DOCSLIB.ORG

(MUS): CHRONIC PAIN and FATIGUE Guideline Summary

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(MUS): CHRONIC PAIN and FATIGUE Guideline Summary VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF MEDICALLY UNEXPLAINED SYMPTOMS (MUS): CHRONIC PAIN AND FATIGUE Guideline Summary PRIMARY CARE GUIDELINE SUMMARY • Establish that the patient has MUS. • Obtain a thorough medical history, physical examination, and medical record review. • Minimize low yield diagnostic testing. • Identify treatable cause (conditions) for the patient’s symptoms. • Determine if the patient can be classified as Chronic Multi-Symptom Illness (CMI) (i.e., has two or more symptoms clusters: pain, fatigue, cognitive dysfunction, or sleep disturbance). • Negotiate treatment options and establish collaboration with the patient. • Provide appropriate patient and family education. • Maximize the use of non-pharmacologic therapies: - Graded aerobic exercise with close monitoring. - Cognitive behavioral therapy (CBT) • Empower patients to take an active role in their recovery. VA access to full guideline: http://www.oqp.med.va.gov/cpg/cpg.htm May 2002 DoD access to full guideline: http://www.cs.amedd.army.mil/Qmo Sponsored & produced by the VA Employee Education System in cooperation with the Offices of Quality & Performance and Public Health & Environmental Hazards and the Department of Defense. Clinical Practice Guideline for Management of Medically Unexplained Symptoms: Chronic Pain and Fatigue 1 Patient with Medically Medically Unexplained symptoms (MUS) Unexplained Symptoms (MUS) [ A ] Patients with MUS: • Have unexplained symptoms after an 2 appropriate assessment. Obtain additional history, physical • May have been given one or more diagnoses examination, Mental Status Examination that lack a well-defined disease explanation. and psychosocial assessment [ B ] 3 4 Are unstable or urgent Y Refer or treat, as indicated, before condition(s) present? continuing in this algorithm [ C ] N 5 • Clarify the symptoms [See side bar] • Build therapeutic alliance Symptom Attributes • Schedule additional appointments of longer duration Duration of symptom [ D ] Onset and triggers Location Co-morbidity 6 Previous episodes Revisit the medical record Intensity and impact [ E ] Previous treatment and medications Past medical, surgical & psychological history Patient perception of symptom 7 [ D ] Obtain focused diagnostic tests, if not already done [ F ] 8 Can another condition or 9 disease (including mood Y Consider treating the disorder) explain condition or disease (cause) the symptoms? [ G ] 11 10 Y Are all symptoms Follow-up resolved? N N 12 Consider initiating symptom-based treatment modalities [ H ] Continued on Page 3 Management of Medially Unexplained Symptoms (MUS): Chronic Pain & Fatigue Summary page 2 Clinical Practice Guideline for Management of Medically Unexplained Symptoms: Chronic Pain and Fatigue Continued from Page 2 13 Does patient present with 2 or more of the following: • Fatigue Y • Pain • Sleep disturbance or cognitive dysfunction? [ I ] 14 Document diagnosis: Consider Anxiety, Sleep Apnea, Upper N Airway Resistance Syndrome, Fibromyalgia, Chronic Fatigue Syndrome or Chronic Multisymptom Illnesses [ J ] 22 Provide symptomatic treatment 15 and consider consultation Summarize the patient's condition [ Q ] Develop a treatment plan [ K ] 23 Follow-up and reassess as 16 indicated Initiate/continue treatment (See Section B 'Interventions') Consider symptomatic treatment Provide patient and family education [ L ] 17 Follow up with scheduled visits, usually at frequent intervals [ M ] Reassess symptoms severity [ N ] 18 Have symptoms and functional status Y improved? [ N ] N 21 19 Adjust dose or change treatment Adjust treatment modality (return to box 16) Encourage & reinforce Consider consultation Monitor for emerging conditions [ P ] [ O ] 20 Follow-up and reassess in 3 to 4 months Management of Medially Unexplained Symptoms (MUS): Chronic Pain & Fatigue Summary page 3 PRIMARY CARE MEDICALLY UNEXPLAINED orientation to place, memorizing and repeating three SYMPTOMS non-related items, and spelling “world” backwards). Patients managed by this guideline have symptoms that Psychosocial Assessment: A psychosocial assessment is remain relatively unexplained after an appropriate medical critical in evaluating the patient with unexplained symp- assessment that includes focused diagnostic testing. toms and should include a screening for suicidal