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In a mouse study, scientists have shown that motor and non-motor symptoms of Parkinson’s disease are associated with two specific neural pathways.

The study paper, published in the journal Nature Neuroscience, opens the door to future research that may help develop interventions to treat the disease and its symptoms.

Parkinson’s disease

According to the National Institute on Aging (NIA), Parkinson’s disease is a progressive neurological condition that typically occurs in people aged 60 and older.

Parkinson’s primarily affects a person’s motor functions, that is, their ability to move their body in a coordinated manner. However, it can also have an impact on a person’s cognition and behavior, leading to mental health issues and problems with memory and attention.

According to the NIA, Parkinson’s occurs when neurons, or brain cells, die or become damaged. Cognitive and motor functions are affected by specific brain cells, and it is damage to these cells in particular that results in the symptoms of Parkinson’s.

Scientists do not know exactly why some people develop Parkinson’s. Research suggests it is likely to be due to a combination of hereditary and environmental factors, as well as the process of aging.

There is no known cure for Parkinson’s disease. As a consequence, treatments usually focus on relieving the symptoms caused by the condition.

To manage these symptoms, it is important to understand the structure of the parts of the brain that may be involved in the key symptoms of the disease.

However, the relationship between different neural circuits and the effects of Parkinson’s disease is still being explored.

Parkinson’s in the brain

In the present study, a team led by researchers from the University of California San Diego (UC San Diego) in La Jolla wanted to contribute to this knowledge.

They conducted a study in mice to understand the relationship between neural circuits in the brain and some of the functions that are typically affected by Parkinson’s disease, such as cognitive and motor abilities.

They looked in particular at the external globus pallidus (GPe) in the brains of mice, which previous research has linked to the motor symptoms of Parkinson’s.

The researchers used multiple methods to give a more detailed overview of this region of the mice’s brains, including electrophysiology, viral tracing, and behavioral experiments.

Importance for Parkinson’s therapy

The researchers identified two areas of the GPe and were able to relate these areas to motor skills and cognitive skills in the mice.

By manipulating neurons in these two parts of the brain, the scientists improved the mice’s locomotion and their reversal learning.

Dr. Byungkook Lim is an associate professor in the Neurobiology Section of the Division of Biological Sciences at UC San Diego and corresponding author of the study.

He explains, “our work demonstrates that the distinct neural circuitries in the basal ganglia are differentially involved in the motor and non-motor symptoms of Parkinsonian-like behaviors that occur at different stages of the disease.”

“This suggests that evaluation of the detailed circuit mechanisms is needed to fully understand the changes in [the] brain during the progression of [Parkinson’s disease] and could provide better therapeutic strategies for the treatment of [Parkinson’s disease].” – Dr. Byungkook Lim

The fact that specific neurons could be linked to particular changes in the brain regions of the mice means that it may be possible to develop new treatments for the symptoms of Parkinson’s.

In Dr. Lim’s words, “[s]elective manipulation of specific changes can rescue one type of symptom — without affecting other symptoms — of Parkinson’s disease.”

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April is Parkinson’s Awareness Month. With this in mind, this week’s edition of Medical Myths tackles the many misunderstandings that surround Parkinson’s disease. We discuss the symptoms and treatment, the outlook for people with the condition, and more.

Parkinson’s disease is a neurodegenerative movement disorder. Over time, dopamine-producing cells in a part of the brain called the substantia nigra deteriorate.

This deterioration, which leads to a reduction in dopamine, produces symptoms. The symptoms tend to develop slowly over time, often starting with a slight tremor in one hand or stiffness in movement.

Aside from tremor and stiffness, other symptoms include difficulties coordinating movements, changes in posture, a fixed facial expression, a reduced sense of smell, mood changes, and sleep problems.

As the disease progresses, some people with Parkinson’s develop dementia.

In 2016, an estimated 6.1 millionTrusted Source people worldwide had Parkinson’s disease. The number of cases has more than doubled in the last 25 years.

In this article, we dispel some of the most common myths associated with Parkinson’s disease.

1. Parkinson’s only affects movement

It is true that the medical community considers Parkinson’s disease a motor disorder. However, people with the condition often also experience nonmotor symptoms, which can begin before the motor symptoms.

Nonmotor symptoms can include cognitive impairment or dementia, depression and anxiety, sleep dysfunction, pain, apathy, sexual dysfunction, and bowel incontinence.

People often overlook these symptoms, but they are important. As the authors of one paper on the topic explain:

“[N]onmotor symptoms dominate the clinical picture of advanced Parkinson’s disease and contribute to severe disability, impaired quality of life, and shortened life expectancy.”

2. Treatment only works for a few years

Although there is no cure for Parkinson’s disease, drugs can help people manage the condition. One of the most effective drugs is levodopa, which the body converts into dopamine once it enters the brain.

There is a long standing myth that levodopa can only relieve symptoms for about 5 years before it stops working. This is a myth. Levodopa can be effective for decades. However, over time, its effectiveness might reduce.

Medical News Today spoke with James Beck, Senior Vice President and Chief Scientific Officer of the Parkinson’s Foundation. He explained why levodopa becomes less potent:

“One of the cruel ironies about Parkinson’s disease is that the key enzyme that converts levodopa to dopamine (aromatic acid decarboxylase or AADC) is predominantly found in the dopamine neurons of the substantia nigra, which are lost during progression of the disease. So, the main way to make dopamine available to the Parkinson’s brain declines as the disease advances.”

In other words, it is not that levodopa stops being effective. Instead, the supply of the enzyme that it needs to be effective becomes more limited.

In the past, doctors and people with Parkinson’s have held off starting treatment because of fears that levodopa would slowly stop working. We now know, though, that this reduction in potency is due not to the length of time that a person takes levodopa but to the progression of the disease.

However, it is true that over time, each dose of levodopa might improve symptoms for a shorter period. This so-called wearing-off means that symptoms start to return before the next dose is due.

3. Levodopa makes symptoms worse

Another misconception about levodopa is that it can make Parkinson’s disease symptoms worse. This is not true.

It is important to note that levodopa can cause other motor symptoms, such as dyskinesia, which refers to involuntary jerky movements. However, the onset of dyskinesia is related to the progress of the underlying disease rather than how long an individual has been taking levodopa.

Therefore, doctors no longer recommend holding off on taking levodopa until later in the disease.

According to the American Parkinson’s Disease Association (APDA), dyskinesia does not generally appear until the individual has been taking levodopa for 4–10 years. The APDA also writes:

“Dyskinesia in its milder form may not be bothersome, and the mobility afforded by taking levodopa may be preferable to the immobility associated with not taking levodopa. People with Parkinson’s must weigh the benefits from using levodopa versus the impact of dyskinesia on their quality of life.”

4. Tremor always signifies Parkinson’s

Tremor is the most well-known symptom of Parkinson’s disease. However, it can also occur as part of other conditions, including drug-induced parkinsonism, vascular parkinsonism, dystonic or essential tremor, psychogenic disease, and dopa-responsive dystonia.

