Chronic fatigue syndrome is a complex illness that produces extreme fatigue over a prolonged period. The condition has also been called post viral fatigue syndrome, myalgic encephalomyelitis (ME) or chronic fatigue and immune dysfunction syndrome. The condition can be extremely debilitating and may continue for months or years.

Since the symptoms are so variable, chronic fatigue syndrome is often unrecognized or misdiagnosed. This makes it difficult to estimate the number of people affected, but it is though to be about 150,000 in the UK. The condition is most often seen in women aged between 25 and 45, but it can affect children or adults of any age and people from all ethnic groups.

What are the causes?

The cause of chronic fatigue syndrome is unknown, although it is believed that several different factors are likely to be involved. In some cases, chronic fatigue syndrome develops after recovery from a viral infection or after an emotional trauma, such as bereayement. In other cases, there is no specific preceding illness or life event. Sometimes, chronic fatigue syndrome is associated with depression, although it is unclear whether depression is a result of the condition or cause of it.

What are the symptoms?

Although the number and severity of symptoms may vary, the major symptoms of chronic fatigue syndrome are:

- Extreme tiredness lasting at least 6 months.
- Impairment of short-term memory or concentration.
- Sore throat.
- Tender lymph nodes.
- Muscle and joint pain without swelling or redness.
- Un refreshing sleep.
- Headaches.
- Prolonged muscle fatigue and feeling ill after even mild exertion.

Many people who have chronic fatigue syndrome also develop symptoms of depression, such as loss of interest in their work and leisure activities, or of anxiety. Conditions involving an allergic reaction, such as eczema and asthma, may become worse in people who have chronic fatigue syndrome.

How is it diagnosed?

Your doctor may suspect chronic fatigue syndrome if you have had prolonged fatigue for more than 6 months with no obvious cause and you also have at least four of the other symptoms listed above. However, since persistent tiredness is a symptom of many other disorders, including an under-active thyroid gland or adrenal glands and anaemia, your doctor will try to exclude other causes first.

Your doctor will probably perform a general physical examination, and he or she may ask you questions to find out if you have psychological problems, such as depression. Blood tests may also be arranged. If no underlying cause is identified, a diagnosis of chronic fatigue syndrome will be made if your symptoms meet the criteria. Since there is no specific diagnostic test for chronic fatigue syndrome, confirmation of the disorder can take some time.

What are the treatment?

Although there is no specific treatment for chronic fatigue syndrome, there are a number of self-help measures that may help you to cope with the condition. Your doctor may give you drugs to help you to relieve some of your symptoms. For example, headaches and muscle and joint pain may be relieved by painkillers or nonsteroidal anti-inflammatory drugs. Anti-depressant drugs may produce an improvement in your condition even if you have not developed symptoms of depression. You may find cognitive therapy and behavior therapy beneficial. A course of physiotherapy will help to build up your stamina. Your doctor may suggest counseling to help you to cope with your illness and jointing a support group may also be helpful.

What is the prognosis?

Chronic fatigue syndrome is a long-term disorder, but there may be periods of relief from some symptoms. Many people find symptoms are worst in the first 1-2 years. In more than half of all cases, the condition clears up after several years.

WITH CHRONIC FATIGUE SYNDROME

If you develop chronic fatigue syndrome, you are likely to have fluctuating energy levels. You will need to be flexible and adjust your lifestyle to help you to live with the condition. The following self-help measures may be useful:

- Graded exercise may be useful. Try to set yourself a progressive increase in activity week by week.
- Set realistic goals for yourself.
- Make dietary changes: in particular, reduce your intake of alcohol and cut out drinks containing caffeine.
- Try to reduce stress.
- Joint a support group so that you do not feel isolated.

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Cluster headaches are brief episodes of often excruciating pain experienced in one part of the head. They occur in a characteristic pattern, usually between one and four times a day, and there may be gaps of months or years between each group of headaches. However, a few people have persistent cluster headaches that occur at regular intervals with very few remission periods between attacks. Like migraines, cluster headaches are likely to be related to an increase in blood flow as a result of widening of the vessels in the brain. These headaches affect about 1 in 100 people in the UK and tend to be more common in men. Smoking and drinking alcohol increase the risk.

What are the symptoms?

Cluster headaches often develop early in the morning. The major symptoms, which appear suddenly and affect one side of the head or face, include:

- Severe pain around one eye or temple.
- Watering and redness of the eye.
- Drooping of the eyelid.
- Stuffiness in the nostril and, sometimes, runny nose on one side.
- Flushing of one side of the face.