ideation Patients are often given multiple labels that lack a well- and substance use disorders. The Patient Health defined disease explanation. Usual clinical features include Questionnaire (PHQ) is an excellent screening tool for a relative lack of objective signs and a chronic symptom assessing the presence of the most common psychiatric course often marked by exacerbations, remissions, and conditions associated with complaints of fatigue: depres- recurrences. Therefore, clinical management must be sion, symptoms, and anxiety. based largely upon patient report, rather than specific find- Unstable/Urgent Conditions ings on clinical examination or diagnostic testing. A Unstable or urgent conditions represent situations that compassionate approach to patients with medically unex- mandate immediate attention. A complete discussion of plained symptoms (MUS) is essential. diagnosis and management of the entire range of possible urgent conditions is beyond the scope of this ASSESSMENT AND DIAGNOSIS guideline. These conditions are generally recognized and A thorough and early review of all sources of informa- managed by the astute primary care clinician and tion can help in validating the patient’s health concerns, include (but are not limited to) the following: while communicating care and understanding—the • Suicidal ideation or psychosis necessary building blocks to an effective patient-clini- • Objective evidence of joint swelling cian partnership. Sources of information include: all • Fever (over 101.1 degrees F/38.4 degrees C) medical records, medical history and psychosocial • Significant weight loss assessment, review of systems, physical examination and mental status examination (MSE), routine test • Focal findings on neurological examination results, and standard health assessments. • Severe anemia or elevated white blood cells Symptoms Additional medical history: In obtaining a medical history, the clinician should focus on key symptoms that Patients who present with unexplained pain or fatigue may suggest a well-defined disease explanation. often carry a cluster of symptoms that must be under- stood as accurately as possible. Taking an accurate Physical examination: Patients with unexplained symp- history is an essential part of the diagnostic work-up. toms have often been examined several times in the past. The following brief standardized assessment measures However, important details may have been overlooked are recommended for routine recording in the medical due to time constraints or the frequency that clinicians record: encounter such complaints in the absence of objective findings. Setting aside time for a detailed and thorough For pain: "On a 0 to 10 scale, 0 being no pain and 10 examination is critical for the assessment and may also being pain as bad as you can imagine, what number help in building an alliance with the patient, who in would you say your pain has been over the past week?" many cases was seen by several clinicians. For symptoms other than pain: "On a 0 to 10 scale, 0 Mental Status Examination (MSE): A careful MSE being no (insert SYMPTOM) and 10 being (insert should be performed, including assessment of appear- SYMPTOM) as bad as you can imagine, what number ance, behavior, mood and affect, cognition, thought would you say your (insert SYMPTOM) has been over content and processes, and insight and judgment. A the past week?" useful screen for cognitive impairment in elderly For symptom impact: "During the past week, how patients consists of four questions from the Mini-Mental much have your symptoms interfered with your usual State Examination (MMSE) (i.e., orientation to time, Management of Medially Unexplained Symptoms (MUS): Chronic Pain & Fatigue Summary page 4 work or activities, 0 being does not interfere at all and for the presence of malignancy, which should be kept in 10 being completely interferes?" mind during the evaluation. It is important not to ignore co-morbidities that may represent a true underlying The clinician should initiate a complete initial symptom condition that will require treatment. assessment (e.g., symptom duration, onset, triggers, and severity for new symptoms not previously assessed). Previous episodes: The patient may have had prior episodes of similar symptoms in the past, as well as Duration: The duration of the symptoms until time of prior treatments. presentation is variable and patients may have spent years seeing numerous clinicians and undergoing exten- Patient