5. Doctors can always provide an accurate outlook

Although doctors understand the range of symptoms that are associated with Parkinson’s, it is very difficult to predict how an individual’s disease will progress. Parkinson’s varies substantially among individuals.

As the authors of one study explain, there are “radical differences in clinical manifestations and progression between patients.”

“The [reason for the] differences observed in how individuals experience Parkinson’s disease and its progression remains unknown.” Dr. Beck explained to MNT. “It could be based on how Parkinson’s began with each individual.”

Scientists are currently investigating ways of making better predictions. Hopefully, in the future, doctors will be able to provide a clearer idea of how an individual’s condition will progress.

6. Everyone with Parkinson’s has tremor

Tremor is perhaps one of the most recognizable symptoms of Parkinson’s disease. However, some people develop nonmotor symptoms before tremor appears.

Also, some individuals do not experience tremor at any point during the disease’s progression.

Speaking with MNT, Dr. Beck explained, “About 20% of people with Parkinson’s disease do not develop a tremor.” Although scientists do not know why this is the case, Dr. Beck believes that tremor severity, in general, might depend on which brain regions the disease affects.

He noted that some scientists think “that people who have a strong tremor have lost more dopamine neurons in an area adjacent to the substantia nigra called the retrorubral area. It is these dopamine neurons (or their loss) that contribute to Parkinson’s tremor.”

7. People might experience ‘flare-ups’

In some conditions, such as multiple sclerosis, people can experience exacerbations, or flare-ups, of their symptoms. Parkinson’s disease, however, does not tend to work in this way.

The symptoms, overall, progress very slowly, although they might fluctuate throughout the day.

If someone’s symptoms do worsen suddenly, it is likely due to other factors. For instance, one study investigated these types of exacerbations in 120 people with Parkinson’s over an 18-month period.

The most common cause was infection, accounting for more than 1 in 4 (25.6%) exacerbations. Other factors included anxiety, medication errors, poor adherence to medications, medication side effects, and a decline in health following surgery.

According to the authors, 81.4% of these episodes were “attributable to reversible or treatable causes.”

8. Beyond drugs, nothing can help

There is a persistent myth that drugs are the only way to ease symptoms or slow disease progression. This is a myth.

There is mounting evidence that staying physically active can reduce symptoms and potentially even slow disease progression.

The Parkinson’s Foundation explains that people with Parkinson’s “who start exercising earlier and [for] a minimum of 2.5 hours a week experience a slowed decline in quality of life compared [with] those who start later. Establishing early exercise habits is essential to overall disease management.”

Research suggests that exercise does not just reduce the motor symptoms of Parkinson’s. For instance, studies have found that exercise helps improve associated sleep problems and cognitive function in people with the condition.

9. Parkinson’s is fatal

This is a misconception. Parkinson’s is not fatal in the same way that a heart attack might be. People with Parkinson’s can live long and meaningful lives.

Compared with individuals who do not have Parkinson’s, those who do have the disease are likely to have a reduced life expectancy. This reduction is more significant for people who develop the disease at a younger age but less pronounced in those who do not develop dementia.

Although Parkinson’s is not fatal, it increases the risk of falls. Serious falls can be fatal, or they can require surgery, which increases the risk of complications or infections.

Another substantial risk is pneumonia. As people with Parkinson’s may have difficulty swallowing, they can inhale particles of food into the lungs. People with Parkinson’s also have weaker cough reflexes, so the food might stay in the lungs, where it can spark an infection.

The inability to cough out the infected material means that these infections can be fatal.

As the APDA explains, “Most patients die with Parkinson’s disease and not from it.”

Moving forward

Although there are still gaps in our knowledge about Parkinson’s disease, researchers continue to dive into the details. When MNT asked Dr. Beck about promising avenues of research, he said:

“I think genetic forms of Parkinson’s disease offer the best hope for treatments that may alter the course of the disease.” Scientists estimate that genetics are responsible for 10–15% of Parkinson’s cases.

“However, in order for any trial to succeed in targeting genetic Parkinson’s, we (patients and clinicians) need to know who carries disease-related mutations. Currently, no one really knows,” explained Dr. Beck.

“That is why the Parkinson’s Foundation launched PD GENEration, a national initiative that offers genetic testing and counseling at no cost for people with Parkinson’s disease. While this is not a cure for Parkinson’s now, our goals for PD GENEration are to accelerate clinical trials for the disease, improve Parkinson’s care and research, and empower people with Parkinson’s and their care teams.”

Slowly, researchers are unpicking the mechanisms at work in Parkinson’s, and, hopefully, they will one day identify more effective treatments and perhaps even a cure.

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In a living systematic review and meta-analysis in The BMJ, scientists from the United Kingdom, along with international collaborators, continue to collate and analyze emerging evidence of how COVID-19 affects women and their babies during and shortly after pregnancy.

In the latest update, the team confirms that pregnant women attending or admitted to the hospital from whatever cause continue to be at a greater risk of severe COVID-19 than nonpregnant women of similar ages.

Preexisting diabetes, chronic hypertension, asthma, smoking, gestational diabetes, preeclampsia, being aged 35 years or over, and having a body mass index (BMI) of 30 or above were all associated with greater odds of severe COVID-19 and requiring admission to the intensive care unit (ICU).

Nonwhite ethnicity was linked with a greater likelihood of ICU admission, but not necessarily with severe COVID-19.

Meanwhile, babies of mothers with COVID-19 were more likely to require admission to the neonatal intensive care unit (NICU). The authors note that this could be due to hospital policies for observation and quarantine of babies in contact with COVID-19.

Dr. John Allotey, the study’s first author and a lecturer in epidemiology and women’s health at the World Health Organization (WHO) Collaborating Centre for Global Women’s Health at the University of Birmingham in the U.K., comments: “Pregnant women should be considered a high risk group, particularly those identified to have risk factors, for severe COVID-19 based on our findings.”

“Mothers should also be reassured that the risks to their babies are very low,” he continues.

Reviewing the evidence

The research team started work on the review in April 2020. For its first iteration, they collated data from available publications between December 2019 and June 2020.

Each week, the researchers looked for newly published data, which they aimed to review every 2–4 months. For the recent update, they added new studies published up until October 2020.

The review now includes data from 192 studies and 29 different countries. Of these studies, 115 were new editions to the latest update.

Overall, the data show that 10% of pregnant women who are either admitted to the hospital or visiting the hospital receive a positive SARS-CoV-2 test.

Pregnant women are more likely than nonpregnant women to have an asymptomatic SARS-CoV-2 infection.

However, the reason for this may lie in the strategy for testing.

Pregnant people routinely undergo COVID-19 testing when they attend hospital appointments, while nonpregnant individuals most likely have a test when they experience symptoms.

“[The] true prevalence of [COVID-19] in pregnancy is likely to be lower than the current estimate if all pregnant women, including those not attending the hospital, are included,” the authors comment in the paper.

While the risk of severe COVID-19 was greater for pregnant women than for nonpregnant women overall, there were specific risk factors that the team identified.

These include age, BMI, preexisting conditions, as well as conditions developed during pregnancy.

