Gustatory Rhinitis: Causes, Symptoms, Treatment
Asthma News
Apr. 30, 2024 — A research team embarked on a quest to understand the diversity and cellular mechanisms of human Th2 cells. By conducting gene expression analyses of inflamed tissues, they pinpointed a subset of Th2 ...
Apr. 26, 2024 — In unincorporated communities in the United States-Mexico borderlands, historically and socially marginalized populations become invisible to the healthcare system, showing that geography acts as a ...
Apr. 25, 2024 — A new tool to identify infants most at risk for severe respiratory syncytial virus (RSV) illness could aid pediatricians in prioritizing children under 1 to receive a preventive medication before RSV ...
Apr. 18, 2024 — A new study shows that immunity after a COVID-19 booster lasts much longer than the primary series alone. These findings are among other, sometimes 'unintuitive,' revelations of how factors ...
Apr. 18, 2024 — The first health impact study of coal train pollution centers on the San Francisco Bay Area, with scientists finding communities near passing coal trains suffer worse health ...
Apr. 10, 2024 — One of the molecules responsible for triggering the inflammation that causes allergic respiratory diseases, such as asthma and allergic rhinitis, has just been discovered. This molecule, from the ...
Apr. 4, 2024 — Scientists have discovered a new cause for asthma that sparks hope for treatment that could prevent the life-threatening ...
Apr. 4, 2024 — Researchers have made a breakthrough into how two chronic respiratory diseases in childhood affect the immune system, paving the way for better ...
Mar. 13, 2024 — Exposure to several combinations of toxic atmospheric pollutants may be triggering asthma symptoms among children, a recent analysis suggests. The study showed that 25 different combinations of air ...
Mar. 13, 2024 — Research finds a nearly 40% decline in the annual average concentration of respirable particulate matter (PM2.5) in Krakow, Poland, between 2010 and 2019 following the implementation of clean air ...
Mar. 12, 2024 — A new study finds that pollution from oil and gas venting and flaring results in $7.4 billion in health damages, more than 700 premature deaths, and 73,000 asthma exacerbations among children ...
Mar. 12, 2024 — A new study finds that policies to reduce carbon dioxide (CO2) emissions from motor vehicles combined with investments in electric vehicles and public transportation would reduce air pollution and ...
Feb. 27, 2024 — Cooking on your gas stove can emit more nano-sized particles into the air than vehicles that run on gas or diesel, possibly increasing your risk of developing asthma or other respiratory illnesses, a ...
Feb. 25, 2024 — A drug that binds to allergy-causing antibodies can protect children from dangerous reactions to accidentally eating allergy-triggering foods, a new study ...
Jan. 30, 2024 — Asthma is more common among high school students who use cannabis, relative to those who do not and the prevalence of asthma increases with the frequency of its use among the students, according to a ...
Jan. 8, 2024 — Measuring airborne grass allergen levels instead of pollen counts will be more beneficial for hay fever sufferers as new research shows grass allergen levels are more consistently associated with hay ...
Dec. 21, 2023 — Researchers have gained a deeper understanding of the nuanced roles of JAK inhibitors, or modulators, in inflammation across various cell types and ...
Dec. 8, 2023 — A landmark study has shown that severe asthma can be controlled using biologic therapies, without the addition of regular high-dose inhaled steroids which can have significant side ...
Dec. 6, 2023 — Researchers have identified an allergy pathway that, when blocked, unleashes antitumor immunity in mouse models of non-small cell lung cancer (NSCLC). And in an early parallel study in humans, ...
Nov. 9, 2023 — A review of 15 years' worth of data found that vitamin D supplementation during pregnancy was linked to reduced rates of asthma and wheezing in children compared to standard prenatal ...
Headaches After Exercise
Exercise-related headaches typically cause throbbing pain on both sides of your head. Exercise headaches can develop either after you finish a tough workout or while you're exercising. Both aerobic exercises (such as running and biking) and weightlifting can trigger them. They also can occur at other times, like when you:
There are two types of exercise headaches:
Primary exercise headache
Usually harmless, primary exercise headaches aren't a sign that there's anything wrong with your health. Experts don't know why they happen, but it may be due to the widening of the blood vessels in your brain when you exercise. They can last as little as 5 minutes or as long as 2 days.
Secondary exercise headache
These exercise headaches signal that something's wrong, often something serious. The headache itself feels similar to a primary exercise headache — throbbing pain on both sides of your head — but other symptoms also may occur, including:
These headaches, which usually last at least a day and can continue for several days, may be caused by:
What is an exertion headache?