perception of symptoms: Patients should be sive evaluations without ever obtaining a diagnosis. given the opportunity to relate their experiences and Many patients may relate the onset of their symptoms to complaints, at each visit, in their own way. Although a significant event (e.g., severe illness, trauma, military time-consuming and likely to include much seemingly mobilization, and viral illness). Some patients may irrelevant information, this has the advantage of present with symptoms after sustaining central/axial providing considerable information concerning the skeletal trauma, such as a motor vehicle accident with patient’s intelligence, emotional make-up and attitudes resultant whiplash. about their complaints. This
Load more

Recommended publications
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • In Diagnosis Must Be Based on Clinical Signs and Symptoms. in This Paper
    242 POST-GRADUATE MEDICAL JOURNAL August, 1938 Postgrad Med J: first published as 10.1136/pgmj.14.154.242 on 1 August 1938. Downloaded from SOME REMARKS ON DIFFERENTIAL DIAGNOSIS OF BLOOD DISEASES. By A. PINEY, M.D., M.R.C.P. (Assistant Physician, St. Mary's Hospital for Women and Children.) Differential diagnosis of blood diseases has been discussed time and again, but, as a rule, blood-pictures, rather than clinical features, have been taken into account, so that the impression has become widespread that the whole problem is one for the laboratory, rather than for the bed-side. It is obvious, however, that the first steps in diagnosis must be based on clinical signs and symptoms. In this paper, there- fore, certain outstanding clinical features of blood diseases, and various rather puzzling syndromes will be described. The outstanding external sign that leads the practitioner to consider the possi- bility of a blood disease is pallor, which is not quite so simple a state as is often supposed. It is, of course, well known that cutaneous pallor is not an infallible sign of anaemia, but it is often presumed that well-coloured mucous membranes are fairly good evidence that anaemia is not present. This is not necessarily true. The conjunctive may be bright pink in spite of anaemia, because mild inflammationProtected by copyright. may be present, masking the pallor. This is quite frequently due to irritation by eyelash dyes. Similarly, the finger-nails, which used to serve as a reliable index of pallor, are now found disguised with coloured varnish.
    [Show full text]
  • Fatigue and Parkinson's Disease
    Fatigue and Parkinson’s Disease Gordon Campbell MSN FNP PADRECC Portland VAMC, October 24, 2014 Sponsored by the NW PADRECC - Parkinson's Disease Research, Education & Clinical Center Portland VA Medical Center www.parkinsons.va.gov/Northwest Outline • What is fatigue? • How differs from sleepiness, depression • How do doctors measure it? • Why is fatigue such a problem in PD? • How if fatigue in PD different? • How will exercise and nutrition help? • Will medications work? What is Fatigue? • One of most common symptoms in medicine. • Fatigue is the desire to rest. No energy. • Chronic fatigue: “overwhelming and sustained exhaustion and decreased capacity to physical or mental work, not relieved by rest • Acute (days) or chronic (months, years) • May be incapacitating • Cannot be checked with doctor’s exam – Not like tremor, stiffness 1 Fatigue: What Is It? • Not sleepiness (cannot stay awake) • Not depression (blue, hopeless, cranky) • Rather is sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest – Get up tired after a night's sleep, always tired. • Also, a subjective lack of physical and/or mental energy that interferes with usual and desired activities Fatigue: A Big Problem • 10 million physician office visits/year in USA. • Usual cause for this fatigue in general doctor’s office = depression. • Different in Parkinson’s disease, various other medical illnesses. 2 Many Illnesses and Drugs Cause Fatigue • Medical diseases – Diabetes – Thyroid disease (too low or too high) – Emphysema, heart failure – Rheumatologic diseases – Cancer or radiation therapy – Anemia • Drugs – Beta blockers, antihistamines, pain killers, alcohol • Other neurological diseases – Strokes – Post polio syndrome – Narcolepsy, obstructive sleep apnea – Old closed head injuries – Multiple sclerosis 5 Dimensions of Fatigue • General fatigue • Physical fatigue • Mental fatigue • Reduced motivation • Reduced activity Depression correlates with all 5 dimensions.
