.

What Causes Memory Loss and Forgetfulness?

Like the rest of our bodies, our brains change with age, meaning that most of us will find ourselves struggling to recall newly learned information or even to think of words we know well. That’s usually not cause for alarm, since some memory loss in elderly people is quite normal and not indicative of memory loss diseases such as Alzheimer’s. But what causes memory loss, and how and why does memory change with age?

Many of the things we think of as normal memory loss with aging can actually be attributed to a slight decline in our ability to perform tasks requiring attention and so-called executive function (planning, sequencing and regulating thought). Specific age-related changes in the brain are associated with that lower executive function. For example, to think of an acquaintance’s name, you must rapidly make connections between brain cells. Each cell (called a neuron) is separated from its neighbors by a tiny gap called a synapse, and a signal from one brain cell must cross that gap to the next one via a chemical messenger called a neurotransmitter. Once across the gap, it must “unlock” a structure called a receptor on the destination cell. With age, both the brain’s chemistry and the structural integrity of the neurons’ wiring deteriorate (The hippocampus, crucial for memory processing, also shrinks). That doesn’t mean you’ll never be able to recall the bit of information that’s eluding you, but it does mean it might take some time for the brain to forge a path to where the memory is stored. Thus most “memory loss” in seniors is actually just a slowing of performance. You can still learn, retain, and recall plenty of information, but it might take you longer—and require a bit more determination—than it did when you were younger.

Some forms of memory loss are caused by head trauma, including brain injuries resulting from high-impact sports such as boxing, soccer and football. Memory loss can be part of a primary brain disease. But it can also happen in people with depression, thyroid malfunction and even vitamin deficiencies, all of which can result in improved memory with appropriate treatment.

We also know that stress, fatigue, sleep deprivation and the feeling of being overwhelmed can contribute to short-term memory loss and forgetfulness. Middle age can be a difficult period of life in which our responsibilities can extend to ourselves, our spouses, our jobs, our children, our parents and even our grandchildren. It’s not uncommon, then, to feel distracted and find it harder to concentrate on things we’re trying to remember.

So how do you know when to visit a doctor for memory loss? If you begin to experience difficulty completing familiar tasks, or have bouts of forgetfulness that extend beyond minor inconvenience and disrupt your day-to-day functioning, there may be something more serious going on than normal age-related memory loss.

What is Mild Cognitive Impairment?

Mild cognitive impairment (MCI) occurs in nearly 20% of adults over age 65. While many people assume it is a precursor to full-blown dementia, fewer than half of people with MCI go on to develop Alzheimer’s dementia within five years. MCI is marked by either memory loss, a decline in cognitive fitness, or both, that is worse than should be expected for the patient’s age.

When the impairment is largely memory-related, doctors refer to it as amnestic MCI. With normal age-related memory loss, people tend to forget fairly trivial things like where they put their car keys. But with amnestic MCI, the things patients forget are more important—who the presidential candidates are, what was discussed in last week’s Zoom meeting, what college your granddaughter attends. Even so, the impairment is considered “mild” because it does not significantly impact day-to-day functions like preparing food, driving and personal hygiene.

The other main subtype of MCI is called non-amnestic. Rather than affecting memory, non-amnestic MCI manifests as cognitive decline in other areas such as language, spatial awareness or the ability to focus and maintain attention. Someone with non-amnestic MCI might find it difficult to keep up with a conversation, pay their bills, make decisions, repair a faucet or understand a speech. Again, however, the impairment is not so severe as to disrupt everyday life.

People whose MCI affects both memory and other types of cognition are said to have multi-domain MCI. Amnestic MCI is the most common subtype.

MCI is highly variable in terms of its severity and trajectory—it may worsen, stay the same or even go away, depending on what’s causing it. Temporary MCI can be brought on by sleep apnea, depression or medications. Risk factors for other kinds of MCI include genetics, stroke, head injury, high cholesterol, high blood pressure, obesity, smoking, and hearing loss. It’s important not to think of these risk factors as “causes” of MCI—instead, each has been associated with the condition.

What is Dementia

Many people confuse mild cognitive impairment (MCI) with dementia. While MCI can in fact be a precursor to the early stages of dementia, dementia is a separate brain disorder. The symptoms of dementia are so severe as to render the patient dependent on others to carry out the tasks of everyday living. But exactly what is dementia

Although memory loss is one of the most common signs of dementia, the disorder often entails other forms of cognitive decline, including a drop-off in the ability to think abstractly, to make reasonable judgments, to speak and understand, and to relate spatially to the environment. Perhaps just as alarming, dementia patients often undergo significant changes to their personalities, becoming agitated and sometimes experiencing delusions.

There are several types of dementia.

Most people know or have heard of someone with Alzheimer’s disease, a type of dementia marked by short-term memory loss so severe that patients often ask the same question minutes apart, forgetting that they have already received an answer. Alzheimer’s patients also frequently experience severe personality changes. People with Alzheimer’s disease have excessive amyloid plaque and neurofibrillary tangles in the brain. But whether these changes are the actual cause continues to be explored. That’s because many older people have similar brain changes but never develop dementia.