The researchers found that pregnant women or those who had recently given birth were more likely to die if they had COVID-19 than those who were the same age but not pregnant. In addition, the rates of premature birth and stillbirth were higher for women with the disease.

However, the team caveat that the premature births are likely to be the result of medical decisions to induce early delivery in those with COVID-19 as the number of spontaneous preterm births was the same as baseline levels. The number of stillbirths across all of the studies included in the review was very small (9 out of 5,794 women with COVID-19).

More data needed

One further issue that this review found is that women who were of nonwhite ethnicity were more likely to require admission to the ICU for COVID-19 treatment.

There was a link between nonwhite ethnicity and a greater likelihood of ICU admission, based on four studies covering 31,456 individuals. Four smaller studies covering 2,263 women suggested that nonwhite ethnicity may result in having a 6% lower chance of severe disease. However, this figure could vary between 43% less likely and 57% more likely.

Other studies have previously found disparities in maternal outcomes between people of different ethnicities.

“The observed disparity could be attributed to associated comorbidities, socioeconomic characteristics, and factors related to access to and quality of care in the preconception, pregnancy, and postpartum periods,” the review’s authors write in their discussion. “The multifaceted contributors to ethnic disparities need to be investigated to reduce mortality and morbidity related to both [COVID-19] and pregnancy.”

The team highlights several limitations of their review, including the fact that the studies included in the analysis did not use the same methods to collect and gather data. This is an issue that all systematic reviews face.

Senior study author Professor Shakila Thangaratinam, who is the Co-Director of the WHO Collaborating Centre for Global Women’s Health, comments on the team’s finding:

“In the current situation, where evidence is rapidly produced, our living systematic review — underpinned by robust methods and continually updated at regular intervals — is crucial to address important research questions and to shape healthcare policy and clinical decision-making.”

“Pregnant women and healthcare professionals will need to take into account the additional risks faced by pregnant women with COVID-19 in making decisions, such as taking-up of vaccines if offered to prevent COVID-19 and plan management in pregnancy.” – Prof. Shakila Thangaratinam

The Centers for Disease Control and Prevention (CDC) additionally state that “[a]lthough the overall risk of severe illness is low, pregnant people are at an increased risk for severe illness from COVID-19 when compared to nonpregnant people.”

They advise nonpharmaceutical interventions, such as mask wearing, physical distancing, avoiding crowds, and limiting contact with people who may have been exposed to the SARS-CoV-2 virus to reduce the risk of developing COVID-19.

The CDC also suggest having a COVID-19 vaccine when it is available to pregnant people and speaking with a healthcare professional about any questions or concerns.

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Hallucinations are sensory perceptions that appear in the absence of stimuli. Although they are often associated with illnesses such as schizophrenia, these phenomena can occur in the absence of mental ill health. But what explains these uncanny occurrences?

There are many types of hallucinations. They can be visual (sight hallucinations), auditory (sound hallucinations), olfactory (smell hallucinations), gustatory (taste hallucinations), or tactile (touch hallucinations).

For every sense, a form of hallucination is possible. The reason for this is that these phenomena are “ghost sensations” — perceptions of stimuli in the absence of actual external stimuli.

More often than not, when people think of hallucinations, they associate them with illnesses that can involve psychosis, such as schizophrenia, or neurocognitive disorders, such as forms of dementia.

Hallucinations are also associated with the use of mind-altering drugs, including LSD and DMT.

But hallucinations are not always due to psychotic disorders or psychedelics. Sometimes, they occur in the absence of these factors.

So what explains hallucinations, how common are they, and what role might they teach us about ourselves? In this Special Feature, we investigate.

More common an occurrence than we think

A study that appeared in the British Journal of Psychiatry in 2017 suggests that hallucinations are far more common among people without psychotic disorders than scientists had previously thought.

The study authors — Dr. Ian Kelleher, from the Royal College of Surgeons in Ireland, and Jordan DeVylder, Ph.D., from the University of Maryland in Baltimore — analyzed data that they had obtained through the 2007 Adult Psychiatric Morbidity Survey, a nationally representative study of mental health in England.

These data included information on the mental health of 7,403 people aged 16 years and older throughout 1 year.

Dr. Kelleher and DeVylder found that visual and auditory hallucinations were almost equally prevalent among participants with borderline personality disorder and those with a nonpsychotic mental illness.

They also found that more than 4% of all the survey respondents — including those who had no diagnosed mental health issues — reported experiencing visual or auditory hallucinations.

“Hallucinations are more common than people realize. They can be frightening experiences, and few people openly talk about it,” Dr. Kelleher observed in an interview for International Business Times.

“Our research is valuable because it can show them they are not alone and that having these symptoms is not necessarily associated with having a mental health disorder. It breaks the taboo,” he added.

Research published in the Scandinavian Journal of Psychology in 2015 also showed that auditory hallucinations were surprisingly common in a representative sample of the general population in Norway.

In a cohort of 2,533 individuals, the “current lifetime prevalence of [auditory verbal hallucinations] was 7.3%.”

Phantom smells also seem to be a more common occurrence than people might think. In 2018, a study published in JAMA Otolaryngology — Head & Neck Surgery showed that 6.5% of people aged 40 years and over had experienced phantom odor perception.

This percentage is based on data from a cohort of 7,417 participants with a mean age of 58 years. However, when it came to explaining this phenomenon, the researchers were at a loss.

“The causes of phantom odor perception are not understood. The condition could be related to overactive odor-sensing cells in the nasal cavity or perhaps a malfunction in the part of the brain that understands odor signals,” says first author Kathleen Bainbridge, Ph.D., from the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health (NIH) in Bethesda, MD.

Surprising potential mechanisms

Researchers have been trying to build a better understanding of the biological mechanisms behind the different types of hallucinations.

In 2019, investigators from the University of Oregon in Eugene conducted a study in mice to try to find out how hallucinations manifest in the brain.

Their study paper — published in Cell Reports — revealed some surprising findings. As the researchers induced visual hallucinations in the rodents by injecting them with a hallucinogenic substance, they saw that this did not “map out” how they expected it to in the brain.

The researchers observed that the hallucinating mice experienced fewer signals firing between the neurons of the visual cortex, the brain region associated with the interpretation of visual information.

“You might expect visual hallucinations would result from neurons in the brain firing like crazy or by mismatched signals. We were surprised to find that a hallucinogenic drug instead led to a reduction of activity in the visual cortex.” – Senior author Prof. Cris Niell

Despite the initial surprise, the study’s senior author notes that it makes sense that visual hallucinations should appear in the brain in this way.

“Understanding what’s happening in the world is a balance of taking in information and your interpretation of that information. If you’re putting less weight on what’s going on around you but then overinterpreting it, that could lead to hallucinations,” he explains.

There is also a large amount of research into the causes and mechanisms associated with auditory hallucinations — some of the most fascinating kinds of ghost sensations.

For instance, a 2017 study featuring in eLife goes some way toward explaining how and why some people may think they hear voices that are actually not there.