    [Show full text]
  • Brain Imaging Reveals Clues About Chronic Fatigue Syndrome 23 May 2014
    Brain imaging reveals clues about chronic fatigue syndrome 23 May 2014 The results are scheduled for publication in the journal PLOS One. "We chose the basal ganglia because they are primary targets of inflammation in the brain," says lead author Andrew Miller, MD. "Results from a number of previous studies suggest that increased inflammation may be a contributing factor to fatigue in CFS patients, and may even be the cause in some patients." Miller is William P. Timmie professor of psychiatry and behavioral sciences at Emory University School of Medicine. The study was a collaboration among researchers at Emory University School of Medicine, the CDC's Chronic Viral Diseases Branch, and the University of Modena and Reggio Credit: Vera Kratochvil/public domain Emilia in Italy. The study was funded by the CDC. The basal ganglia are structures deep within the brain, thought to be responsible for control of A brain imaging study shows that patients with movements and responses to rewards as well as chronic fatigue syndrome may have reduced cognitive functions. Several neurological disorders responses, compared with healthy controls, in a involve dysfunction of the basal ganglia, including region of the brain connected with fatigue. The Parkinson's disease and Huntington's disease, for findings suggest that chronic fatigue syndrome is example. associated with changes in the brain involving brain circuits that regulate motor activity and In previous published studies by Emory motivation. researchers, people taking interferon alpha as a treatment for hepatitis C, which can induce severe Compared with healthy controls, patients with fatigue, also show reduced activity in the basal chronic fatigue syndrome had less activation of the ganglia.
    [Show full text]
  • Meaning of Tenderness in Medical Term
    Meaning Of Tenderness In Medical Term Floccose Flipper tissued initially. Ci-devant Tiebout debilitated moveably or fifing noumenally when Sayer is intermittent. Atrial and unspirited Tre lapidify: which Sky is analectic enough? Only includes the room care of the wound, including arranging financial support the tenderness of medical term Do you know how delicate it is to detention a little sunshine? Pain MedlinePlus. Put ice or more cold towel on my sore one for 10 to 20 minutes at a render to stop swelling Put of thin cloth. Glossary of Research Medical Terms McLaren Health Care. Fever aches from Pfizer Moderna jabs aren't dangerous but. If anywhere have a release arm fatigue or even a fever among your COVID-19. The tenderness in a time for correcting very important. Medical Terminology Enhanced Edition. At other times it could need investigations and a referral for you visit see a specialist to spawn the diagnosis. Pain Taber's Medical Dictionary Taber's Online. Sore dry tender axillarycervical lymph nodes and sensitivity to external. Sore Eyes Symptoms Causes Treatments Healthgrades. Service to always been amazing. Understanding of breach terms seasonal avian and pandemic. An intraocular tumor is. The medical term for painful intercourse is dyspareunia dis-puh-ROO-nee-uh defined as persistent or recurrent genital pain that occurs just. Essential English words for medical professionals nurses doctors paramedics in an English-speaking context Each spouse has meaning and if sentence. Please update your pain may help reduce swelling, and meaning of tenderness medical term for dme may have a premium in the process that your first aid concepts and require intact facet joints.