Exertion headache is another name for an exercise headache. Primary exercise headaches used to be called primary exertional headaches or benign exertional headaches.
Exercise-related headaches typically cause throbbing pain on both sides of your head. Exercise headaches can develop either after you finish a tough workout or while you're exercising. Both aerobic exercises (such as running and biking) and weightlifting can trigger them. (Photo Credit: E+/Getty Images)
Though the reasons for your post-workout headache might not always be clear, there are several possibilities.
Exertion headache
Another name for exercise headache, these may be triggered by temporary changes to the blood vessels in your brain during exercise. When you work out, your body, including your brain, has higher demands for oxygen-rich blood. Your blood vessels widen to allow more blood to flow through them. It's possible that when the blood vessels in your brain widen, they create pressure in your skull, leading to a headache.
Headaches and dehydration
You become dehydrated when your body loses more water than it takes in. That can happen during exercise or other physical activity if you sweat heavily and drink too little fluid to make up for what you've lost. Dehydration causes your brain to shrink and pull away from your skull. That puts painful pressure on your nerves, triggering a headache after exercise. You can ease the pain by drinking water or other fluids.
Electrolyte imbalance
Electrolytes are minerals, such as potassium, calcium, and sodium, that play important roles in your health. You get most of them from your diet. They balance the fluids in your body, keep your heart beating normally, and help your nerves and muscles function properly. Your electrolytes can become unbalanced by exercise because they leave your body when you sweat. An exercise headache is just one symptom of an electrolyte imbalance. Other symptoms include:
Low blood sugar
Glucose, or blood sugar, provides most of the energy needed to power your body, including your brain. You can burn through it during your workout. When you have low blood sugar, a condition called hypoglycemia, you may develop a headache. Hypoglycemia is much more common in people who have diabetes. Juice, regular (not diet) soda, and other sugary drinks or foods can quickly restore your blood sugar. If your workout is super intense, though, the opposite can happen — activities such as heavy weightlifting, sprinting, and competitive sports raise your adrenaline, which in turn causes a spike in your blood sugar, which is called hyperglycemia. This, too, can cause an exercise headache.
Headache from overexertion
You can exert yourself physically in ways other than exercise and end up with a headache. These headaches typically develop when you engage your abdominal (stomach) muscles or increase pressure in your chest. This can happen in several situations, such as:
These headaches usually don't last more than a few minutes. However, if you keep up the exertion, the headache can get worse and last longer.
Heat exhaustion
Your body has a built-in cooling system that produces sweat when your body temperature rises above normal. This happens during exercise. If your body can't cool itself enough, your increased temperature can trigger heat exhaustion.
One symptom is, you guessed it, a headache. Other symptoms of heat exhaustion include:
You're more likely to experience heat exhaustion if you are dehydrated as well. Other contributing factors include:
Certain medications and health conditions also can make heat exhaustion more likely. Ask your doctor whether your current health and prescriptions could put you at risk.
Environmental factors
Working out in certain conditions can also make an exercise headache more likely. These include:
Fortunately, you can take steps to lessen your chances of a painful exercise headache.
Stay hydrated
Dehydration can trigger exercise headaches, so make sure to drink plenty of fluids before and during your workout. Here are some guidelines:
Consider sports drinks if your exercise will be very intense and longer than an hour. These drinks contain potassium, calories, and nutrients that can support longer workouts.
Keep electrolytes balanced
You can get a headache after exercise if your electrolytes become unbalanced. Electrolytes are minerals, such as potassium, calcium, and sodium, that play important roles in your health, including helping your muscles work correctly. You get most electrolytes from your diet, and they leave your body when you sweat.
Staying hydrated with water can help you maintain a proper electrolyte balance. You likely won't have to worry about losing too many electrolytes during workouts of less than an hour. However, if you plan to exercise longer, stay hydrated with a sports drink that contains electrolytes.
If you sweat out a lot of salt, you should have either a sports drink or water along with a salty snack before a workout. To find out if you sweat out salt while working out, check your skin and clothes for a salty residue while you exercise or after you're done.
You also can maintain an electrolyte balance by eating a diet rich in nutrients, including:
Other steps to prevent an exercise headache
Take note of the exercises you were doing when your headache started. If you get a headache each time you do those exercises, try something different to see whether or not it causes an exercise headache.