According to the authors, this may be the effect of an error or “short-circuit” in processing internal speech and differentiating it from speaking out loud.

When people speak out loud, the researchers explain, the brain does two things. First, it sends instructions to the vocal cords, tongue, and lips — our vocal apparatus — to prompt them to move in the right way so as to vocalize the correct sounds.

At the same time, the brain also makes an internal copy of these instructions, which scientists call the “efference copy.” This duplicate allows the brain regions associated with hearing to predict the sounds that the vocal apparatus is about to make correctly.

This is part of how we recognize our own voice and speech.

“The efference copy dampens the brain’s response to self-generated vocalizations, giving less mental resources to these sounds because they are so predictable,” explains first author Prof. Thomas Whitford.

Through their study, Prof. Whitford and his colleagues found that the brain makes an efference copy not just of the thoughts intended for vocalization, but also of the inner talk — the internal chatter that people process in the background without expressing out loud.

It is likely, the scientists hypothesize, that auditory hallucinations arise when something goes wrong with the efference copy of people’s internal monologues.

“We all hear voices in our heads. Perhaps the problem arises when our brain is unable to tell that we are the ones producing them.” – Prof. Thomas Whitford

What hallucinations teach us

Many of the hallucinations that people might experience are, in fact, of the run-of-the-mill variety. For example, a vague sensation that you have heard the phone ringing when no one actually called or catching the shadow of a silhouette from the corner of the eye when there is no one there.

Dr. Philip Corlett and Dr. Albert Powers, two scientists from Yale University and the Connecticut Mental Health Center in New Haven, CT, have conducted many experiments into the nature of hallucinations.

They argue that there is a spectrum of phantom sensations and that many hallucinations might actually reflect how our brains work — namely, by making predictions about stimuli and the environments that we navigate.

In a paper published in World Psychiatry in 2018, they write that hallucinations might emerge from a “mismatch” between the predictions that our brains make about our surrounding reality and the actual reality.

In another study paper, published in 2017 in the journal Science, the two researchers and Dr. Christoph Mathys, an associate professor at Aarhus University in Denmark, present the evidence they collected through a series of experiments that appear to support this notion.

“When we go about the world, we’re not just passively perceiving sensory inputs through our eyes and ears. We actually build a model in our minds of what we expect to be present,” Dr. Corlett told The Atlantic, noting that when those expectations do not come to pass, this may sometimes translate as a hallucination.

Other scientists note that even more pronounced hallucinations could sometimes be of benefit to the person experiencing them.

In a 2017 paper in Psychology and Psychotherapy: Theory, Research and Practice, Drs. Filippo Varese, Warren Mansell, and Sara Tai — from the University of Manchester in the United Kingdom — note that not all auditory hallucinations are distressing.

Their study, which enlisted people with mental health issues who also experienced auditory hallucinations, found that how people reacted to the voices that they thought they heard made an important difference to whether those voices hindered or encouraged them in their daily pursuits.

“Most voice-hearers with mental health difficulties in our study experienced their voices as a hindrance to achieving their goals and viewed their voices as distressing and problematic. But other voice-hearers find that voices facilitate their valued goals and are, therefore, a pleasant and constructive part of their lives,” Dr. Varese points out.

Going forward, the researchers say, such insights might help mental health professionals assist their clients in turning the tables on potentially distressing hallucinations.

“[…] we should seek to help clients explore how their voices relate to goals that are important to them and empower them to progress toward those goals. That would be a more meaningful and acceptable way of supporting them,” he suggests.

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Asthma is a chronic lung condition in which the airways narrow and become inflamed, which leads to wheezing, coughing, and chest tightness. Extrinsic asthma and intrinsic asthma are subtypes of asthma.

The symptoms of these subtypes are the same, but they have different triggers:

  • Extrinsic asthma symptoms occur in response to allergens, such as dust mites, pollen, and mold. It is also called allergic asthma and is the most common form of asthma.
  • Intrinsic asthma has a range of triggers, including weather conditions, exercise, infections, and stress. People may call it nonallergic asthma.

In this article, we discuss the causes, symptoms, and treatment of intrinsic and extrinsic asthma.

Intrinsic vs. extrinsic asthma

Intrinsic and extrinsic asthma are two subtypes of asthma, which people more commonly refer to as allergic and nonallergic asthma.

Both types cause the same symptoms. The difference between the two subtypes is what causes and triggers asthma symptoms. The treatments are similar for each type, although the prevention strategies differ.

Triggers

Woman taking inhaler for asthma whilst playing football. Intrinsic and extrinsic asthma have the same symptoms but different triggers
Intrinsic and extrinsic asthma have the same symptoms but different triggers.

In people with extrinsic asthma, allergens trigger the respiratory symptoms. Common triggers for extrinsic asthma include:

  • pollen
  • mold
  • dust mites
  • pet dander
  • cockroaches
  • rodents

In some cases, a person is allergic to more than one substance, and several allergens trigger asthma symptoms.

In people with intrinsic asthma, allergies are not responsible for the symptoms. Instead, the following triggers cause symptoms:

  • cold
  • humidity
  • stress
  • exercise
  • pollution
  • irritants in the air, such as smoke
  • respiratory infections, such as colds, the flu, and sinus infections

In some cases, intrinsic asthma can occur with no known cause.

Prevalence

Extrinsic or allergic asthma is the most common form of the disease. According to the Asthma and Allergy Foundation of America, about 60% of people with asthma have allergic asthma.

Less commonly, intrinsic or nonallergic asthma occurs. Research in The Journal of Allergy and Clinical Immunologyindicates that intrinsic asthma occurs in anywhere from 10% to 33% of people with asthma.

It occurs more often in females than males and typically develops later in life than extrinsic asthma.

Causes

In all types of asthma, a person has overly sensitive airways and airway inflammation, which produces asthma symptoms.

Inflammation causes swelling in the airways that narrows the tubes and makes breathing difficult. The body also produces excess mucus, which further impairs breathing. These factors decrease the amount of air that can get into the lungs.

The inflammatory processes are similar in extrinsic and intrinsic asthma. In both, the immune system releases cells called T-helper cells and mast cells.

Research has found that there may be more similarities between the two types of asthma than researchers previously thought. Both types of asthma involve the production of IgE locally at the airways in response to the relevant triggers:

  • Extrinsic asthma occurs when the immune system overreacts to a harmless substance, such as pollen or dust. The body releases an antibody called immunoglobin E (IgE). The release of this antibody leads to inflammation and asthma symptoms.
  • Intrinsic asthma occurs when something other than allergens triggers an immune system response. People are not always able to identify the trigger.

Symptoms

The symptoms of extrinsic and intrinsic asthma are the same and may include:

  • wheezing
  • chest tightness
  • shortness of breath
  • coughing
  • increased mucus production
  • trouble breathing

Symptoms can vary in severity and may develop suddenly. Ignoring the signs and symptoms of an asthma attack can lead to a life-threatening situation. Recognizing symptoms as soon as possible and following an asthma action plan can help decrease the severity of an attack and reduce complications.