    [Show full text]
  • Fatigue After Stroke
    SPECIAL REPORT Fatigue after stroke PJ Tyrrell Fatigue is a common symptom after stroke. It is not invariably related to stroke severity & DG Smithard† and can occur in the absence of depression. It is one of the most troublesome symptoms for †Author for correspondence many patients and yet nothing is known of its causation. There are no specific treatments. William Harvey Hospital, Richard Steven’s Ward, This article assesses the available literature in the context of what is known about fatigue Ashford, Kent, in other disorders. Post-stroke fatigue may be a manifestation of sickness behavior, TN24 0LZ, UK mediated through the central effects of the cytokine interleukin-1, perhaps via effects on Tel.: +44 123 361 6214 Fax: +44 123 361 6662 glutamate neurotransmission. Possible therapeutic strategies are discussed which might be [email protected] a logical basis from which to plan randomized control trials. Following stroke, approximately a third of common and disabling symptom of Parkinson’s patients die, a third recover and a third remain disease [7,8] and of systemic lupus [9]. More than significantly disabled. Even those who recover 90% of patients with poliomyelitis develop a physically may be left with significant emotional delayed syndrome of post-myelitis fatigue [10]. and psychologic dysfunction – including anxi- Fatigue is the most prevalent symptom of ety, readjustment reactions and depression. One patients with cancer who receive radiation, cyto- common but often overlooked symptom is toxic or other therapies [11], and it may persist fatigue. This may occur soon or late after stroke, for years after the cessation of treatment [12].
    [Show full text]
  • Review of Systems – Return Visit Have You Had Any Problems Related to the Following Symptoms in the Past Month? Circle Yes Or No
    REVIEW OF SYSTEMS – RETURN VISIT HAVE YOU HAD ANY PROBLEMS RELATED TO THE FOLLOWING SYMPTOMS IN THE PAST MONTH? CIRCLE YES OR NO Today’s Date: ______________ Name: _______________________________ Date of Birth: __________________ GENERAL GENITOURINARY Fatigue Y N Blood in Urine Y N Fever / Chills Y N Menstrual Irregularity Y N Night Sweats Y N Painful Menstrual Cycle Y N Weight Gain Y N Vaginal Discharge Y N Weight Loss Y N Vaginal Dryness Y N EYES Vaginal Itching Y N Vision Changes Y N Painful Sex Y N EAR, NOSE, & THROAT SKIN Hearing Loss Y N Hair Loss Y N Runny Nose Y N New Skin Lesions Y N Ringing in Ears Y N Rash Y N Sinus Problem Y N Pigmentation Change Y N Sore Throat Y N NEUROLOGIC BREAST Headache Y N Breast Lump Y N Muscular Weakness Y N Tenderness Y N Tingling or Numbness Y N Nipple Discharge Y N Memory Difficulties Y N CARDIOVASCULAR MUSCULOSKELETAL Chest Pain Y N Back Pain Y N Swelling in Legs Y N Limitation of Motion Y N Palpitations Y N Joint Pain Y N Fainting Y N Muscle Pain Y N Irregular Heart Beat Y N ENDOCRINE RESPIRATORY Cold Intolerance Y N Cough Y N Heat Intolerance Y N Shortness of Breath Y N Excessive Thirst Y N Post Nasal Drip Y N Excessive Amount of Urine Y N Wheezing Y N PSYCHOLOGY GASTROINTESTINAL Difficulty Sleeping Y N Abdominal Pain Y N Depression Y N Constipation Y N Anxiety Y N Diarrhea Y N Suicidal Thoughts Y N Hemorrhoids Y N HEMATOLOGIC / LYMPHATIC Nausea Y N Easy Bruising Y N Vomiting Y N Easy Bleeding Y N GENITOURINARY Swollen Lymph Glands Y N Burning with Urination Y N ALLERGY / IMMUNOLOGY Urinary
    [Show full text]
  • Tension-Type Headache CQ III-1
    III Tension-type headache CQ III-1 How is tension-type headache classified? Recommendation Since 1962, various classifications for tension-type headache have been proposed. Currently, classification according to the International Classification of Headache Disorders 3rd Edition (beta version) (ICHD-3beta) published in 2013 is recommended. Grade A Background and Objective Diagnostic classification that forms the basis of guidelines is certainly important for formulating clinical care and treatment policies. The ICHD-3beta is not simply a document based on classification, it also addresses diagnosis and treatment scientifically and practically from all aspects. Comments and Evidence The classification of tension-type headache (TTH) is provided by the International Classification of Headache Disorders 3rd edition beta version (ICHD-3beta).1)2) The division of tension-type headache into episodic and chronic