Researchers have long known that sex hormones such as estrogen play a role in migraine. But there’s been little research on how that works.
Do women with migraine have higher estrogen levels in general?
Higher levels at the peak of the monthly cycle?
Research published in the June 1, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology, shows that, for women with a history of migraine, estrogen levels may drop more rapidly in the days just before menstruation than they do for women who do not have migraine history. For other hormone patterns, there were no differences between women with migraine and women who did not have migraine.
The study also showed that the women with a migraine history had a faster rate of estrogen decline regardless of whether they had a migraine during that cycle.
“These results suggest that a ‘two-hit’ process may link estrogen withdrawal to menstrual migraine. More rapid estrogen decline may make women vulnerable to common triggers for migraine attacks such as stress, lack of sleep, foods and wine,” said study author Jelena Pavlovic, MD, PhD, of Albert Einstein College of Medicine/Montefiore Medical Center in Bronx, NY, and a member of the American Academy of Neurology.
For the study, researchers reviewed migraine history, daily headache diaries and hormone data for 114 women with a history of migraine and 223 women without a history of migraine. The women were an average 47 years old. The investigators measured hormone levels from daily urine samples for one monthly cycle; the participants’ peak hormone levels, average daily levels and day-to-day rates of decline were calculated over the five days following each hormone peak in their cycles.
In the two days after the peak estrogen level in the luteal phase of the cycle, which is the time after ovulation and before menstruation, the estrogen levels in the women with migraine dropped by 40 percent compared to 30 percent for women without migraine. The rate dropped 34 picrograms per milligram of creatinine (pg/mgCr) in women with migraine, compared to 23 pg/mgCr in women without migraine.
“Future studies should focus on the relationship between headaches and daily hormone changes and explore the possible underpinnings of these results,” said Pavlovi?.
While the study’s size and amount of hormone data are strengths, limitations include proportionately more Chinese and Japanese women in the group of women without migraine and more white and black women in the migraine group. The level of sex hormones may differ according to racial and ethnic differences.
Do you often wonder what the person next to you is thinking?
You might be high in mind-reading motivation (MRM), a newly coined term for the practice of observing and interpreting bits of social information, like whether the person next to you is rhythmically drumming his fingers because he’s anxious or if someone is preoccupied because she’s gazing off into the distance.
MRM is the tendency to engage with the mental states and perspectives of others. But it’s much more than just a means of passing idle time. Being high in MRM leads to many social benefits, including better teamwork, according to Melanie Green, an associate professor in the University at Buffalo Department of Communication and corresponding author of the groundbreaking new study published in the journalMotivation and Emotion.
“We’re not talking about the psychic phenomenon or anything like that, but simply using cues from other people’s behavior, their non-verbal signals, to try to figure out what they’re thinking,” says Green.
MRM is an entirely new construct – developed by Green and her coauthors Jordan M. Carpenter at the University of Pennsylvania and Tanya Vacharkulksemsuk at Haas School of Business, University of California, Berkeley – which also has implications for advertising and relationships.
Individuals high in MRM enjoy speculating on others’ thoughts based on the potentially hundreds of social cues they might receive. Those low in MRM dislike or have no interest in doing so. MRM is about the motivation to engage with other minds, and is distinct from the ability to accurately interpret others’ cues.
“We didn’t measure ability directly in our study of teamwork, but the research suggests that just the motivation to understand others, and presumably the behaviors that go along with that motivation, appear to lead to benefits,” says Green.
In addition to facilitating cooperation and better teamwork, people high in MRM also consider people in great detail and have a nuanced understanding of those around them.
“Those high in MRM seem to develop richer psychological portraits of those around them,” says Green. “It’s the difference between saying ‘this person strives for success, but is afraid of achieving it’ as opposed to ‘this person is a great cook.'”
The relevance of those portraits also appears to have implications for advertising and the salience of certain messages.
“High MRM people are more drawn to and pay more attention to messages with an identifiable source – a spokesperson or an ad focusing on company values – that is, someone whose perspective they can try to understand.” says Green. “On the other hand, low MRM people seem to pay more attention to ads that are more impersonal, like those that just discuss the product – a message that does not appear to come from a particular person or group.”
Although there is no previous research in MRM, there is a long history of studies on perspective taking. But much of that research has focused on situations where perspective taking, in a sense, is required.