Treatments

The treatment options for intrinsic and extrinsic asthma are similar and include medications, lifestyle changes, and the avoidance of triggers. Since the triggers are different, the prevention strategies may differ.

Reducing triggers

It may be easier to identify the triggers for extrinsic asthma because allergies are the culprit. With both types of asthma, the identification of triggers allows an individual to take steps to reduce exposure and decrease symptoms.

The following steps can help reduce asthma symptoms in people with extrinsic asthma:

  • fixing leaky pipes to prevent mold buildup
  • keeping doors and windows closed when the pollen count is high
  • vacuuming often to reduce dust
  • keeping pets out of the bedroom

Triggers of intrinsic asthma do not involve a specific allergen. Due to the variability of triggers, it can take a little longer to determine the cause of flare-ups. People may find that avoiding humid, dry, or cold weather can prevent symptoms.

Medications

People can use the following medications to treat flare-ups of both intrinsic and extrinsic asthma:

Short-acting bronchodilators

Short-acting bronchodilators, also called quick relief medications, reduce symptoms fast. They work by relaxing the muscles of the airways.

Long-acting medications

People take long-acting bronchodilators daily, and they also open up the airways. Long-acting bronchodilators do not treat sudden symptoms as they take longer to work than short-acting bronchodilators.

Corticosteroids

Corticosteroids decrease inflammation in the airways. People take steroids daily to prevent symptoms.

Omalizumab

Omalizumab is an anti-IgE antibody therapy that prevents the release of IgE. Reducing IgE decreases the allergic response and prevents asthma symptoms.

People usually use omalizumab to treat extrinsic asthma, but it may also help with intrinsic asthma.

Lifestyle changes

Lifestyle changes might also help decrease symptoms of both types of asthma.

People with asthma may wish to consider adopting the following lifestyle practices:

  • maintaining a healthy weight
  • quitting smoking
  • avoiding secondhand smoke
  • reducing stress
  • getting a flu vaccine each year
  • washing the hands frequently to decrease the risk of infection

Outlook

Although there is currently no cure for either extrinsic or intrinsic asthma, people can manage the symptoms with medications, prevention methods, and lifestyle changes.

Intrinsic asthma is often harder to control than extrinsic asthma, as identifying its triggers is sometimes difficult. People can work closely with a doctor to determine the causes of asthma symptoms and find an effective treatment.

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Dental implants are artificial structures that a dental surgeon inserts into a person’s jawbone. A person may need an implant if they have lost one or more teeth.

Keep reading to learn about the types of implants and associated risks. We also describe what to expect from dental implant surgery and how much the procedure may cost.

What are dental implants?

A dental implant is a structure that replaces a missing tooth. With screw-like devices, the surgeon inserts an implant into the jawbone, and it acts as an anchor for an artificial tooth, called a crown.

A device called an abutment connects the artificial tooth to the dental implant.

The crown is custom-made to fit the person’s mouth and match the color of their teeth. Crowns look, feel, and function like natural teeth.

Implants have several advantages over dentures, which are removable artificial teeth. Implants:

  • are more natural and comfortable
  • have a higher success rate
  • improve chewing function
  • lead to a lower risk of cavities developing in nearby teeth
  • lead to better maintenance of bone at the site of the lost tooth
  • cause decreased sensitivity in nearby teeth
  • do not need to be taken out and cleaned every night

However, dental implants are not suitable for everyone. The implanting devices must bond with the jawbone, so a person’s bones must be healthy before they can undergo implant surgery.

Types

There are two types of dental implant: endosteal and subperiosteal.

Endosteal implants are the most common type. A surgeon embeds them in the jawbone, and each can hold one or more artificial teeth.

A surgeon affixes a subperiosteal implant on top of the jawbone. Dental surgeons choose this option for people who do not have much height to their jawbone.

Safety

According to the American Academy of Implant Dentistry, around 3 million people in the United States have dental implants, and this number increases by about 500,000 every year.

Dental implant surgery is safe when a qualified and experienced surgeon or dentist performs it. It is also the only dental restoration option that maintains the health of the person’s jawbone and stimulates its growth.

Risks

Some people are not eligible for dental implant surgery. It is not safe for dental surgeons to operate on people with:

  • acute illness
  • uncontrollable metabolic disease
  • bone or soft tissue disease or infection

If these issues are resolved, a person can have the surgery.

In some cases, dental surgeons refrain from operating on people with:

  • heavy smoking habits
  • parafunctional habits, such as tooth grinding or clenching
  • behavioral or psychiatric disorders
  • HIV
  • diabetes
  • osteoporosis
  • AIDS

If people with any of the above undergo dental implant surgery, there is a higher risk of the implant failing.

Dental surgeons may also choose not to operate on people undergoing the following treatments, due to an increased risk of implant complications:

  • bisphosphonate drug treatment for bone loss diseases
  • chemotherapy
  • radiation therapy of the head or neck

Potential complications of implant surgery

People who undergo this procedure may experience complications during or afterward. The issues may include:

  • nerve damage, resulting in altered sensation in the surgical area
  • an opening of the incision following surgery
  • movement of the implant
  • exposure of the implant above the gumline
  • infection of the implant

People who experience movement or exposure of the implant may need to undergo additional procedures to improve the health of the bone and gums or remove or replace the implant.

The following are some signs and symptoms that an implant placement has been unsuccessful:

  • the implant is excessively mobile
  • pus or other secretions come from the site
  • pain when tapping the implant
  • rapid, progressive bone loss

Procedures

Each person is likely to have a different experience of dental implant surgery. Factors that may influence this include:

  • the number of teeth requiring replacement
  • the location of the implants within the jaw
  • the quality and quantity of bone at the implant site
  • the person’s underlying oral and systemic health

Depending on these factors, additional procedures may be necessary. These can include:

Sinus augmentation

Placing an implant in the upper jawbone is usually difficult because of the location of the sinuses.

The surgeon may need to perform a sinus augmentation — a procedure to lift the floor of the sinuses to allow more bone to develop so that the implantation can be successful.

Ridge modification

Some people have a jawbone abnormality that prevents enough bone for an implant from developing. In such cases, a surgeon may need to perform a ridge modification.

This involves lifting the gum to expose the area of deformed bone. The surgeon will then use a bone or bone substitute to repair and build up the area. This improves the quality of the jawbone in preparation for dental implant surgery.

Maintenance

After a person has undergone dental implant surgery, they must continue to brush and floss their teeth regularly. Artificial teeth require the same care and maintenance as regular teeth.

The surgeon or dentist will also schedule follow-up visits to monitor the implants and make sure that the teeth and gums are healthy. It is important to return to the dentist every 6 months for professional cleanings.

Cost

The cost of dental implant surgery varies, and the following factors can influence it:

  • the number and types of implants required
  • the location of the implants within the jaw
  • whether there is a need for any additional procedures to prepare the mouth for surgery

A dentist or another oral health professional can estimate the cost of dental implant surgery during an initial examination.

Some dental insurance policies cover a larger portion of the cost.

Other tooth replacement options, such as bridges, may be less expensive. However, bridges are harder to keep clean and often require replacement and repair, increasing the overall cost. Dental implants may provide longer-term benefits if a person takes care of them well.