types adopted by the first edition of the International Classification of Headache Disorders (1988)3) is extremely useful. The International Classification of Headache Disorders 2nd edition (ICHD-II) further subdivides the episodic type according to frequency, and states that this is based on the difference in pathophysiology. The former episodic tension-type headache (ETTH) is further classified into 2.1 infrequent episodic tension-type headache (IETTH) with headache episodes less than once per month (<12 days/year), and 2.2 frequent episodic tension-type headache (FETTH) with higher frequency and longer duration (<15 days/month). The infrequent subtype has little impact on the individual, and to a certain extent, is understood to be within the range of physiological response to stress in daily life. However, frequent episodes may cause disability that sometimes requires expensive drugs and prophylactic medication.
    [Show full text]
  • ME/CFS) Key Facts
    KEY FACTS FEBRUARY 2015 For more information visit www.iom.edu/MECFS Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Key Facts What is the prevalence of ME/CFS? • ME/CFS affects 836,000 to 2.5 million Americans. • An estimated 84 to 91 percent of people with ME/CFS have not yet been diagnosed, meaning the true prevalence of ME/CFS is unknown. • ME/CFS affects women more often than men. Most patients currently diagnosed with ME/CFS are Caucasian, but some studies suggest that ME/CFS is more common in minority groups. • The average age of onset is 33, although ME/CFS has been reported in patients younger than age 10 and older than age 70. What are the symptoms and other effects of ME/CFS? • There are five main symptoms of ME/CFS: 1. Reduction or impairment in ability to carry out normal daily activities, accompanied by pro- found fatigue; 2. Post-exertional malaise (worsening of symptoms after physical, cognitive, or emotional effort); 3. Unrefreshing sleep; 4. Cognitive impairment; and 5. Orthostatic intolerance (symptoms that worsen when a person stands upright and improve when the person lies back down). • Other common manifestations of ME/CFS include pain, failure to recover from a prior infection, and abnormal immune function. • At least one-quarter of ME/CFS patients are bed- or house-bound at some point in their illness. • Symptoms can persist for years, and most patients never regain their pre-disease level of health or functioning. • ME/CFS patients experience loss of productivity and high medical costs that contribute to a total economic burden of $17 to $24 billion annually.
    [Show full text]
  • Cluster Headacheheadache
    ClusterCluster HeadacheHeadache 1 OBJECTIVESOBJECTIVES Describe the clinical features and diagnosis of cluster headache Discuss the pathogenesis of cluster pain and autonomic features Review acute and preventive therapy Overview of new treatment horizons for refractory chronic cluster 2 IHSIHS CLASSIFICATIONCLASSIFICATION Cluster headache n Episodic type (80%) n Chronic type (20%) (Cluster period lasts for more than one year without remission or remission lasts less than 14 days) Episodic Chronic IHS Headache Classification Committee. Cephalalgia. 2004. Although the unique clinical features of cluster headache (CH) have been recognized since the 17th century, the striking periodicity was not articulated until the 1940s. The term “cluster headache” was coined in the 1950s, and since then the International Headache Society (IHS) has identified and classified two major temporal patterns of CH (1). The episodic type (ECH), by far the most common (90%), is characterized by discrete attack and remission phases. The chronic type (CCH) is defined by attacks that occur daily for more than one year without remission or with remission periods lasting less than 14 days. Cluster headache is rare (about 0.4% of the general population), and it predominates in males, although recent studies indicate that the rate in females is rising (2). Onset can occur at any age but usually begins between 30 and 50 years of age (3). In contrast to migraine headache, genetics in cluster headache is not thought to be important, although recent studies have shown a positive family history in about 7% of patients with cluster headache. When compared with prevalence of CH in the general population, first-degree relatives have about a 14-fold increased risk of developing CH.