Vascular dementia is caused by an interruption of the blood flow to the brain. This can happen after a stroke, brain bleed or head trauma, But more often the cause is reduced blood flow from narrowing of multiple small arteries that feed oxygen and nutrients to the brain. The symptoms are similar to people with Alzheimer’s disease, but it also depends on which parts of the brain are most affected.

Dementia with Lewy bodies arises from an accumulation of harmful proteins in the brain cells causing progressive problems with cognition, memory and movement.

Although Parkinson’s disease is usually thought of as a movement disorder, some people develop symptoms similar to other types of dementia, such as problems with executive function, information retrieval and attention.

Frontotemporal dementia occurs when neurons in the brain’s frontal lobe or temporal lobe die off, leaving the patient to experience personality changes so stark as to be frequently misdiagnosed as psychiatric problems.

The symptoms of primary age-related tauopathy, or PART, can appear similar to those of Alzheimer’s disease. But the symptoms of PART are mostly limited to memory loss and not the other cognitive-behavioral problems usually associated with Alzheimer’s.

People with more than one of these memory loss diseases are said to have mixed dementia.

What is the Difference between Dementia and Alzheimer’s?

Dementia is the generic term for cognitive and memory decline sufficiently severe that the patient requires assistance with everyday functioning. Alzheimer’s disease is the most common cause of dementia, with nearly 5 million Americans affected, but it is by no means the only cause.

Alzheimer’s is a progressive disease, meaning that it worsens over time, sometimes in as little as four years. During the early stages, the patient experiences memory loss but is still able to live independently. In mid-stage Alzheimer’s, the patient may begin to neglect their personal care and to forget significant information. By the late stages of the illness, people require help with even the most basic aspects of daily living, and normal conversation becomes impossible.

What happens to the brain to cause Alzheimer’s? Two substances play a likely role. Both are naturally occurring proteins. Beta-amyloid accumulates in the brain until it forms plaques in the gaps between nerve cells that are conduits for signals that travel through the brain. The other key protein, called tau, also accumulates over time and forms tangles inside the brain cells. The two proteins together kill cells in areas of the brain necessary for memory, personality and other cognitive abilities.

How to Improve Memory and Concentration?

The good news is that, although with age you should expect to experience some forgetfulness, there is plenty you can do to minimize memory loss and even improve and enhance your memory as you get older.

Among the best ways to improve memory are the same lifestyle changes that reduce the risk of heart disease and stroke. For example, quit smoking, drink alcohol in moderation or avoid drinking completely, and limit intake of sugary and processed foods.

But when it comes to how to improve memory, eliminating factors is just part of the puzzle—the other piece is adding in new habits. For example, eating foods that help memory, such as leafy green vegetables, nuts, berries, tea, coffee and oily fish, is a great way to promote your overall health while strengthening your brain.

Regular exercise boosts the growth of brain cells and the production of neurotransmitters, enhancing memory. A mix of aerobic (cardio) and strength exercises is best.

If you’re not getting enough sleep, you might be harming your cognition and memory. Aim for seven to nine hours each night.

Meditation, stress reduction and keeping up a good network of social relationships have all been shown to stave off the effects of aging on the brain.

One key to keeping your mind young is to keep it busy and challenged through lifelong learning and stimulation. Traveling, learning new languages, picking up a musical instrument, taking art or cooking classes, doing puzzles, playing board games—all these things promote the growth of new brain cells and help the brain forge new pathways.
Memory enhancement can also come from properly managing your physical and mental health.

If you know or suspect that you suffer from depression, get it treated.

Since many medications can cause brain fog and bouts of forgetfulness, you should review your prescriptions with your doctor and see if dosages can be changed or eliminated. Especially consider drugs with anti-cholinergic properties, such as the older antihistamines (e.g. diphenhydramine, Benadryl), some older antidepressants (e.g. amitriptyline, Elavil), and drugs for urinary symptoms (e.g. oxybutynin, Ditropan).  

Checking your hearing, vision, blood pressure and blood levels of thyroid function and cholesterol may find abnormalities which could easily be addressed and result in improved memory.

Brain experts have developed many tips for improving memory as you attempt to remember such things as names, to-do lists, facts or other information. For example, associating new information with things you already know can help you retain it—like remembering that you’re in parking spot 42 because your son is 42 years old. With another technique, called chunking, you break up a list into categories—if you were memorizing all the countries of Europe, grouping the Baltic States (Estonia, Latvia and Lithuania) lets you see them as one group. Using a more advanced technique, called loci, you “visit” a familiar location in your mind, mentally placing the items you want to memorize at various places along the path.

Certain habitual behaviors will help you remember the information that gets you through your day. One such habit is staying organized—if you always put your car keys on the counter, you won’t have to wonder where you left them. If you write down every appointment or put it into your smartphone, you won’t miss any. If you keep to-do lists, up-to-date address books, and lists of passwords, you won’t face the struggle of trying to recall information when it’s urgent. It’s also helpful to create certain mental habits, such as repeating a person’s name as soon as you’re introduced, paraphrasing parts of a conversation to reinforce the message, and becoming a more careful reader (and re-reader) to really drive home the content.