Summary

Dental implants are fixtures in the bone that replace missing teeth. Implants have a high success rate and can provide long-term benefits.

Some people need additional procedures to prepare their mouth for dental implants. These will add to the overall cost. The number and type of implants required can also raise the cost.

Anyone considering dental implant surgery should ask their dentist whether it is right for them.

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Insomnia can have a serious impact on a person’s health and well-being. Now, a study of females aged 50 and over has found that some parts of the diet most likely contribute to this sleep disorder.

Insomnia affects many people all over the world. According to the National Sleep Foundation, up to 40% of people in the United States experience some insomnia symptoms each year.

Researchers have taken due note of this, as numerous studies have suggested that insomnia is not just a mild annoyance: It may actually be linked with many other negative health outcomes.

According to the Centers for Disease Control and Prevention (CDC), short sleep duration and sleep disruptions are associated withTrusted Source cardiovascular problems, diabetes, and depression, to name a few.

For this reason, specialists have been looking for ways of preventing or treating insomnia and other sleep disorders — starting by looking for all the possible causes.

Existing research has already called attention to the fact that diet may influence a person’s sleep qualityTrusted Source. Now, a study from Columbia University Vagelos College of Physicians and Surgeons in New York City, NY, suggests that a diet high in refined carbohydrates — particularly added sugars — is linked to a higher risk of insomnia. This, at least, appears to be the case among females aged 50 and over.

The research team reports these findings in a study paper that now appears in The American Journal of Clinical NutritionTrusted Source.

“Insomnia is often treated with cognitive behavioural therapy or medications, but these can be expensive or carry side effects,” explains senior study author James Gangwisch, PhD.

But, he adds, “[b]y identifying other factors that lead to insomnia, we may find straightforward and low cost interventions with fewer potential side effects.”

The possible underlying mechanism

The researchers worked with the data of 53,069 female participants aged 50–79, all of whom had enrolled in the Women’s Health Initiative Observational Study between September 1994 and December 1998.

To understand whether or not there really is a link between dietary choices and the risk of insomnia, the investigators looked for any associations between different diets and sleep disruptions.

Gangwisch and colleagues found a link between a higher risk of insomnia and a diet rich in refined carbohydrates. This includes foods with added sugars, soda, white rice, and white bread.

The researchers caution that it was unclear from their analysis whether the consumption of refined carbohydrates led to insomnia, or that people who experienced insomnia were more likely to consume refined carbs, especially sugary foods.

However, they do note that there is a possible underlying mechanism that might explain added sugars causing sleep disruptions.

“When blood sugar is raised quickly, your body reacts by releasing insulin, and the resulting drop in blood sugar can lead to the release of hormones such as adrenaline and cortisol, which can interfere with sleep,” Gangwisch explains.

Why fruit will not impact sleep

The study authors also explain why not all foods that contain sugar will lead to the same effect. Fruits and vegetables — which naturally contain sugar — are unlikely to raise blood sugar levels nearly as quickly as foods containing added sugars.

This is because these natural foods are also high in fiber, which means that the body absorbs the sugar more slowly, preventing a spike in blood sugar levels.

Indeed, the female participants who had diets rich in vegetables and whole fruits — but not fruit juices — did not have an increased risk of insomnia.

“Whole fruits contain sugar, but the fiber in them slow the rate of absorption to help prevent spikes in blood sugar,” says Gangwisch.

“This suggests that the dietary culprit triggering the women’s insomnia was the highly processed foods that contain larger amounts of refined sugars that aren’t found naturally in food.”

James Gangwisch, Ph.D.

The researchers only worked with females aged 50 and over, but they believe that the findings could also apply to males and people of other ages. Going forward, they argue that this idea is worth exploring in more detailed studies.

“Based on our findings, we would need randomized clinical trials to determine if a dietary intervention, focused on increasing the consumption of whole foods and complex carbohydrates, could be used to prevent and treat insomnia,” concludes Gangwisch.

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There are various types of headache that can affect people during the night. Certain types of headache only happen at night, while some are far more likely to occur during the night or early hours of the morning.

In this article, we look at the different types of headache that people may experience at night.

We also discuss symptoms and treatment options.

Causes of nighttime headaches

The sections below contain information about different types of headache that are likely to occur at night.

Hypnic headache

Hypnic headaches are rare. According to the Migraine Trust, they occur most often in people over the age of 50, although they can also affect younger people. Hypnic headaches are more common in females than males.

Hypnic headaches only occur during sleep. If a person experiences nighttime headaches more than 10 times per month, they may have hypnic headaches. In some cases, hypnic headaches can occur if people sleep during the day.

Some people call hypnic headaches “the alarm clock headache,” because they cause people to wake up — often at the same time each night. In fact, people may find that a hypnic headache wakes them up between 1 a.m. and 3 a.m.

Symptoms of hypnic headache may include:

  • throbbing pain
  • pain on one or both sides of the head
  • pain that lasts anywhere between 15 minutes and 4 hours but usually lasts for around 30–60 minutes
  • increased sensitivity to light and sound
  • watery eyes or a blocked nose
  • nausea

Some people may have more than one hypnic headache per night.

Cluster headache

People who experience multiple headaches may have a cluster headache. These headache episodes, or clusters, can happen between one and eight times per day and last between 15 minutes and 3 hours. Cluster headaches are also one of the most painful types of headache.

Cluster headaches commonly occur at night and can cause people to wake up 1–2 hours after falling asleep.

Researchers are not sure what causes cluster headaches, but genetics may play a part. They usually occur in people who are over the age of 20. Males and people who smoke heavily are also more likely to experience cluster headaches.

Certain factors may also trigger cluster headaches, including:

  • alcohol intake
  • strong smells, such as paint fumes or solvents
  • exercise
  • overheating

Symptoms of cluster headaches can include:

  • severe stabbing pain on one side of the head, which can include the eye and temple area
  • red, watery eyes
  • runny nose
  • sweating on the side of the head where the headache is
  • restlessness and agitation
  • a headache that stops abruptly

Tension headache

Tension headaches can occur due to stress, tight muscles, or fatigue. People may experience tension headaches at night due to tension building up throughout the day.

Symptoms of a tension headache include:

  • a dull ache or squeezing sensation on both sides of the head
  • pain that feels like a tight band or vice around the head
  • aching muscles in the neck, shoulders, or back
  • tightness in the jaw
  • pain that lasts between 20 minutes and 2 hours

Migraine

Migraine can cause intense head pain and wake people up from sleeping.

According to the American Migraine Foundation, the most common time for people to experience a migraine is the early morning. This is because any pain medication they may be taking to treat the head pain will often stop working after 4–8 hours.

The National Sleep Foundation report that 50% of migraine episodes occur between the hours of 4 a.m. and 9 a.m.

Symptoms of migraine include:

  • moderate-to-severe pain
  • nausea
  • vomiting
  • increased sensitivity to light and sound
  • changes in vision, such as seeing flashing lights or zigzag patterns

Each migraine episode can last 4–72 hours.