    [Show full text]
  • HEADACHES and ME/CFS INTRODUCTION Headaches Are Often Reported by People with ME/CFS
    MANAGEMENT FILE the ME association by DR CHARLES SHEPHERD, our medical adviser This leaflet is based on an article which first appeared in the ME Association’s quarterly ME Essential magazine. MEA membership costs £18 a year for people living in the UK/BFPO. For contact details, see foot of this page. February 2020 HEADACHES AND ME/CFS INTRODUCTION Headaches are often reported by people with ME/CFS. They also form part of the symptom list for most diagnostic criteria for ME/CFS. But headaches can obviously have other causes – physical and psychological – as well. WHAT CAUSES HEADACHES? Doctors classify headaches as being sides of the head – as if a rubber band arteries in the head and neck. primary where there is no obvious link has been stretched around it. Common Temporal arteritis is a medical to an underlying medical problem, or causes include stress, depression, lack emergency that requires urgent treat- secondary where there is a clear link. of proper sleep, skipping meals, not ment with high-dose steroids. drinking enough fluid and alcohol. Primary headaches include: Headaches in women can be caused Secondary headaches are caused by Cluster headaches by hormonal problems – including an existing medical problem. Some of An excruciatingly painful headache taking the contraceptive pill, going these are serious, which is why you must that causes intense pain around one through the menopause, pregnancy, see your doctor if you have severe or eye. Cluster headaches are fairly rare and as part of period pain. persistent headaches. and tend to occur in clusters for a It’s also worth noting that a headache month or two, sometimes around the Common causes, which are normally is the most common symptom of same time each year.
    [Show full text]
  • Adverse Events Following Immunization Associated With
    J Korean Med Sci. 2021 May 3;36(17):e114 https://doi.org/10.3346/jkms.2021.36.e114 eISSN 1598-6357·pISSN 1011-8934 Original Article Adverse Events Following Preventive & Social Medicine Immunization Associated with Coronavirus Disease 2019 Vaccination Reported in the Mobile Vaccine Adverse Events Reporting System Minji Jeon ,1* Jehun Kim ,2* Chi Eun Oh ,3 and Jin-Young Lee 1 1Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea 2Division of Pulmonary and Critical Care Medicine, Kosin University Gospel Hospital, Kosin University Received: Mar 30, 2021 College of Medicine, Busan, Korea Accepted: Apr 9, 2021 3Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea Address for Correspondence: Jin-Young Lee, MD Division of Infectious Diseases, Department of Medicine, Kosin University Gospel Hospital, ABSTRACT Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic Background: Vaccination against coronavirus disease 2019 (COVID-19) is underway globally of Korea. E-mail: [email protected] to prevent the infection caused by the severe acute respiratory syndrome coronavirus 2. We aimed to investigate the adverse events following immunization (AEFIs) for COVID-19 among *Minji Jeon and Jehun Kim contributed equally healthcare workers (HCWs). to this work. Methods: This was a retrospective study of the AEFIs associated with the first dose of the © 2021 The Korean Academy of Medical ChAdOx1 nCoV-19 vaccine at the Kosin University Gospel Hospital from March 3 to March 22, Sciences. 2021. We investigated the systemic and local adverse events during the 7 days following the This is an Open Access article distributed vaccination using the Mobile Vaccine Adverse Events Reporting System (MVAERS) developed under the terms of the Creative Commons by our hospital.
    [Show full text]