Children who regularly consume more calories than they use will gain weight. If this is not reversed, the child will become obese over time. Consumption of just 100 calories (the equivalent of 8 ounces of a soft drink) above daily requirements will typically result in a 10-pound weight gain over one year. Many different factors contribute to this imbalance between calorie intake and consumption.
* Genetic factors
o Obesity tends to run in families.
o A child with an obese parent, brother, or sister is more likely to become obese.
o Genetics alone does not cause obesity. Obesity will occur only when a child eats more calories than he or she uses.
* Dietary habits
o Children's dietary habits have shifted away from healthy foods (such as fruits, vegetables, and whole grains) to a much greater reliance on fast food, processed snack foods, and sugary drinks.
o These foods tend to be high in fat and/or calories and low in many other nutrients.
o Patterns associated with obesity are eating when not hungry and eating while watching TV or doing homework.
* Socioeconomic status
o Low family incomes and having nonworking parents are associated with greater calorie intake for activity level.
* Physical inactivity
o The popularity of television, computers, and video games translates into an increasingly sedentary (inactive) lifestyle for many children in the United States.
o Children in the United States spend an average of over three hours per day watching television. Not only does this use little energy (calories), it also encourages snacking.
o Fewer than half of children in the United States have a parent who engages in regular physical exercise.
o Only one third of children in the United States have daily physical education at school.
o Parents' busy schedules and fears about safety prevent many children from taking part in after-school sports programs.
* Certain medical conditions can cause obesity, but these are very rare. They include hormone or other chemical imbalances and inherited disorders of metabolism.
* Certain medications can cause weight gain by altering how the body processes food or stores fat.
Migraine
More than 29.5 million Americans suffer from migraine, with women being affected three times more often than men. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70% to 80% of sufferers have a family history of migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider. Migraine is often misdiagnosed as sinus headache or tension-type headache.
Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.
Migraine characteristics can include:
The pain of migraine occurs when excited brain cells trigger the trigeminal nerve to release chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem, an area of the brain that processes pain information. The pain of migraine is a referred pain that is typically felt around the eye or temple area. Pain can also occur in the face, sinus, jaw or neck area. Once the attack is full-blown, many people will be sensitive to anything touching their head. Activities such as combing their hair or shaving may be painful or unpleasant.
Diagnosis of migraine headache is made by establishing the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. By definition, the physical examination of a patient with migraine headache in between the attacks of migraine does not reveal any organic causes for the headaches. Tests such as the CT scan and MRI are useful to confirm the lack of organic causes for the headaches.
There is currently no test to confirm the diagnosis of migraine
The Food and Drug Administration (FDA) has approved three over-the-counter products to treat migraine. Excedrin® Migraine (a combination of aspirin, acetaminophen and caffeine) is indicated for migraine and its associated symptoms. Advil® Migraine and Motrin® Migraine Pain, both ibuprofen medications, are approved to treat migraine headache and its pain.
The use of other prescription anti-inflammatory agents may be effective for some migraines. These agents may have gastrointestinal side effects, which limit their use since larger than normal doses may be required to treat the migraine attack.
Migraine-specific therapies are designed specifically to treat migraine attacks. Ergotamine preparations are no longer readily available. Dihydroergotamine (DHE) may be used for self-injection. DHE is also available as the nasal spray Migranal. A combination product containing isometheptene (Midrin®) is not usually effective for migraine. Sumatriptan (Imitrex®), a 5-HT agonist, is available in self-injectable, nasal spray and rapidly-dissolving tablet forms. Other 5-HT agonists are almotriptan (Axert®), naratriptan (Amerge®, rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®) and eletriptan (Relpax®). All are available in tablet form. Both rizatriptan and zolmitriptan are available in an orally disintegrating tablet (Maxalt-MLT and Zomig-ZMT), which can be taken without water. Zomig also comes in a nasal spray.