How to Avoid Memory Loss?

In study after study, physical activity has been associated not just with higher cognitive function but with a decreased risk of memory loss over time. The brains of people who exercise regularly shrink less with age than those of sedentary people (especially the hippocampus, a brain structure key to memory), and their white matter stays healthier. Exercising three or more times per week has been associated with a 40-50% lower risk of diagnosis with dementia.

In one study, adults at a high fitness level were 88% less likely than those of medium fitness to develop dementia, and high fitness appeared to delay the onset of dementia by 11 years. To reap the benefits of exercise, you must be consistent, so set aside a dedicated time for exercise and stick with it. Swimming, walking and tennis are great activities. Joining a gym and taking fitness classes works very well for some people, since socialization is known to boost brain health.

Another way to avoid memory loss is to be mindful of what you eat. While some specific foods are associated with brain health, food marketers sometimes exaggerate their benefits. That’s why it’s better to think in terms of broad patterns and styles of eating. One rule of thumb is to build your eating habits around foods that are good for your heart, since the same diet that is heart-healthy is also good for the brain. You may have heard of the Mediterranean diet, which has been shown to promote heart health. It centers on plant-based foods, fish, nuts and olive oil. A variation of the Mediterranean diet, called the MIND diet (Mediterranean diet Intervention for Neurodegenerative Delay) was designed with the explicit goal of optimizing brain health. It’s heavy on leafy green vegetables, nuts, berries, fish and poultry, and avoids red meat, butter, cheese and sweets. In one study, MIND diet adherents were 30-35% less likely to score poorly on cognitive tests.

But what about memory supplements? Can’t you simply take an over-the-counter pill or capsule to get a memory boost? Unfortunately, marketers frequently make unproven claims about the benefits of these products. For example, ginkgo biloba is often touted as a wonder supplement for mental function, but numerous studies have found that it has no effect on memory, attention or risk of dementia. You do need certain vitamins for memory, but studies have not shown that taking more than the recommended daily allowance (RDA) has a beneficial effect. Still, B vitamins and vitamin D might merit special attention, since they’re particularly important for keeping dementia at bay. A blood test can tell you whether you’re vitamin B12-deficient, in which case a supplement is a good idea. You can get plenty of vitamin D through 10-15 minutes of sun exposure daily, but if that’s not possible, a supplement may be called for.

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Depression – Harvard Health

What is depression?

Depression is more than just a passing blue mood, a “bad day,” or temporary sadness. The most common symptom is a low mood that can sometimes appear as irritability. Often the person with depression is not able to enjoy activities that he or she normally enjoys.

There are several types of depression, including:
Major depression. With major depression, there is a profound sadness or a sense of despair. The symptoms of major depression are defined as lasting at least two weeks, but usually they go on much longer.
Bipolar disorder (previously called manic depression or manic depressive illness). Bipolar disorder is a mental disorder characterized by wide mood swings from high (manic) to low (depressed). It is commonly divided into two subtypes (bipolar I and bipolar II) based on the dividing line between mania and hypomania.

  • Bipolar I disorder is the classic form where a person has had at least one manic episode.
  • In bipolar II disorder, the person has never had a manic episode, but has had at least one hypomanic episode and at least one period of significant depression.

Most people who have manic episodes also experience periods of depression. In fact, there is some evidence that the depression phase is much more common than periods of mania in this illness. Bipolar depression can be much more distressing than mania and, because of the risk of suicide, is potentially more dangerous.

Persistent depressive disorder (previously called dysthymia). Persistent depressive disorder is less severe than an episode of major depression, but lasts longer. Many people with this disorder describe having been depressed as long as they can remember, or feeling as though they go in and out of depression all the time.

Postpartum depression. A major depressive episode may occur within the first two to three months after giving birth to a baby. In that case, it may be called major depressive disorder with peripartum onset. Most people refer to it as postpartum depression.

Seasonal affective disorder. Depression that occurs mainly during the winter months is usually called seasonal affective disorder, or SAD. It also may be called major depressive disorder with seasonal pattern.

A variety of symptoms usually accompany the low mood of any type of depression. And the symptoms can vary significantly among different people.

Many people with depression also have anxiety. They may worry more than average about their physical health. They may have excessive conflict in their relationships or function poorly at work. Sexual functioning may be a problem. People with depression are also at more risk for abusing alcohol or other substances.

Depression probably involves changes in the areas of the brain that control mood. The nerve cells may be functioning poorly in certain regions of the brain. Altered communication between nerve cells or nerve circuits can make it harder for a person’s brain to regulate his or her mood.

Hormone changes may also negatively affect mood. An individual’s life experiences can affect these biological processes. And a person’s genetic makeup influences how vulnerable he or she is to experiencing depression.

An episode of depression can be triggered by a stressful life event. But in many cases, depression does not appear to be related to a specific event.
Episodes of depression can occur at any age. Depression is diagnosed in women twice as often as in men. People who have a family member with major depression are more likely to develop depression or drinking problems.