Individual episodes of pain may last from a few minutes to about 3 hours. The average attack lasts 15-30 minutes. If you have a sudden, severe headache for the first time or if you have symptoms that are different from those of previous headaches, you should consult your doctor at one so that a more serious underlying cause can be excluded.

What might be done?

Your doctor may prescribe an anti-migraine drug to help to reduce the length and severity of cluster attack. In a sudden, severe attack, oxygen inhaled through a mask may bring relief. If the attacks continue lithium and calcium channel blockers are sometimes effective.

If the cluster is prolonged, a short course of corticosteroids may help to prevent the headaches recurring. These drugs should be gradually reduced in dose, as advised by your doctor, as the headaches disappear.

If you are prone to cluster headaches, you should not smoke or drink even small amounts of alcohol because both increase the risk of an attack.

Cluster headaches may continue for the rest of your life, but you may have prolonged periods of remission.

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Each year about 1 in 10 people in the UK has a migraine. Migraine is more common a women, and people usually have their first attack before the age of 30. First attacks can occur in children as young as 2 years old but their onset is rare in people over the age of 50. Migraine headaches recur at varying intervals. Some people have attacks several times a month; others have fewer than one a year. Most people find that migraine attacks occur less frequently and become less severe as they get older.

There are two major types of migraine: migraine with aura and migraine without aura. Aura is the term used for group of symptoms, including visual disturbances, that develop before the onset of the main headache. Migraine with aura accounts for about 1 in 5 of all migraine cases. Some people have attacks of both types of migraine.

What are the causes?

The underlying cause of migraine is unknown, but increased blood flow as a result of widening of the blood vessels in the brain is known to occur during a migraine. A bout 8 in 10 people who have migraine have a close relative with the disorder. Stress and depression may be trigger factors, as may the relief of stress, such as relaxing after a difficult day. Other potential triggers include missed meals, lack of sleep, and certain foods, such as cheese or chocolate. Many women find that their migraines tend to occur around the time of menstruation.

What are the symptoms?

Migraine headaches, either with or without aura, are sometimes preceded by a group of symptoms that are collectively known as a prodrome. These prodrome symptoms tend to appear about an hour before the main symptoms begin. The prodrome often includes:

- Anxiety or mood changes.
- Altered sense of taste and smell.
- Either an excess or a lack of energy.

People who have a migraine with aura experience a number of further symptoms before the migraine, including:

- Visual disturbances, such as blurred vision and bright flashes.
- Pins and needles, numbness, or a sensation of weakness on the face or on one side of the body.

The main symptoms, common to both types of migraine, then develop. These symptoms include:

- Hadache that is severe, throbbing, made worse by movement, and usually felt on one side of the head, over one eye, or around one temple.
- Nausea or vomiting.
- Dislike of bright light or loud noises.

A migraine may last for anything from a few hours to a few days but eventually clear up. After a migraine, you may feel tired and unable to concentrate.

What might be done?

Your doctor will usually be able to diagnose a migraine from your symptoms. Rarely, test such as MRI or CT scanning of the brain may be carried out to rule out more serious causes such as a brain tumour.

Once migraine has been diagnosed, your doctor may prescribe drugs that reduce the duration of the attacks, help to treat the symptoms, or prevent further migraine occurring. For example, he or she may prescribe an anti-migraine drug, such as a triptan drug that, if taken in the early stages of an attack, will usually prevent the migraine from developing further. Ergotamine, an other anti-migraine drug, may also be given to help to relieve an attack but should not be taken for long periods of time.

If a full-blown migraine develops, painkillers or non-steroidal anti-inflammatory drugs may help to relieve the pain. If you also experience nausea and vomiting, anti-emetic drugs may provide relief.

Self-help measures may be useful in preventing further migraines. If you experience severe migraines or you have more than four attacks a month, your doctor may prescribe a drug such as propranolol to take every day to prevent attacks.


PREVENTING A MIGRAINE

Many factors are known to trigger a migraine. You need to identify the ones that affect you. Avoiding these factors may reduce the frequency and severity of attacks.

- Keep a diary for a few weeks to help to pinpoint trigger factors.
- Avoid any food that brings on an attack. Common dietary triggers of migraine include red wine, chocolate, and cheese (especially matured cheese).
- Eat regularly, because missing a meal may trigger an attack.
- Follow a regular sleep pattern if possible, because changing it may trigger an attack.
- If stress is a trigger, try relaxation exercises.