Abortive medications are most effective when taken early in an attack, while the pain is still mild and before skin sensitivity increases. The goal is complete relief of pain and associated symptoms, allowing the sufferer to quickly return to normal functioning.
Some attacks may not be eliminated by abortive therapy, yet the patient requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic, but if the patient is experiencing frequent migraine attacks habituating analgesics should be avoided. Butorphanol (Stadol®) is available for intranasal administration and is not typically associated with dependency problems, but may result in dependency if used regularly for pain relief. Alternative medical treatments with medications belonging to the group known as the Phenothiazines have proven useful as non-analgesic options for treating severe migraine headaches. Patients with prolonged migraine attacks lasting more than 24 hours are experiencing status migraine and corticosteroids may be used in these cases due to their anti-inflammatory effects.
Many factors can trigger migraine attacks, such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near daily use of medications designed for relieving headache attacks; bright lights, sunlight, fluorescent lights, TV and movie viewing; certain foods; and excessive noise. Stress and/or underlying depression are important trigger factors that can be diagnosed and treated adequately.
Migraine characteristics can include:
- Pain typically on one side of the head
- Pain has a pulsating or throbbing quality
- Moderate to intense pain affecting daily activities
- Nausea or vomiting
- Sensitivity to light or sound
- Attacks last four to 72 hours, sometimes longer
- Visual disturbances or aura
- Exertion such as climbing stairs makes headache worse
The pain of migraine occurs when excited brain cells trigger the trigeminal nerve to release chemicals that irritate and cause swelling of blood vessels on the surface of the brain. These swollen blood vessels send pain signals to the brainstem, an area of the brain that processes pain information. The pain of migraine is a referred pain that is typically felt around the eye or temple area. Pain can also occur in the face, sinus, jaw or neck area. Once the attack is full-blown, many people will be sensitive to anything touching their head. Activities such as combing their hair or shaving may be painful or unpleasant.
Diagnosis of migraine headache is made by establishing the history of the migraine-related symptoms and other headache characteristics as well as a family history of similar headaches. By definition, the physical examination of a patient with migraine headache in between the attacks of migraine does not reveal any organic causes for the headaches. Tests such as the CT scan and MRI are useful to confirm the lack of organic causes for the headaches.
There is currently no test to confirm the diagnosis of migraine
Treatment
Many factors may contribute to the occurrence of migraine attacks. They are known as trigger factors and may include diet, sleep, activity, psychological issues as well as many other factors. The use of a diary to record events that may play a role in causing the headaches can be useful for you and your healthcare provider. Avoidance of identifiable trigger factors reduces the number of headaches a patient may experience. Healthful lifestyles including regular exercise and avoidance of nicotine may also enhance migraine management. Non-pharmacological techniques for control of migraine are helpful to some patients. These include biofeedback, physical medicine, and counseling. These, as with most elements of migraine, need to be individualized to the patient. AcuteThe Food and Drug Administration (FDA) has approved three over-the-counter products to treat migraine. Excedrin® Migraine (a combination of aspirin, acetaminophen and caffeine) is indicated for migraine and its associated symptoms. Advil® Migraine and Motrin® Migraine Pain, both ibuprofen medications, are approved to treat migraine headache and its pain.
The use of other prescription anti-inflammatory agents may be effective for some migraines. These agents may have gastrointestinal side effects, which limit their use since larger than normal doses may be required to treat the migraine attack.
Migraine-specific therapies are designed specifically to treat migraine attacks. Ergotamine preparations are no longer readily available. Dihydroergotamine (DHE) may be used for self-injection. DHE is also available as the nasal spray Migranal. A combination product containing isometheptene (Midrin®) is not usually effective for migraine. Sumatriptan (Imitrex®), a 5-HT agonist, is available in self-injectable, nasal spray and rapidly-dissolving tablet forms. Other 5-HT agonists are almotriptan (Axert®), naratriptan (Amerge®, rizatriptan (Maxalt®), zolmitriptan (Zomig®), frovatriptan (Frova®) and eletriptan (Relpax®). All are available in tablet form. Both rizatriptan and zolmitriptan are available in an orally disintegrating tablet (Maxalt-MLT and Zomig-ZMT), which can be taken without water. Zomig also comes in a nasal spray.