What are the main depression symptoms?

A depressed person may gain or lose weight, eat more or less than usual, have difficulty concentrating, and have trouble sleeping or sleep more than usual. He or she may feel tired and have no energy for work or play. Small burdens or obstacles may appear impossible to manage. The person can appear slowed down, or agitated and restless. The symptoms can be quite noticeable to others.

A particularly painful symptom of this illness is an unshakable feeling of worthlessness and guilt. The person may feel guilty about a specific life experience, or may feel general guilt not related to anything in particular.

If pain and self-criticism become great enough, they can lead to feelings of hopelessness, self-destructive behavior, or thoughts of death and suicide. The vast majority of people who suffer severe depression do not attempt or commit suicide, but they are more likely to do so than people who are not depressed.

Symptoms of major depression include:

  • distinctly depressed or irritable mood
  • loss of interest or pleasure
  • decreased or increased weight or appetite
  • decreased or increased sleep
  • appearing slowed or agitated
  • fatigue and loss of energy
  • feeling worthless or guilty
  • poor concentration or indecisiveness
  • thoughts of death, or suicide plans or attempts

People with persistent depressive disorder may have many of the same symptoms. While the symptoms tend to be less severe, they are long-lasting.

How is depression diagnosed?

A primary care physician or a mental health professional usually can diagnose depression by asking questions about a person’s medical history and symptoms.

The simplest screening tool to help determine if a person may be depressed is the PHQ-2. Over the last two weeks, how often have you experienced:

  • Little interest or pleasure in doing things
  • Feeling down, depressed or hopeless

If it is more than several days over the past two weeks, your doctor will pursue additional questions. There are no specific tests for depression.

Many people with depression do not seek evaluation or treatment because of society’s attitudes about depression. The person may feel the depression is his or her fault or may worry about what others will think. Also, the depression itself may distort a person’s ability to recognize the problem. Therefore, family members or friends may need to encourage someone showing symptoms of depression to seek help.

Also, it is important to be evaluated by a primary care physician to make sure the symptoms are not being caused by a medical condition or medication.

How is depression treated?

No single treatment—whether it’s a drug or a style of therapy—can ease depression in every case. However, research suggests you will improve your chances of getting relief if you combine antidepression medication and therapy. One report that pooled findings from 25 studies found that adding psychotherapy to an antidepressant drug was more helpful than medication alone in treating major depression. Earlier research suggested that one reason therapy and medication may complement each other is that they have different effects on the brain.

Often, treatment is divided into three phases. Keep in mind, though, that there are no sharp lines dividing the phases, and very few people take a straight path through them.

  1. In the initial phase, the aim is to relieve symptoms. Generally, this occurs within four to eight weeks, but it may take longer depending on your response to the first treatments you try.
  2. In the continuation phase, you work with your doctor to maximize your improvements. Further treatment adjustments, such as modifying the dosage of a depression medication and sometimes adding a second drug, can help. This period may take another four to five months.
  3. In the maintenance phase, the aim is to prevent relapse. Ongoing treatment is often necessary, especially if you have already experienced several depressive episodes, have chronic low mood, or have risk factors that make a recurrence more likely.

If your symptoms are mild or moderate, it is often reasonable to start with either an antidepressant medication or psychotherapy. If your depression is mild, there is a greater chance that you will respond well to psychotherapy alone. Generally, as symptoms become more severe, it is more important to consider medication earlier in your treatment.

Of course, consider all your options carefully, and discuss them with the professionals you are consulting. If one type of treatment alone isn’t helping you—and especially if your depression is getting worse—you can always try combination treatment.

A medication from a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is often prescribed first. These medications include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). They are not without problems, but they are fairly easy to take and relatively safe compared with previous generations of antidepressants.

SSRIs are known to cause problems with sexual functioning, some nausea, and an increase in anxiety in the early stages of treatment.

Other effective antidepressants include bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), and duloxetine (Cymbalta).

It usually takes at least two to six weeks of taking an antidepressant to see improvement. It may take several attempts to find the medication that works best. Once the right medication is found, it may take up to a few months to find a proper dose and for the full positive effect to be seen.

A number of different psychotherapy techniques have been demonstrated to be helpful, depending on the causes of the depression, the availability of family and other social support, and an individual’s personal style and preference. A technique called cognitive behavioral therapy can help a depressed person recognize negative thinking and teach techniques for controlling symptoms. Other types of therapy, including psychodynamic, insight-oriented, and interpersonal psychotherapy, can help depressed people to sort out conflicts in important relationships or explore the history behind symptoms.

If you suffer from depression, you will benefit from learning all you can about the illness. You can also make use of any support networks that may be available in your community.

Does taking an antidepressant increase suicide risk?

The FDA still requires manufacturers of antidepressants to include a so-called “black box warning” on their product labeling. The warning is intended to address the concern that antidepressants may increase the risk of suicide in children, adolescents, and young adults. This problem has remained a focus of research, but the evidence surrounding it remains hard to interpret.

A small number of young people taking these medications probably do have an unusual reaction and end up feeling much worse, rather than better. Any medication that affects mood can have an unexpected negative effect in some people.