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Tension headaches are often the result of stress or bad posture, which cause a tightening of the muscles in the neck and scalp. Tension headaches usually last only a few hours, but some people may have persistent headaches that last for several days or weeks. Recurrent tension headaches often affect people with depression or those who are under continuous stress due to difficulties at work or at home. Tension headaches are often made worse by noise and hot, stuffy environments. This type of headache occurs most commonly in women over the age of 20.

What are the symptoms?

Symptoms often begin late in the morning or in the early afternoon and may persist for several hours. They include:
- Pain that is usually constant and may be throbbing. Pain is felt above the eyes or more generally over the head.
- Feeling of pressure behind the eyes.
- Tightening of neck muscles.
- feeling of tightness around the head. People who have persistent headaches often find it difficult to sleep. They may also become depressed and feel depleted of energy.

What can I do?

Taking an over-the-counter painkiller such as paracetamol may help to relieve a tension headache. However, the prolonged use of painkilling drugs may cause headache eventually. If you have a severe headache that lasts for more than 24 hours, does not response to self-help measures, or is associated with symptoms such as vomiting or blurred vision, consult hour doctor immediately.

What may the doctor do?

Your doctor will ask about the severity and frequency of your headaches and may look for sign of stress or depression. A diagnosis of tension headache is often clear from the symptoms, but you may need further tests, such as MRI or CT scanning of the brain, to check for an underlying cause.

Your doctor may recommend ways for you to deal with stress, such as yoga or relaxation exercises. If you are suffering from depression, he or she may prescribe anti-depression had been relieved, tension headaches usually clear up, but they may recur in the future.

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In the UK, 8 in 10 people have at least one headache each year. The majority of headaches last for only a few hours, but some persist for weeks.

Pain may occur in only one part of the head, such as above the eyes, or it may be spread across the entire head. The type of pain varies, it may be sharp and sudden or dull and constant. Sometimes, other symptoms, such as nausea, occur at the same time.

What are the causes?

There are many possible causes of headache that determine the site and nature of the pain. About 3 in 4 of all headaches are caused by tension in the scalp muscles. Tension head-aches tend to recur frequently and cause moderate pain that affects both sides of the head. Other types of headache, including migraine and cluster headaches, have a variety of possible causes.

Very few headaches have a serious underlying cause, but those that do require urgent medical attention. For example, a severe headache may be a sign of meningtitis, a condition in which the membranes covering the brain an spinal cord become inflamed, or subarachnoid haemorrhage, in which there is bleeding between the membranes covering the brain. In an elderly person, a headache with tenderness of the scalp or temple may be due to temporal arteritis, an inflammation of the blood vessels in the head. Occasionally, headache results from prolonged use of strong painkillers.

If your headache is severe, lasts more than 24 hours, or is accompanied by other symptoms, such as problems with your vision or vomiting, should seek medical advice without delay.

What might be done?

You will be physically examined by your doctor. If it appears that an underlying disorder is causing your headache, you may have tests, such as CT scanning or MRI of your brain.

Treatment depends on the cause of the headache. A tension headache will usually clear up with rest and painkillers. Cluster headaches and migraine headaches can be treated with a specific drug. Such as a triptan drug or ergotamine

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Pain is the body’s response to an injury or disease that results in tissue damage. Pain usually functions as a protective warning mechanism that helps to prevent further damage, although chronic (long-term) pain often seems to serve no useful function. Everyone has experienced pain, but its type and severity depend to some extent on the cause. For example, pain that results from a sports injury may be less severe than that of a similar injury caused by a violent assault. Mood and personality also affect the way we perceive pain. For example, fear or anxiety can make pain worse, while relaxation may help to relieve it to a certain extent.

The brain and spinal cord produce their own painkillers, known as endorphins, in response to pain. Endorphins, are natural chemicals that are closely related to morphine and act as highly effective pain relievers for short periods but are less effective for chronic pain.

Most forms of pain can how be controlled as a result of improvements in treatment, and it is rare for someone to have to live with persistent pain.

What are the causes?

When tissue is damaged by trauma, infection, or a problem with its blood supply, specialized nerve endings called pain receptors are stimulated. Electrical signals travel along the nerves and through the spinal cord to the brain, which interprets them as pain. While this is happening, the damaged tissues release chemicals known as prostaglandins, which cause inflammation and swelling. The prostaglandins further stimulate the pain receptors. The skin and other sensitive parts of the body, such as the tongue and the eyes, have a large number of pain receptors and are therefore very sensitive to painful stimuli. The internal organs of the body have fewer pain receptors and are insensitive to most types of injury.

What are the types?