A headache after exercise can be a pain, but it rarely means something's wrong with your health. Instead, it may simply mean you need to drink more water, exercise in cooler conditions, or another factor that can be changed. However, if you have not had an exercise headache or it comes on very suddenly, it's best to call your doctor right away to make sure it's nothing serious.
Is it good to exercise when you have a headache?
If you develop a headache when exercising, it may get worse if you continue to exercise.
When I exercise, will my headache go away?
It's possible. Regular exercise can help relieve tension and prevent headaches.
Which exercise is best for a headache?
Moderate exercise, such as swimming, cycling, and walking, can help with headaches. Aim for 30 minutes a day, 5 days a week.
What pressure points get rid of a headache?
There are a few pressure points that may help ease your headache:
Is it good to rest when you have a headache?
Yes. Resting in a cool, dark room can help ease your headache.
Chronic Exertional Compartment Syndrome
IntroductionThe diagnosis of chronic exertional compartment syndrome (CECS) is commonly delayed due to the poor use of terminology by athletes, and many clinicians, that virtually any pain in the leg is 'shin splints'. We will be able to provide our patients with a better serviceif we can target a more specific diagnosis with earlier and focused treatment. Therefore, when the history and presentation are most consistent with a stress fracture, radiographs and possibly an MRI or a bone scan should be obtained. If the pain is posterior and related to blood flow, venous or arterial Doppler studies or magnetic resonance angiography should be obtained to confirm the diagnosis of a blood clot or popliteal artery syndrome. Finally, when the history includes increasing pain with exertion with associated resolution with rest, the working diagnosis of CECS should be confirmed with intracompartmental pressure testing. Although alternative techniques using infrared sensors have been proposed,1 most experts agree that intracompartmental pressure testing is the gold standard.
Key questions, however, remain regarding the specific protocol a clinician should undergo when performing intracompartmental pressure testing. Should both legs be tested? Should the isolated, most symptomatic compartment or all four compartments be routinely tested? Are resting, immediate postexertion and delayed postexertion tests required for adequate testing?
Historical protocolsClassic use of intracompartmental pressure measurements was established for the diagnosis of acute and not CECSs. In general, the clinical presentation for an acute compartment syndrome is more obvious with exquisite, unrelenting pain associated with a palpably tense compartment. In these cases, it is reasonable to test only the suspicious compartment. Indeed, it is within the standard of care to proceed with a fascial release in the acute setting even without confirming elevated pressures with an intracompartmental pressure measurement. For CECS, the standard of care is to confirm the diagnosis with intracompartmental pressure measurements. A study done in the UK reported that 83% of clinicians use intracompartmental pressure testing to confirm the diagnosis.2
The classic reference for exertional compartment testing can be credited to Pedowitz and colleagues.3 They provided the definitions of a positive test for exertional compartment syndromes, which have been the reference for over two decades: resting pressures >15 mm Hg, postexertion pressures >30 mm Hg and delayed pressure measurements >20 mm Hg (criteria with 95% CI). Most clinicians also base their diagnosis on an increase of >10 mm Hg compared with the resting pressure.
Do we need all three tests in a given compartment (pre, post and delayed)?It is generally accepted that the immediate postexertion intracompartmental pressure measurement is the best measure to confirm the diagnosis of exertional compartment syndrome. The need for pre and delayed measurements has been debated. Gracia-Mata and colleagues4 in their study on adolescents in Spain routinely performed pre, post, 5-min delayed and 15-min delayed testing. In their 2003 review article, Fraipont and Adamson5 discussed the various positive criteria at rest, postexertion and delayed but did not make a definitive recommendation that all or only exertional measurements were necessary.
My routine is to obtain resting pre-exertional measurements and immediate postexertion measurements. I believe that observing an increase from the baseline is important in confirming and witnessing the effect of exertion on the process. On many occasions, I have seen resting pressures of 15–19 mm Hg never changing to become postexertion positive; on rare occasions, I have seen a pre-exertion measure as high as 25–30 mm Hg actually go down with exercises. Each of these would seem to argue against the use of pre-exertional measures; however, I have also seen a number of cases in which the pre-exertion measure was 5–9 mm Hg and the postexertion measure jumped up to 25–29 mm Hg. In these cases, the absolute final pressure would not have qualified for surgical release but the change in pressure (ΔP) clearly indicates an exertional effect of the pressures and 90% of these patients do well with surgical release. Historically, I also calculated delayed measures on all patients, but ultimately found that these measures did not affect my clinical plans. My routine is to get pre- and postexertion measures on all patients.