Diagnosis

A doctor should be able to diagnose the type of headache a person has by conducting a physical examination, taking their medical history, and looking at any symptoms.

If a person has any other symptoms that suggest an underlying cause to nighttime headaches, a doctor may also carry out:

  • blood tests
  • MRI or CT scans
  • EEG tests, to look at brain wave patterns

Treatment

The following sections list treatment options based on the type of nighttime headache a person may have.

Hypnic headache

To treat hypnic headaches, a person can consume caffeine before going to sleep. For people with hypnic headaches, consuming caffeine at bedtime does not seem to prevent them from sleeping.

In some cases, other treatment options may be more effective.

These include:

  • melatonin
  • flunarizine
  • indomethacin
  • lithium carbonate

People with stomach ulcers should avoid taking indomethacin, however.

Also, people with dehydration who use diuretics or have kidney or thyroid disease should consult their doctor before taking lithium carbonate.

Cluster headache

Although there is currently no cure for cluster headaches, there are treatment options to relieve the pain. Cluster headaches produce intense pain rapidly, so many pain relief medications are not effective enough.

According to the Migraine Trust, effective pain relief treatment for cluster headaches can include:

  • High flow oxygen: People can take in extra oxygen through a cylinder and face mask. Breathing in oxygen at a rate of 7–12 liters per minute may help delay or stop a headache episode. This may take 15–20 minutes to treat cluster headaches.
  • Sumatriptan: People can take this medication as an injection, which may relieve pain in 10 minutes during a cluster headache episode. People can also take sumatriptan as a tablet or nasal spray, but these forms can be slower to treat the pain.
  • Zolmitriptan nasal spray: This may be effective for treating cluster headaches in some people, but it can be slow to take effect.

Using preventive treatments is usually an effective way to stop the cluster headaches before they start. Preventive medications include:

  • verapamil
  • methysergide
  • lithium
  • corticosteroids
  • ergotamine
  • topiramate

Some of these preventive treatments can have side effects, so a doctor may need to monitor people while they are taking them.

Tension headache

If a person experiences tension headaches at night, taking over-the-counter pain relief medication before bedtime may help.

Applying a warm compress to the area or taking a warm bath or shower before bed can also help relax the muscles and relieve any tension.

Migraine

There is currently no cure for migraine, though it is possible to treat the symptoms. People can take medication either to relieve the pain during a migraine episode or to prevent the development of a migraine in the first place.

Managing stress through relaxation techniques and regular exercise may also help prevent the severity or frequency of a migraine episode.

When to see a doctor

A person should see their doctor if they have frequent or severe headaches at night. A doctor will be able to carry out tests to check for any underlying causes and to find out which type of headache the person may be experiencing.

A person should also see their doctor if they notice any unusual symptoms, such as:

  • getting new headaches after the age of 50
  • changes in personality or mental state
  • getting headaches after a knock to the head
  • headaches that stop them doing everyday activities
  • fatigue or muscle weakness

Tips for good sleep

People may be able to prevent or reduce the severity of headaches at night through practicing good sleeping habits.

For example, people may be able to get better sleep by:

  • waking up and going to sleep at the same time every day
  • getting 7–8 hours of sleep each night
  • avoiding caffeine before bedtime, unless using it specifically as a treatment option
  • avoiding alcohol and nicotine, as these can affect sleep
  • unwinding and relaxing before going to sleep

Summary

People may be able to relieve headaches at night with pain relief medication, relaxation techniques, and good sleeping habits.

If a person has severe or persistent headaches at night or notices other symptoms alongside a nighttime headache, they should see their doctor.

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Pain under the left armpit can be concerning, and many people associate any pain on the left side of their body with a heart attack. However, most of the time, pain under the left armpit has a less serious cause.

The armpit is a complex meeting point for muscles and connective tissues, lymph nodes, and blood vessels. As such, many issues in this area can lead to pain.

Causes range from pulled muscles and mild allergic reactions to more severe issues, such as an underlying infection.

While many of the causes of left armpit pain are not harmful in the long term, anyone experiencing breathing difficulties and pain in their chest, jaw, or neck should see a doctor immediately.

Causes of left armpit pain include:

A pulled muscle

Many muscles around the shoulder and armpit can cause pain if a person injures them.

People can pull a muscle when reaching for an object, twisting incorrectly, or overstretching.

People who exercise regularly, especially those who do weight training, may be more likely to experience muscle pulls and strains.

In these cases, the pain should go away over time, as long as the individual rests the injured muscle and does gentle stretches.

If the pain does not go away after about a week, it is best to see a doctor.

Allergic reactions

Armpits are a frequent location for allergic reactions, which could cause pain under the left armpit or both armpits.

Most allergic reactions in this area will occur due to chemicals people apply to their bodies or clothes that touch the armpits.

Possible allergens include:

  • detergent
  • fabric softener
  • soap
  • deodorant
  • perfume
  • shaving cream
  • moisturizing creams or lotions

These products may contain chemicals or perfumes that irritate the skin. A rash may also form.

Anyone who suspects that their skin is sensitive to a particular allergen should note the products they used that day and report them to a dermatologist.

Allergy testing may help find the irritating product. Avoiding products with any harsh chemicals or other ingredients can also improve symptoms in these cases.

Cosmetic procedures

Simple cosmetic procedures, such as shaving or waxing, can also be to blame for pain under the armpit. These hair removal techniques may lead to other issues, such as ingrown hairs, cysts, or general irritation and chafing in the armpit.

Skin infections

A skin infection under the armpit may cause itching and pain. Bacteria thrive in warm, damp environments such as the armpits.

An overgrowth of bacteria in this area may lead to an infection, which could cause redness, swelling, and pain, among other symptoms.

Other forms of infection, such as fungal infections due to ringworm or yeast, may also cause similar pain and irritation in the area.

Mild skin infections should clear up without treatment if a person keeps the area clean and dry. However, a doctor may recommend antibiotic creams or medications to treat more severe cases.

Hidradenitis

Hidradenitis is a chronic condition that causes similar symptoms to severe acne. Hidradenitis occurs due to clogged hair follicles and glands. It is common in areas such as the armpits, where the skin rubs together.

Hidradenitis can lead to multiple cysts or boils developing in the area. In addition to these breakouts, the person will likely experience pain and tenderness.

Doctors can treat hidradenitis with anti-inflammatory medications. Some cases may require surgery.

Varicella zoster virus

The varicella zoster virus causes chickenpox and shingles. Breakouts of both illnesses are possible under the armpits, although chickenpox usually beginsTrusted Source on the face, back, and chest.

A shingles rash usually developsTrusted Source as a single strip on one side of the face or body, left or right. A person with shingles may also experience:

  • a fever
  • headaches
  • chills
  • an upset stomach

A person may feel pain and tingling in the area before the visible rash develops.

A doctor may prescribe antiviral medications to speed up the healing process, as well as pain medications to help ease symptoms.

Swollen lymph nodes

Lymph nodes are small, bean shaped bundles of tissue that play a vital role in the immune system. Lymph nodes help filter toxins from the lymph and deliver white blood cells to help fight disease.