Although each individual may describe the character or the site of pain in a different way, there are some types of pain that usually result from specific problems. For example, throbbing pain is often due to increased blood flow, either as a result of widening of the blood vessels, as may occur in migraine, or because of an increase in blood flow through injured tissues. Severe, shooting pains, such as sciatica, can be caused by pressure or irritation of the nerve at the point where it emerges from the spinal cord. Colicky pain is caused by intermittent stretching and contraction of muscles in the walls of the intestines, or in other parts of the body such as the bile ducts, which lead from the liver to the intestine.

The location if the pain usually acts as a good guide to its source. However, in some cases, overlapping nerve path-ways can result in a confused message, causing pain to be felt in a different area of the body from the site where it originates. This type of pain, known as referred pain, occurs when nerves carrying the sensation of pain merge with other nerves before they reach the brain. For example, hip problems may be felt as knee pain, while problems with a tooth may be felt as earache. Heart problems, can cause pain across the chest, into the neck, and in one or both arms. Pain due to problems in the intestines tends to be felt in the centre of the abdomen and is felt locally only when the abdominal wall is affected, as in the late stages of appendicitis.

Sudden (acute) severe pain may be associated with other symptoms, such as pale skin, sweating, nausea or vomiting, rapid pulse, and dilated pupils, and may even result in fainting. Prolonged period of severe pain that continue for weeks or months may lead to depression, loss of weight as a result of decreased appetite, and disturbed sleep.

What might be done?

If you experience severe or recurrent unexplained pain, you should see your doctor who may be able to establish the cause of pain after a physical examination. Further investigations, including blood tests and imaging tests such as ultrasound scanning, may be necessary if there is no obvious cause.

Since it is difficult to measure the severity of pain, your doctor may ask how the pain affects your sleep and your ability to cope with daily activities. You may also be asked to describe the severity of the pain on a scale of 1 to 10 for almost unbearable pain.

The most effective remedy for pain is treatment of the underlying cause, if possible. However, pain relief is also important until treatment of the cause takes effect. There are many different ways to relieve pain, including drugs and physical methods. The form of pain relief chosen depends on the cause and type of pain you experience.

Since pain, especially persistent pain, is influenced with other factors such as personality and levels of stress, treatment has to be tailored to the individual.

Drug treatment: virtually all short-lived pain and much long-term pain can be relieved by painkillers. When pain is caused by local prostaglandin release, treatment with a non-steroidal anti-inflammatory dugs such as ibuprofen often works well because these dugs limit the release of prostaglandins.

Opioid drugs, such as morphine and codeine, act directly on the part of the brain that perceives pain and are usually highly effective. Opioid drugs may be needed to relieve intense pain, such as that following surgery, and the severe pain associated with some cancers. The risk of addition to these drugs is small when they are used for short periods, and dependence is not a cause for concern when they are used in caring for a terminally ill person.

In addition to painkillers, a number of other drugs are prescribed for certain types of pain. These include local anaesthetics and drugs that affect the transmission of nerve impulses, such as anti-depressant drugs and anti-convulsant drugs. Pain that is caused by muscle tension may be relieved by small doses of anti-depressants. Anti-convulsant drugs are often used to treat pain associated with neuropathies, such as trigeminal neuralgia.

Physical treatment: a wide range of non-drug therapies is available to help to relieve pain, including gentle massage and the use of hot or cold compresses. These treatments both after blood flow through damaged tissues and stimulate other nerve endings, blocking pain.

Acupuncture is helpful for some types of helpful for some types of pain and may be used to relieve pain after operations or for persistent pain that does not respond to other types of treatment. Acupuncture is believed to work by causing the brain to release endorphins or by stimulating nerve endings near the site of the pain so that they stop sending pain messages.

If your pain is due to damaged ligaments or muscles, your doctor may offer ultrasound treatment, in which sound waves produce vibrations in the tissues and generate heat. Transcutaneous electrical nerve stimulation uses electric impulses to reduce pain by stimulating the nerves and is sometimes used for lower back pain or during labour.

What is the prognosis?

Almost all pain can be relieved to some degree, even if the underlying cause of the pain cannot be definitively treated. However, persistent pain is often more difficult to control than acute pain.

PAIN RELIFE USING TENS

Transcutaneous electrical nerve stimulation (TENS) is sometimes useful for relieving severe, persistent pain, such as back pain. In TENS, electrical impulses are relayed from an impulse generator to electrodes placed on the skin in the area of the pain. After about 30 minutes, pain may be significantly reduced. Relief may last for several hours. TENS can be used while pursuing normal activities.

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