However, some experts worry that this warning has had too much of a chilling effect on the use of antidepressants for treatment. It is potentially dangerous for both doctors and patients to be too cautious about using a helpful intervention. When depression goes untreated, the risk of suicide goes up. Paradoxically, it is possible that the labeling puts more people at risk for suicide if it means that some people do not receive the treatment they need.

Therefore, independent of this debate, it is always important to monitor your treatment closely. No matter what age you are or what treatment you’re getting, report any troubling symptoms or worsening mood to your doctor immediately.

How to help someone with depression

Like a pebble thrown into a pond, depression creates ripples that spread far from their immediate point of impact. Those closest to people who have these illnesses often suffer alongside them. It’s upsetting and often frustrating to deal with the inevitable fallout. But you can do a lot to help a loved one and yourself handle this difficult period.

Encourage him or her to get treatment and stick with it. Remind the person about taking antidepressant medication or keeping therapy appointments.

Don’t ignore comments about suicide. If you believe your loved one is suicidal, call his or her doctor or therapist. Mental health professionals can’t divulge information about a patient without permission, but it is not a violation of confidentiality for them to listen to you. In urgent situations, if you can’t reach the doctor or therapist, you may want to call a local crisis hotline for advice or bring the person to a local ER.

Care for yourself. Being a caregiver is a difficult job. You may want to seek individual therapy or join a support group. Numerous mental health organizations sponsor such groups and can also provide you with information on the illness and the latest treatments.

Offer emotional support. Your patience and love can make a huge difference. Ask questions and listen carefully to the answers. Try not to brush off or judge the other person’s feelings, but do offer hope. Suggest activities that you can do together, and keep in mind that it takes time to get better. Don’t worry if you don’t know what to say — it takes a great deal of training (such as that received by therapists) to advise people in emotional distress.

Recognize that depression may manifest as irritability or anger, which is often directed toward family and other loved ones. Remind yourself that a disease is causing your loved one to act differently or perhaps be difficult. Do not blame him or her, just like you wouldn’t if it were chronic physical pain that caused the person to change in certain ways.
Many participants said they kept trying different combinations of these specific strategies, and learned what helped through trial and error.

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Back Pain – Harvard Health

What’s causing my back pain?

When a person says I have back pain, we usually interpret that to mean low back pain. For good reason, the pain and tightness most often hit the lower part of the back.

Back pain can be a symptom of many different illnesses and conditions.The main cause of the pain can be a problem with the back itself or by a problem in another part of the body. In many cases, doctors can’t find a cause for the pain. When a cause is found, common explanations include:

  • Stress or injury involving the back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; and short term overload of back muscles caused by any unusual stress, such as lifting or pregnancy
  • Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the bone-thinning disease osteoporosis
  • Degenerative arthritis, a “wear and tear” process that may be related to age, injury and genetic predisposition.
  • Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disk (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)
  • Kidney stones or a kidney infection (pyelonephritis).

Rarer causes include:

  • Inflammatory arthritis, including ankylosing spondylitis and related conditions
  • A spinal tumor or a cancer that has spread (metastasized) to the spine from elsewhere in the body
  • Infection, which may be in the disk space, bone (osteomyelitis), abdomen, pelvis or bloodstream.

When should I worry about back pain?

Back pain varies widely. Some symptoms (often called “red flag” symptoms) may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer and neurological symptoms, such as numbness, weakness or incontinence (involuntary loss of urine or stool). If any of these symptoms occur, contact your doctor immediately.

Back pain is often accompanied by other symptoms that may help point to its cause. For example:

  • Back sprain or strain – Back pain typically begins on the day after heavy exertion or an activity that requires twisting. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.
  • Fibromyalgia – In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. People usually complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful to touch, called tender points.
  • Degenerative arthritis of the spine – Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.
  • Inflammatory arthritis, including ankylosing spondylitis and related conditions – In these disorders, there is pain in the lower back, together with morning stiffness in the back, hips or both.  Back pain in these condition tends to improve with exercise. Other features may include psoriasis, eye pain and redness, or diarrhea, depending on the specific disorder causing back pain. This group of diseases is a relatively rare cause of back pain.
  • Osteoporosis – This common condition is characterized by thinned, weakened bones that fracture easily. It is most common in postmenopausal women. When vertebrae become compressed because of fracture, posture may become stooped over or hunched along with back pain. Osteoporosis is not painful unless a bone fractures.
  • Protruding disk – People with significant disk disease sometimes have severe pain in the lower back. If a disk compresses a nerve, the pain may spread down one leg. The pain gets worse during bending or twisting.
  • Spinal stenosis – Pain, numbness and weakness affect the back and legs. Symptoms get worse when you are standing or walking, but are relieved by sitting or leaning forward.
  • Pyelonephritis – People with a kidney infection typically develop sudden, intense pain just beneath the ribs in the back that may travel around the side toward the lower abdomen or sometimes down to the groin. There also can be a high fever, shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. There may be additional bladder related symptoms, such as the need to urinate more often than normal or pain or discomfort during urination.