The armpit houses a large number of lymph nodes. Lymph nodes swell as part of an overall reaction by the immune system, such as to an infection or illness.

Swollen lymph nodes in the armpit may cause:

  • a single or multiple lumps
  • tenderness
  • pain

If the swelling does not go down after an infection, such as the common cold, goes away, or the person is not feeling any other symptoms, they should speak to a doctor.

Psoriasis

Psoriasis is an autoimmune condition that leads to an overgrowth of skin cells. The buildup of skin cells forms patches called plaques. These plaques can cause symptoms such as itching and pain.

Psoriasis plaques can form anywhere, including the armpit. Some forms of psoriasis are more common in this area, including inverse psoriasis.

Psoriasis treatment typically includes both topical and oral medications to control symptoms.

Nerve damage

Nerve damage may also cause pain under the armpit. Nerve damage can be the result of a physical injury, such as one from overuse during sports or from an accident or fall.

Nerve damage can feel like:

  • pain
  • tingling
  • numbness
  • burning

Certain conditions, such as diabetes, may also lead to nerve damage or neuropathy. The National Institute of Diabetes and Digestive and Kidney Diseases note that up to half of people with diabetes have peripheral neuropathy, which is nerve damage.

While peripheral neuropathy typically affects the feet and legs, it may also affect the arms in some individuals. Diabetes treatment may help slow nerve damage progression.

Angina

Angina occurs due to a lack of oxygen-rich blood flow to the heart. This can be because one of the arteries leading to the heart is narrow or blocked.

Angina causes chest pain and discomfort, which is sometimes severe. It may also cause pressure and pain in other areas, including the:

  • armpits
  • shoulders
  • back
  • neck
  • jaw

Some people may also experience a feeling similar to indigestion.

Angina is a symptom of an underlying heart condition, for example, coronary heart disease, which can lead to a heart attack.

There are also many other types of angina. Anyone who suspects they have angina should talk to their doctor.

Cancer

In rare cases, pain under the left armpit that does not go away may be a sign of a cancerous growth, including breast cancer.

Cancer can cause the lymph nodes under the armpit to swell painfully. An individual may notice a lump under their arm or in their armpit that causes persistent pain or discomfort.

Underarm pain may also be the result of a specific cancer treatment, such as lymph node removal or mastectomy.

Anyone noticing texture changes or lumps in their chest or breast tissue should seek medical attention.

Treatment options for cancer will depend on its stage, which refers to how much it has spread. In general, earlier stages are easier to treat.

When to see a doctor

Anyone noticing the following symptoms along with left armpit pain should seek immediate medical attention:

  • shortness of breath
  • dizziness
  • pain in the chest, jaw, or shoulder

A doctor can also diagnose and treat pain from other issues, such as infections or swollen lymph nodes.

Pain under the left armpit from sources such as a pulled muscle should go away within about a week in most cases. Anyone who experiences symptoms beyond this time frame should see a doctor for a full diagnosis.

Summary

There are many possible causes of pain under the left armpit. The person may have pulled a muscle or may have swollen lymph nodes from an infection.

Other causes can be more serious, such as angina. Anyone concerned about their symptoms should see a doctor for a full diagnosis and treatment.

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“I used to be a full-time patient at this facility,” says Michelle Eze, a drug abuse survivor, as she signs her name in the register for a check-up with her psychiatrist at Karu General Hospital in Abuja, Nigeria’s Federal Capital Territory(FCT).

“I’m so glad I sought help in time as I was dependent on drugs and it cost me so much. It negatively affected the relationship with my family and people around me. I was disowned and left to face this harsh world all by myself. Drug abuse is a problem we should all join hands and fight it.”

Michelle is now a full-time ambassador against drug abuse among women.

One out of every four people who uses drugs in Nigeria is a woman, according to a 2018 report by the United Nations Office on Drugs and Crime (UNODC).

Over 300,000 Nigerians are high-risk drug users

Approximately 376 000 people – or about 0.4% of the Nigerian population aged 15-64 – are reckoned to be high-risk drug users, according to the UNODC report. Nearly 90% of these users regularly take opioids – particularly pharmaceutical opioids such as tramadol codeine, or morphine – while the others take cocaine or amphetamines.

Over 20% of the high-risk drug users inject drugs, with women first injecting on average at 20 years old and men first injecting on average at around 21 years old. HIV prevalence among women who inject drugs is almost seven times higher than among men who inject, according to the 2010 National Agency for the Control of AIDS (NACA) Integrated Biological and Behavioural Surveillance survey.

“At Karu hospital, we receive roughly 15 patients every day and usually at least half of them report to be using one drug or another,” says Pius Wabass, a psychiatric nurse on the Karu General Hospital’s psychiatry ward.

“These patients are often so young – under 40 – and, of late, more women are checking into our facility. The misuse of drugs

has serious health repercussions. Medically, opioids are primarily used for pain relief, including anaesthesia, while amphetamines are powerful stimulators of the central nervous system used to treat some medical conditions.”

Efforts to respond to drug use in Nigeria

As countries including Nigeria make efforts to respond to drug use among the population, health experts note that there are some factors that affect women more than men. A lot of factors have been identified as putting women at increased risk, some are psychological, cultural, social and economic aspects of their lives. Another issue is the general perception that drug use is a male issue and women users are often reluctant to seek help. The Federal Ministry of Health (FMOH) is now addressing this.

“The FMoH has taken up this challenge and currently working with all stakeholders to respond to drug use among young people, especially women,” explains Dr Jimoh Salaudeen from the Food and Drug Division, FMOH. As part of the response, a women-specific drug treatment programme has been established at the federal neuropsychiatric hospital in Kware in Sokoto State and the ministry hopes to replicate such centres across the country.”

Dr Salaudeen continues: “There is a strong linkage between opioid use disorders and health conditions such as preterm births, stillbirths, poor foetal growth, maternal death and neonatal abstinence syndrome. This is why the Ministry of Health has prioritized sexual reproductive health, particularly for women, within the context of drug treatment and harm reduction.”

Working assiduously to reduce drug demand and harm in Nigeria

The FMOH, with the support of WHO, established the National Technical Working Group (NTWG) on drug demand and harm reduction in Nigeria in May 2019.

“The NTWG is working under the leadership of the Minister of Health and is actively engaged in implementing a comprehensive public health response to the challenge of drug use in the country,” says Dr Rex Mpazanje, WHO Cluster Coordinator for Communicable and Non Communicable Diseases.Close

“This effort also includes bringing together different stakeholders at the national and state level for a concerted response. This includes advocacy, capacity building and resource mobilization to ensure promotion of evidence-based prevention activities and the availability of drug treatment and harm reduction programmes at community level.”

Target 3.5 of the United Nations 2030 Sustainable Development Goals (SDGs) is to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. WHO Nigeria will continue to support to the Government of Nigeria in achieving this goal.

The behavioural medicine unit of the Karu General Hospital, Abuja. Many drug abuse patients are treated here.

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