Abortive medications are most effective when taken early in an attack, while the pain is still mild and before skin sensitivity increases. The goal is complete relief of pain and associated symptoms, allowing the sufferer to quickly return to normal functioning.
Some attacks may not be eliminated by abortive therapy, yet the patient requires pain-relieving measures. Due to the severity of the headaches, some patients may require a narcotic analgesic, but if the patient is experiencing frequent migraine attacks habituating analgesics should be avoided. Butorphanol (Stadol®) is available for intranasal administration and is not typically associated with dependency problems, but may result in dependency if used regularly for pain relief. Alternative medical treatments with medications belonging to the group known as the Phenothiazines have proven useful as non-analgesic options for treating severe migraine headaches. Patients with prolonged migraine attacks lasting more than 24 hours are experiencing status migraine and corticosteroids may be used in these cases due to their anti-inflammatory effects.
Obesity in Children
Obesity means an excess amount of body fat. No general agreement exists on the definition of obesity in children as it does adults. Most professionals use published guidelines based on the body mass index(BMI), or a modified BMI for age, to measure obesity in children. Others define obesity in children as body weight at least 20% higher than a healthy weight for a child of that height, or a body fat percentage above 25% in boys or above 32% in girls.
Although rare in the past, obesity is now among the most widespread medical problems affecting children and adolescents living in the United States and other developed countries. About 15% of adolescents (aged 12-19 years) and children (aged 6-11 years) are obese in the United States according to the American Obesity Association. The numbers are expected to continue increasing. Childhood obesity represents one of our greatest health challenges.
Obesity has a profound effect on a child's life. Obesity increases the child's risk of numerous health problems, and it also can create emotional and social problems. Obese children are also more likely to be obese as adults, increasing their risk of serious health problems such as heart disease and stroke.
If your child is overweight, further weight gain can be prevented. Parents can help their children keep their weight in the healthy range.
* In infancy, breastfeeding and delaying introduction of solid foods may help prevent obesity.
* In early childhood, children should be given healthful, low-fat snacks and take part in vigorous physical activity every day. Their television viewing should be limited to no more than seven hours per week (which includes video games and the Internet).
* Older children can be taught to select healthy, nutritious foods and to develop good exercise habits. Their time spent watching television and playing with computer or video games should be limited to no more than seven hours each week. Avoid snacking or eating meals while watching TV, movies, and videos.
Although rare in the past, obesity is now among the most widespread medical problems affecting children and adolescents living in the United States and other developed countries. About 15% of adolescents (aged 12-19 years) and children (aged 6-11 years) are obese in the United States according to the American Obesity Association. The numbers are expected to continue increasing. Childhood obesity represents one of our greatest health challenges.
Obesity has a profound effect on a child's life. Obesity increases the child's risk of numerous health problems, and it also can create emotional and social problems. Obese children are also more likely to be obese as adults, increasing their risk of serious health problems such as heart disease and stroke.
If your child is overweight, further weight gain can be prevented. Parents can help their children keep their weight in the healthy range.
* In infancy, breastfeeding and delaying introduction of solid foods may help prevent obesity.
* In early childhood, children should be given healthful, low-fat snacks and take part in vigorous physical activity every day. Their television viewing should be limited to no more than seven hours per week (which includes video games and the Internet).
* Older children can be taught to select healthy, nutritious foods and to develop good exercise habits. Their time spent watching television and playing with computer or video games should be limited to no more than seven hours each week. Avoid snacking or eating meals while watching TV, movies, and videos.
Psychogenic basilar migraine
We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment.