“Think about seeing some kind of trouble and trying to figure out what’s wrong,” she says. “Or noticing your partner is upset and you try to figure out what they’re thinking.”
Green and her colleagues thought there might be a difference in how much people enjoy or were motivated to speculate on people’s thoughts in situations where there was no situational need or institutional pressure. It could be as simple as a bus passenger considering the thoughts of those across the aisle.
“This hadn’t been previously considered from the standpoint of individual differences,” says Green.
If you or someone you care about experience an emotional problem it won’t be long before you hear that cognitive behaviour therapy, or CBT, is probably the treatment of choice.
Research over the last 40 years or so has found CBT to be helpful for all manner of problems, including anxiety, depression, insomnia, pain, anger, sexual problems, and the list goes on. But what exactly is it?
CBT is probably best understood by what it is trying to achieve. The main premise of CBT is that problems develop as a consequence of learnt ways of thinking (cognition) and behaving, and that learning new ways of thinking and behaving will have more helpful impacts on emotions and well-being.
Cognition: the C in CBT
The cognitive element of CBT refers to our thoughts, mental images, self-talk and core beliefs about ourselves (I’m ok, or I’m not), other people (they are generally friendly or they’re not) and the world around us (the future is bright or it’s not).
The more threatening our thoughts (I’m going to be criticised), the more anxious we will feel. The more hopeless we believe the future is (there’s no point), the more depressed we will feel. The more strongly we believe things should be different (the world must not be this way!), the more frustrated and angry we will feel.
The way we think is guided by what we pay attention to (a tendency to focus on negative things?), the way we interpret what is happening around us (seeing the glass half-full?) and the experiences we are most likely to remember (such as the times things went bad rather than the times things went well).
We all use particular styles of thinking from time to time that can get us into trouble. We are “catastrophising” when we blow things way out of proportion (things are rarely that bad). Using words like “never” and “always” is a good sign we’re thinking in an overgeneralised way (most bad things happen somewhere between never and always).
It’s important to remember that thoughts are, well, just thoughts. They are not immutable facts.
Most of the thoughts we have throughout the day are random streams of consciousness that are simply the output of creative minds. And many people can interpret exactly the same situation in many different ways.
Behaviour: the B in CBT
The behavioural aspect of CBT is based on learning theory. If you’ve heard of Pavlov’s dogs then you know about classical conditioning. Pavlov rang a bell just before he gave his dogs some food. Eventually the dogs started to salivate when they heard a bell ring (even if no food was given). They learnt that the bell signalled food. (Voila! Classical conditioning.)
Emotional responses can be classically conditioned in a similar way. As a simple example, someone with a dog phobia might recall being bitten as a child (perhaps by one of Pavlov’s dogs?). A cognitive behaviour therapist might speculate that the child developed a classically conditioned fear response to the dog.
Just like the bell triggered Pavlov’s dogs to salivate, an image or thought of a dog can trigger fear (even if the dog has no intention of biting).
Pavlov found that if he repeatedly rang the bell without providing food eventually the dogs stopped salivating when they heard the bell. They learnt that the bell no longer signalled food.
Similarly, if we repeatedly expose someone with a dog phobia to dogs without them being bitten, then they will learn that dogs are not dangerous and the fear response will stop being triggered. It turns out that repeated exposure to any feared object or situation (in the absence of the fear coming true) can effectively diminish the fear response.
A cognitive behaviour therapist is interested in all the things we do (or avoid doing) to manage the difficulties life throws our way. This might include unhelpful behaviours such as always avoiding the things we fear, excessively using drugs or alcohol, being controlling or violent towards others, and the list goes on.
Avoidance denies us any chance to challenge our fears and build confidence that we can cope. Alcohol and drugs might feel good and distract us in the short term, but ultimately our problems still exist and might be even worse in the longer term.
Being controlling towards others might help us feel powerful and in control in the short term, but this can conceal an underlying core belief of vulnerability (if I don’t control my environment, then perhaps it will control me).
These problems are only likely to be resolved when the fears driving these unhelpful behaviours are directly challenged and modified.
Therapy: the T in CBT
Cognitive behaviour therapists help clients better understand why they might have developed particular problems and, more importantly, what vicious cycles are maintaining them.
The most important questions for treatment are:
How do our thoughts, behaviours, physiology, interpersonal relationships and emotions interact to maintain problems in our lives?
How can we break these cycles?