How do doctors diagnose the cause of back pain?

Your doctor will ask about your symptoms and your medical history. He or she will examine your back muscles and spine and will move you certain ways to check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg.

Your symptoms and the physical examination may give your doctor enough information to diagnose the problem. However, with back pain, your doctor may only be able to tell you that the problem is not serious. If your doctor determines that your back pain is caused by muscle strain, obesity, pregnancy or another cause that is not urgent, you may not need any additional tests. However, if he or she suspects a more serious problem involving your vertebrae or spinal nerves, especially if your back pain has lasted longer than 12 weeks, you may need one or more of the following tests:

  • X-rays of your back
  • Blood test
  • Urine tests
  • Spinal magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Nerve conduction studies and electromyography to determine whether nerves, muscles or both may be injured
  • Bone scan, especially if you have a previous history of cancer

How long does back pain last?

How long back pain lasts depends on its cause. For example, if your pain is caused by strain from overexertion, symptoms usually subside over days or weeks and you may be able to return gradually to your normal activities. However, you should avoid heavy lifting, prolonged sitting or sudden bending or twisting until your back gets better.

Women who have back pain caused by the added weight of pregnancy almost always will get better after delivery. People who are obese may need to lose weight before back pain eases.

People with back pain caused by pyelonephritis often begin to feel better within days after they start taking antibiotics, although they usually need to continue taking antibiotics for up to two weeks.

People with more serious forms of back pain caused by problems with the vertebrae or spinal nerves may have more persistent back pain that lasts for months and may last for years.

What’s the best way to prevent back pain?

You can help prevent some forms of back pain by strengthening your back with exercises and by avoiding activities that lead to back injury.

Movement is the best way to ward off back pain. Regular physical activity can make the back stronger to reduce future episodes of pain. Exercises should focus on increasing strength and improving range of motion — as well as ensuring balance on both sides of the body, as some back pain can start when one side of the body is stronger than the other.

In addition, whenever possible, avoid prolonged sitting. If you sit at a desk in the office all day, get up periodically — at least every 30 minutes — and walk around. Walk to get a drink of water or to pick up your mail. Take breaks throughout the course of the day to prevent future bouts of pain.

Other measures that may help prevent back pain include:

  • Maintaining good posture.
  • Always lifting objects from a squatting position, using your hips and your legs to do the heavy work. Avoid lifting, twisting and bending at the same time.

To help prevent osteoporosis, make sure you get enough calcium and vitamin D daily to meet the dietary requirements for your age group. Follow a routine program of weight-bearing exercise. Avoid smoking and limit the amount of alcohol you drink. If you are a woman who has entered menopause, speak with your doctor about testing for osteoporosis and medications that can help to prevent or reverse it.

What treatments relieve back pain?

Medications tend to have only temporary and modest benefits, so it makes sense to try something other than a pill for back pain relief. The specifics depend on the type and duration of back pain.

For new low back pain relief (lasting less than 12 weeks), try:

  • heat
  • massage
  • acupuncture
  • spinal manipulation, as with chiropractic care.

If these don’t work, an NSAID such as ibuprofen or naproxen or a muscle relaxant are reasonable options. But given their potential to cause side effects and their modest benefit, they aren’t the first choice.

For chronic low back pain relief (lasting 12 weeks or more), try:

  • exercise (including stretching, improving balance, and strengthening core muscles)
  • physical therapy
  • acupuncture
  • mindfulness-based programs intended to cope with or reduce stress.

Other approaches, such as tai chi, yoga, or progressive relaxation techniques may also be helpful.

If these don’t work, treatment with an NSAID or duloxetine is worth consideration. However, opioids should be avoided for chronic low back pain in most cases.

It’s important to emphasize these suggestions are for low back pain that might begin after an unusually strenuous workout or shoveling snow. It’s not for serious causes of back pain such as a major injury, cancer, infection, or fractures.

When is back surgery needed?

The decision to consider back surgery should always come after trying nonsurgical or “conservative” options. There are exceptions. For example, if a person has back pain and progressive weakening in one or both legs or loses control of bladder or bowel function, prompt surgical intervention may be necessary.

Most often acute back pain will resolve after 6 to 8 weeks. So, it’s usually best to be patient and give nonsurgical options time to work. Even if the discomfort persists, surgery is most likely to be successful when the person’s pain clearly correlates to abnormal findings on an imaging test like an MRI.

However, imaging tests often show abnormal changes that have nothing to do with the pain. That’s when surgery is unlikely to help and perhaps offers no relief, as well as risking complications.

When conservative measures have not provided sufficient pain relief for a herniated disc causing persistent sciatica or spinal stenosis, you and your doctor might consider surgery. The procedures back surgeons perform most often are discectomy and laminectomy.

In a discectomy, the surgeon removes part of a herniated disc, which occurs when a disc ruptures and its jelly-like center leaks, irritating nearby nerves.

Back surgeons perform laminectomy for spinal stenosis (narrowing of spaces in the spine), causing pressure on a nerve going into the legs. The surgeon removes the bony plate (lamina) on the back of the vertebra where the stenosis is located. This opens up more space for the spinal nerves. Laminectomy can be performed through a tiny incision and guided by video from a miniature camera.