Why test all four compartments?Exertional compartment syndromes tend to be more subtle with less obvious physical findings than acute compartment syndromes. Indeed, it is often impossible by clinical presentation alone to clarify if a single or adjacent compartment is involved. I have found from having performed hundreds of tests over 17 years of practice that patients with anterolateral leg pain, more commonly than not, will turn out to have elevated pressures in both the anterior and lateral compartments despite their primary symptoms being in only one compartment. Although minimal symptomatic involvement of the deep posterior is less common, missing the diagnosis will lead to a postoperative failure. Isolated release of a single compartment leads to the risk of failure or recurrence in many of these patients as the untreated compartment becomes more symptomatic. The measurement of success should be symptom-free return to sport after surgical fascial release with no need to return for a second surgery. No patient ever wants to have to go back to surgery again due to a missed/delayed diagnosis of a compartment that went untested and later became symptomatic. When I test all four compartments in every patient, the patient is keenly aware that he is accepting an extra needle poke so as to reduce his risk of ever having to come back for a second surgery.
Do we need to test both legs?Clearly, an astute clinician must consider all diagnoses in each leg before instituting treatment. Overlapping pathologies such as stress fractures and medial tibial stress syndrome with CECS are common. Indeed, in many cases, if the associated pathology is treated, symptoms of CECS will defervesce and the surgical release of the pressure positive, exertional compartment syndrome can become unnecessary. Nonetheless, if associated pathologies are not present, it must be acknowledged that CECS may be bilateral in 75–90% of the patients. Therefore, if you do not test both legs, you are missing the diagnosis in at least three quarters of your patients!
It has been argued that if one symptomatic compartment is positive then you can assume the contralateral symptomatic leg is also positive. The question is which compartment? Is it always right anterior–left anterior; right lateral–left lateral? No one knows. Indeed, if we follow this logic and we know that 75–90% are bilateral, it follows directly that we would be doing unnecessary surgery on 10–25% of patients! As for me, I leave nothing to chance or guess work. If I am going to perform a fascial release with its inherent risks of complication, I want to know absolutely that I have the correct diagnosis for each compartment involved.
So what is the danger of intracompartmental pressure testing?It must be admitted that anytime one breaks the skin, infection is a risk. This complication is extraordinarily rare when the skin is prepped for any of a myriad of needle pokes ranging from blood draws, therapeutic injections, joint aspiration and dry needle therapeutic technique. In over 1000 compartments tested in my career, I have never seen an infection or a neurologic injury as a complication of testing. Local bleeding is not uncommon at the time of the study, yet it usually responds to simple pressure and rarely leads to any visible sign of ecchymosis much less haematoma.
If there is a hazard or downside of multiple needle pokes at multiple sites, it is that the patient experiences more pain with the testing. I routinely educate my patients that it is rare to have patients request a repeat of the tests at a later point in time. Patients invariably accept the increased pain of multiple pokes when they understand that it improves the diagnostic accuracy and likely increases their chance of success and reduces the risk of a second surgery. Nobody likes needle pokes but there are some pearls that the clinician can use to make the testing more tolerable to the patient.
Use a local anaesthetic with a small 27-gauge needle to numb up the entry sites for the larger bore needle. The anaesthetic should be capable of penetrating the subcutaneous tissue but not the compartment.
Let the anesthetic take effect for a few minutes before proceeding with the larger bore needle required for testing.
Have the patient try to relax their muscles when testing. It hurts more when they tense up.
I routinely use only one skin puncture to test deep and superficial posterior compartments and another puncture to test the anterior and lateral compartments. I simply re-direct my needle outside the fascia but in the subcutaneous tissue.
I re-use the same skin puncture sites when the patient returns for postexertional measurements.
The goal of a good clinician should be to make an accurate diagnosis that will guide the treatment of patients and optimise their ultimate outcome with the least amount of risk. I am confident that the diagnosis of exertional compartment syndrome is best done by performing pre and postexertional compartment pressure measures on all four compartments of both legs. Save the painful aspect of the testing, the risk related to additional needle pokes is negligible. The ultimate benefit is that on knowing which compartments are actually involved, the effectedcompartment can be released with little worry that the patient will have to return for additional surgery in the future due to an unrecognised, undiagnosed exertional compartment syndrome in an adjacent compartment.
Comments
Post a Comment