Here are some things you can expect from a competent cognitive behaviour therapist.
A strong therapeutic relationship: Cognitive behavioural therapists appreciate that therapy can be emotional and difficult. They know their client needs to trust them before they will be able to work effectively together. Empathy, genuineness, unconditional positive regard and warmth need to be there in spades.
Collaboration: CBT involves a close working relationship between the client and therapist. The client is seen as an expert in their lives and the therapist is seen as an expert in evidence-supported treatments. Both forms of expertise are equally important to achieve a good outcome.
Goal-setting: CBT aims to be an efficient and time-limited form of therapy. A cognitive behavioural therapist will be very interested in what you would like to achieve from therapy. Together you will plan how to get there and how long it should take.
There is some flexibility if progress is slower than expected, but for most problems the therapist thinks in weeks or months rather than years.
Monitoring and evaluation: Cognitive behavioural therapists don’t rely on their own judgement about when clients' problems have resolved; the therapist might be wrong. Rather, they measure change from the client’s perspective.
The therapist might ask the client to complete some monitoring or questionnaires during therapy so that progress can be tracked.
Cognitive behavioural therapists don’t blame the client if the problem isn’t improving. The therapist takes responsibility for changing what is done in therapy to ensure things get back on track.
Practical skills: CBT aims to teach clients to relate differently to their thoughts, physical sensations, emotions and behaviours so that they don’t get caught up in them in problematic ways.
One technique might involve identifying negative thoughts and challenging them by recognising when they are overly catastrophic and generating more realistic and helpful alternatives.
The techniques covered in CBT will depend on the nature of the problem, but you can expect to leave therapy with a toolkit full of helpful skills.
Between-session tasks: Clients never come to therapy just to feel good for the hour they are in the therapists’ office. They come to improve their lives out in the real world. For this reason, cognitive behaviour therapists encourage clients to apply their new skills between sessions and report back on how it went. This is where much of the hard work, learning and changes occur in CBT.
Here and how focus: CBT acknowledges the role that past experiences play in shaping who we are, but at the same time recognises that little can be done to change what has already occurred.
Instead, CBT focuses on identifying what is left behind from these experiences in the form of core beliefs about ourselves, others, and the world, and how these beliefs impact on present-day experiences.
Modifying these core beliefs can change our emotional responses to memories of earlier negative experiences, and can change the way we respond to challenges in our lives now and into the future.
The process of therapy is challenging and takes courage. A cognitive behavioural therapist’s role is to guide, support and cheer-lead when required. CBT’s overarching aim is to increase clients’ coping self-efficacy – their confidence in their own ability to manage their problems on their own.
If a cognitive behavioural therapist has done a good job, the client should leave therapy knowing that they are responsible for the benefits they have achieved from therapy and that they can continue to build on these gains well into the future.
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
Cyclothymic Disorder (also called cyclothymia)— defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
Other Specified and Unspecified Bipolar and Related Disorders— defined by bipolar disorder symptoms that do not match the three categories listed above.
Signs and Symptoms
People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.
People having a manic episode may:
People having a depressive episode may:
Feel very “up,” “high,” or elated
Have a lot of energy
Have increased activity levels
Feel “jumpy” or “wired”
Have trouble sleeping
Become more active than usual
Talk really fast about a lot of different things
Be agitated, irritable, or “touchy”
Feel like their thoughts are going very fast
Think they can do a lot of things at once
Do risky things, like spend a lot of money or have reckless sex
Feel very sad, down, empty, or hopeless
Have very little energy
Have decreased activity levels
Have trouble sleeping, they may sleep too little or too much
Feel like they can’t enjoy anything
Feel worried and empty
Have trouble concentrating
Forget things a lot
Eat too much or too little
Feel tired or “slowed down”
Think about death or suicide
Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.
Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.
Proper diagnosis and treatment help people with bipolar disorder lead healthy and productive lives. Talking with a doctor or other licensed mental health professional is the first step for anyone who thinks he or she may have bipolar disorder. The doctor can complete a physical exam to rule out other conditions. If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation or provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.
Note for Health Care Providers: People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to ensure that bipolar disorder is not mistakenly diagnosed as major depression. Unlike people with bipolar disorder, people who have depression only (also called unipolar depression) do not experience mania. They may, however, experience some manic symptoms at the same time, which is also known as major depressive disorder with mixed features.
Bipolar Disorder and Other Illnesses
Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. In addition, many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.
Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:
Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special powers.
Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has committed a crime.
As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.
Anxiety and ADHD: Anxiety disorders and attention-deficit hyperactivity disorder (ADHD) are often diagnosed among people with bipolar disorder.
Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.
Scientists are studying the possible causes of bipolar disorder. Most agree that there is no single cause. Instead, it is likely that many factors contribute to the illness or increase risk.
Brain Structure and Functioning: Some studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. Learning more about these differences, along with new information from genetic studies, helps scientists better understand bipolar disorder and predict which types of treatment will work most effectively.
Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, despite the fact that identical twins share all of the same genes.
Family History: Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of the disorder. However, it is important to note that most people with a family history of bipolar disorder will not develop the illness.
Treatments and Therapies
Treatment helps many people—even those with the most severe forms of bipolar disorder—gain better control of their mood swings and other bipolar symptoms. An effective treatment plan usually includes a combination of medication and psychotherapy (also called “talk therapy”). Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment helps to control these symptoms.
Different types of medications can help control symptoms of bipolar disorder. An individual may need to try several different medications before finding ones that work best.
Medications generally used to treat bipolar disorder include:
Anyone taking a medication should:
Talk with a doctor or a pharmacist to understand the risks and benefits of the medication
Report any concerns about side effects to a doctor right away. The doctor may need to change the dose or try a different medication.
Avoid stopping a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch or by phone at 1-800-332-1088. Clients and doctors may send reports.
When done in combination with medication, psychotherapy (also called “talk therapy”) can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:
Electroconvulsive Therapy (ECT): ECT can provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. People with bipolar disorder should discuss possible benefits and risks of ECT with a qualified health professional.
Sleep Medications: People with bipolar disorder who have trouble sleeping usually find that treatment is helpful. However, if sleeplessness does not improve, a doctor may suggest a change in medications. If the problem continues, the doctor may prescribe sedatives or other sleep medications.
Supplements: Not much research has been conducted on herbal or natural supplements and how they may affect bipolar disorder.
It is important for a doctor to know about all prescription drugs, over-the-counter medications, and supplements a client is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.
Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a client and doctor work closely together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help clients and doctors track and treat bipolar disorder most effectively.
A family doctor is a good resource and can be the first stop in searching for help.
For general information on mental health and to find local treatment services, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).
If You Are in Crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.
If you are thinking about harming yourself or thinking about suicide:
Tell someone who can help right away
Call your licensed mental health professional if you are already working with one
Call your doctor
Go to the nearest hospital emergency department
If a loved one is considering suicide:
Do not leave him or her alone
Try to get your loved one to seek immediate help from a doctor or the nearest hospital emergency room, or call 911
Remove access to firearms or other potential tools for suicide, including medications
Acombination of text messages and individual counselling sessions to motivate patients with rheumatoid arthritis may lead to improved patient outcomes, scientists have found for the first time.
This type of behavioural intervention was effective at reducing daily sitting time by an average of more than two hours in rheumatoid arthritis (RA) patients, and also reduced their cholesterol levels.
Due to their disease, patients with RA tend to be more sedentary than the general population, which can have serious health consequences, including an increased risk of cardiovascular disease and premature death.
Patients with RA already have an increased risk of cardiovascular disease and premature death, partly caused by the chronic inflammatory rheumatic disease itself, and partly by traditional risk factors, such as hyperlipidaemia.
lthough exercise is known to have a positive effect on pain and physical functioning in patients with RA, pain often acts as a barrier against maintenance of a physically active lifestyle.
more feasible approach for improving health and well-being in RA patients would therefore be to focus on reducing sedentary behaviour and increasing light intensity activity, rather than solely concentrating on increasing moderate and vigorous physical activity.
"We know that behavioural approaches are effective in reducing sedentary behaviour in healthy populations," said Tanja Thomsen of the Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases in Denmark.
"Our findings support the introduction of behavioural approaches as an effective way to improve the health of rheumatoid arthritis patients, which may also be applicable in other populations with chronic disease and limited mobility," Thomsen added.
As many as 75 adult RA patients with a self-reported daily sitting time greater than five hours and Health Assessment Questionnaire score less than 2.5 underwent a 16-week individually tailored, behavioural intervention that included three individual motivational counselling sessions with a health professional and regular text messages aimed at improving motivation to reduce daily sitting time and replacing it with light intensity physical activity.