Sometimes there is so much narrowing that a simple laminectomy won’t do the job. In such cases, a laminectomy with spinal fusion may be needed. In addition to removing one or more bony plates, the surgeon removes discs and other tissues, and then stabilizes the spine with cement or hardware.

Laminectomy alone is usually just as effective as spinal fusion, and so is the preferred option when possible to help relieve lower back pain.

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Headache – Harvard Health

Types of headaches

Most headaches fall into four main categories: tension, migraine, cluster, and sinus.

Tension headache. Tension headaches are the most common headache, affecting about three of every four adults at some point in their lives. The typical tension headache produces a dull, squeezing pain on both sides of the head. Most episodes are mild to moderate in severity and occur infrequently, but some people can get severe tension headaches three or four times a week. The discomfort usually last 20 minutes to two hours. While physical and emotional stress often plays a role in tension headaches, other factors can contribute, like illness, lack of sleep, and missed meals. Problems involving the neck or jaw muscles and joints can also cause tension headaches.
Migraine headache. Migraines are typically less common than tension headaches but are usually much more severe. They affect more women than men. Genetics also play a role. In fact approximately 70% of migraine sufferers have at least one close relative with the condition. Neurologists believe migraines are caused by changes in blood flow and nerve cell activity in the brain . Migraines cause moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. Episodes usually last four to 24 hours or even longer. Migraines often begin in the evening or during sleep. In some people, the attacks are preceded by several hours of fatigue, depression, and sluggishness or by irritability and restlessness.
Cluster headache. Cluster headaches are uncommon, yet severe. The pain always strikes one side of the head, starting abruptly and lasting for about 30 minutes to three hours. They occur five times more often in men than women. As the name suggests, these headaches tend to come in clusters. About 90% of cluster attacks follow a pattern of one or two headaches a day over two to eight weeks, alternating with headache-free stretches. Usually, the remission time between episodes lasts six months to a year, but can be as short as a few weeks or as long as several years. It’s unclear what causes cluster headaches, although certain triggers are associated with outbreaks, such as alcohol, foods high in nitrites like processed meat and green leafy vegetables (spinach, lettuce), tobacco products, bright lights, and hot weather.
Sinus headache. The sinuses are air-filled spaces above, between, and beneath your eyes, on either side of your nose. Both the nose and sinuses are lined with a thin membrane. Sinus headaches can occur when this inner membrane becomes inflamed, when fluid builds up in the sinuses and can’t drain out through the nose, or when pressure in the sinuses is lower than environmental air pressure. Sinus headache pain is most often felt in the center of the face, the bridge of the nose, and the cheeks, but may also occur behind the eyes or in the center of the forehead.
Other headache types include:
Thunderclap. As the name suggests, a thunderclap headache strikes suddenly with excruciating pain. It is a serious situation that requires immediate medical attention because it could indicate bleeding in or around the brain.
COVID-19. Headaches are one of the most common symptoms of COVID-19, and the severity and duration vary from person to person.
Cervicogenic. With this type of headache, pain begins in the neck and travels to the head and face. Cervicogenic headaches are sometimes confused with migraines and tension headaches, which can also cause neck pain. They result from structural problems at the top of the spine involving thecervical vertebrae. Injuries like whiplash, arthritis, and infections are thought to be common causes.
Other situations can trigger occasional or recurring headaches. For instance, many drugs list headaches among their side effects. (Check with your doctor if you have frequent headaches and use medication, over-the-counter, prescription,or both, for more than 10 to 15 days a month.) Sudden, strenuous exercise and sexual intercourse can also cause headaches, as can high blood pressure (hypertension).

What are common headache symptoms?

Headache symptoms can vary depending on the type, although there is some overlap. Here are the trademark symptoms for the most common headaches.
Tension headache symptoms. The typical tension headache produces a dull, squeezing pain and pressure on both sides of the head. People with severe tension headaches may feel like their head is trapped in a vise. The shoulders and neck can also ache.
Migraine headache symptoms. In typical cases, migraine pain occurs on one side of the head, often beginning around the eye and temple before spreading to the back of the head. The throbbing or pulsating may be severe. Nausea is common, and many migraine sufferers also have watery eyes, a running nose, or congestion. One way to remember the symptoms of migraine is the acronym POUND:

  • P: Pulsating pain
  • O: One-day duration of severe untreated attacks
  • U: Unilateral (one-sided) pain
  • N: Nausea and vomiting
  • D: Disabling intensity

About 20% of migraine sufferers also experience auras, a sequence of visual or sensory disturbances, such as temporary loss of vision, halos, sparkles or flashing lights, wavy lines, and numbness or tingling on one side of the body, especially in the face or hand. The aura can occur before and during an attack.
Although a migraine can come on without warning, there is often a trigger. Specific trigger(s) can vary, but a migraine sufferer usually remains sensitive to the same ones. Some common triggers include:

  • changing weather, like rising humidity and heat
  • lack of sleep or oversleeping
  • fatigue
  • emotional stress
  • sensory triggers, such as bright or flickering lights, loud noises, and strong smells
  • missing a meal
  • alcohol, especially red wine
  • chocolate
  • nitrates in cured meats and fish
  • aged cheese
  • an increase or decrease in caffeine
  • monosodium glutamate or MSG (often present in Asian and prepared foods)

Sinus headache symptoms. Sinus headaches can trigger pain over the forehead, around the nose and eyes, over the cheeks, or in the upper teeth and gums.
Cluster headache symptoms. The deep and explosive pain of cluster headaches always strikes one side of the head, often near the temple. The eye on the painful side becomes red and watery, the eyelid may droop, and the nose runs or is blocked. The attack starts abruptly and lasts for approximately 30 minutes to three hours. Nausea and sensitivity to light and sound also may accompany the pain.

What are the best headache treatments?

For the occasional, mild to moderately painful headache, an over-the-counter (OTC) pain medication is often sufficient treatment. These include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, naproxen (Aleve), and ibuprofen (Motrin, Advil). Always follow the label’s instructions and take these medications only as directed. Consult your doctor if you use OTC drugs more than a couple of times a week to manage headaches.

Non-drug remedies include eating a snack and drinking water or a caffeinated beverage like coffee. Some people find relief from placing a cold compress on their head and/or a heating pad or warm towel around their neck and shoulders. Taking a warm shower or a nap may also help. Relaxation techniques, such as deep breathing, meditation, and visualization can ease headache pain by relaxing muscles and reducing tension.  
Certain types of headaches may require stronger treatments. For example:

  • Tension headache. People who suffer from severe tension headaches are more likely to benefit from a doctor-prescribed pain medication or a muscle relaxant.
  • Migraine headache. Migraine sufferers may be able to control their headaches with OTC pain relievers if taken early in the attack. For more severe episodes, prescription drugs are needed.

Most doctors recommend triptan drugs, which are available as tablets, nasal sprays, or injections. Examples include sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt). Triptans act on specific serotonin receptors to constrict dilated blood vessels throughout the body. Most people feel the effects after 20 to 30 minutes and complete relief within one to two hours. Still, the sooner you take them once symptoms appear, the better. Some people require a second dose within 12 to 24 hours.

Other prescription drugs used to treat migraines are ditans and calcitonin gene-related peptide (CGRP) inhibitors. Ditans act on different serotonin receptors found mainly within the brain. However, they don’t constrict blood vessels like triptans, which makes them a safer alternative for people with heart disease or high blood pressure. Lasmiditan (Reyvow) currently is the only FDA-approved ditan.

CGRP inhibitors (known informally as “gepants”) block the CGRP chemical that inflames nerve endings and causes blood vessels to dilate. Currently three gepants have been approved for migraines: ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and atogepant (Qulipta).

Cluster headache. For cluster headaches, sumatriptan (also used to treat migraines) is often effective, particularly when given by injection. Another option is inhaling oxygen, administered in an emergency room or at home from a portable tank, which can be prescribed by a doctor. If there’s no improvement after 15 minutes of inhaling, further oxygen therapy may not help.

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Reducing Sugar in Your Diet – Harvard Health

“Sugar and spice, everything nice,” the old saying goes.

But according to overwhelming evidence, there’s nothing nice about sugar when it comes to your health. Scores of research studies have linked added sugar to obesity and diabetes—as well as high blood pressure and elevated triglycerides that can lead to heart disease. 

What’s more, sugar is nothing but “empty calories”—has little to no nutritional value and it does nothing to stave off hunger. 

But how can you cut back on harmful sugar without giving up the sweetness you crave?

Now, thanks to the experts at Harvard Medical School, you can have the instant, research-backed answers you need that can have a dramatic impact on your health. It’s all in the instant-answer online guide Reducing Sugar in Your Diet.

Instant answers are just 5 minutes away!:

  • Yummy foods that help short-circuit harmful sugar spikes after a meal. 
  • The truth about natural sugar alternatives: The straight scoop on raw sugar, honey, agave syrup and more. 
  • The smart artificial sweetener that makes a healthier substitute for baking sugar.
  • The three secret letters that reveal sneaky “added sugar” on food labels.  
  • How healthier sugar alcohols let you enjoy the sweetness of processed sugar with just half the calories.  Discover the easy way to spot them on food labels. 
  • The biggest sources of hidden sugars—including certain fruit and sports drinks, condiments, soups and yogurts. 
  • Sweet and tasty desserts that make filling, nutritious alternatives to traditional high-calorie fare. 
  • How sugar substitutes can actually work against your quest for better health

Start now to wean yourself from health-threatening added sugar …starting today!

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Benefits of Apple Cider Vinegar Gummy Candies as a Dietary Supplement

You’ve probably heard of apple cider vinegar, the golden elixir known for its potential health perks. Did you know that apple cider vinegar has been linked to improved digestion and a boost in metabolism? Yep, studies suggest that it helps kickstart your body’s fat-burning potential.  Credit: Pexels In a 2018 study published in the Journal

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