Bulimia Nervosa

People who have bulimia will feel out of control when binging on very large amounts of food during short periods of time. They then desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person’s life and has a very negative effect, both emotionally and physically. People who have bulimia are usually normal weight or even a bit overweight.
Emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating, and withdrawal from friends and family.
Bulimia will likely inflict physical damage on the person’s body. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body’s electrolytes and leads to cardiac arrhythmias, heart failure and even death. If you have experienced these symptoms or are experiencing these symptoms do not be afraid to seek help. There are treatments available to you that can help you manage this and overcome this disorder. Be a positive, healthier you!!

By: Amanda Moret, PMHNP, FNP

Headache and Epilepsy

Headaches, especially migraines, and epilepsy have common clinical features. Both are neurological disorders that have a genetic predisposition and share a common pathophysiological mechanisms including an imbalance between excitatory and inhibitory factors that result in spells of altered brain function and autonomic symptoms.

Headache can be a sole manifestation of epileptic seizure and headache is commonly associated with preictal, ictal and postictal symptoms as in epilepsy patients. Headache in epilepsy patients can occur as an interictal, peri-ictal, ictal or postictal symptoms with diverse clinical features, making it difficult to differentiate migraine from epilepsy in some patients.

Migraine and epilepsy are highly comorbid conditions and several anti-epileptic drugs (AED) are also used to treat migraine patients. Valproic acid (VPA) and topiramate (TPM) are approved AED for the preventive use of migraine. Many other drugs including gabapentin, acetazolamide, carbamazepine, oxcarbazepine, and zonisamide are also suggested to have the preventive role for migraine.

The incidence of headaches associated with epileptic seizures is quite different among various studies, however, all studies consistently show that postictal headache is the most common type of headache, with the incidence from 24 to 60%. In one study, headache was the most frequently encountered postictal symptom in patients with epilepsy (38%) followed by dizziness and confusion, and the presence of postictal headache was very useful in differentiating patients with epileptic seizures from patients with non-epileptic seizures

Kim, D. W., & Lee, S. K. (2017). Headache and Epilepsy. Journal of Epilepsy Research, 7(1), 7–15. http://doi.org/10.14581/jer.17002

By: Tanesha Reynolds, DNP, FNP

Anorexia Nervosa

People with anorexia will deny themselves food to the point of self-starvation as they continue to obsess about weight loss. A person with anorexia will deny hunger and refuse to eat, practice binge eating and purging behaviors, or exercise themselves to the point of exhaustion as they attempt to limit, eliminate, or ‘burn’ calories.
Emotional symptoms of anorexia include irritability, social withdrawal, and lack of mood or emotions. They are often not able to understand the seriousness of the situation, will have a fear of eating in public, and have obsessions with food and exercise. Many times, food rituals are developed, or people may eliminate an entire category of food from their diet for fear of being or feeling ‘fat’.
Anorexia is very physical on the body. Low food intake and inadequate nutrition leaves the person very thin. The person’s body is forced to slow down to conserve energy which can cause irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythm, low blood pressure, dehydration, and difficulty sleeping. If you or anyone you know may be experiencing symptoms of anorexia don’t be afraid to seek help. There are treatment methods available to you, and your treatment providers include you in the care plan. Please reach out if you ever experience these symptoms.

By: Amanda Moret, PMHNP, FNP

Post Traumatic Headaches

Headache is the most frequently reported symptom after a traumatic brain injury. According to the American Headache Society, headaches can impact patients even five years after the injury occurred.

In a study of more than 300 moderate to severe post traumatic brain injury patients admitted to an in-patient rehab unit, over a five year period, “more than half of the headaches could be classified as migraine or probable migraine and over a third of patients had several headaches a week or daily headaches. Headache pain remained high over time with average pain rated between 5.6 and 6.4 based on a 0-10 scale.”

Do not write off your headache after a traumatic brain injury. Patients should document the frequency, intensity, and impact of headache on daily functioning, so their health care provider can determine the best treatment option.

There is no reason to suffer from intense headaches after an injury. Please call us at the Manhattan Center for Headache and Neurology for a consultation and one of our care providers will be happy to help you with an individualized treatment plan for your post traumatic headaches.

by: Tanesha Reynolds, DNP, FNP

Dissociative Disorders

Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness, and memory. People of all ages, races, ethnicities, and socioeconomic status may experience a dissociative disorder.
The symptoms of a dissociative disorder generally first develop as a response to a traumatic event to keep those memories under control. Stressful situations can worsen symptoms and cause inadequate functioning in daily activities. Each person’s symptoms may be different due to the type of dissociation they are experiencing.
Signs and symptoms include: significant memory loss of specific times, people, and events; out of body experiences such as if you were watching a movie of yourself; mental health issues such as depression, anxiety, and suicidal thoughts; a sense of detachment from your emotions or feeling emotional numbness; or a lack of sense of self-identity.
Treatments include a combination of medications and therapies. Antidepressants can help along with cognitive behavioral therapy (CBT). Dialectical behavioral therapy (DBT) is another option, as well as eye movement desensitization and reprocessing (EMDR) therapy. Ask your doctor what is right for you if you feel that you have experienced any of these symptoms.

How to Cope with Migraines in College

Moving from home to dorming on a college campus is a drastic change for freshman students. While the new found freedom and responsibility may be exciting, this transition is filled with situations that can trigger a headache or a migraine attack. Increased stress, new foods, and irregular sleep patterns are among the many triggers that can induce an attack. Identifying triggers and planning ahead of time can prevent migraines from disrupting your college experience.

Helpful hints to create a better college experience:

Visit your headache specialist in advance to help identify potential triggers based on your past history
You may develop new triggers in addition to your old prevalent triggers
Keep a strict headache diary as it can help to identify triggers, so you can avoid them
You may have a plan for your pre-existing migraines, but a change in plan will be warranted in this situation
Writing down how to handle potential scenarios can be helpful
Create a headache preparedness kit for your bookbag to manage sudden attacks
Stock the dorm refrigerator with water or power drinks to remain hydrated
If possible, visit the health care center at your college in advance to obtain the policy/process of reporting a headache or migraine attack
Notify your professors, academic advisors, roommates, and others ahead of time as they will be much more likely to work with you in the event of an attack.

Early Psychosis

Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what is not. Early, or first episode psychosis (FEP), refers to when a person first shows signs of losing touch with reality. Acting quickly and connecting the person with adequate treatment during FEP can be life altering and change their future for the better.
FEP rarely has a sudden onset. Usually the person has gradual non-specific changes in thoughts and perceptions, but they are unaware of what is going on. Families are often the first people to see the warning signs of FEP, therefore they often help the patient seek treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, stigmas, and feeling unsettled.
Determining when the onset of FEP is happening is difficult. Early warning signs include: a troubling drop in grades or job performance; trouble thinking clearly or concentrating; suspiciousness or uneasiness with others; decline in self-care or personal hygiene; spending significantly more time alone than usual; or strong inappropriate emotions or having no emotions at all. Treatment at this stage gives the patient a better chance of positive outcomes. The following are some signs and symptoms to be aware of for an episode of FEP: hearing, seeing, tasting, or believing things that others do not; persistent unusual thoughts that cannot be set aside regardless of what others believe; and the rest of the early warning signs.
If someone you know if showing any of these signs do not be afraid to talk to them about this. Seek treatment as soon as possible for this will give the patient the best opportunity for positive outcomes. Stigmas should not be associated, as this person is no different than anyone else. They are simply experiencing something that needs to be treated so they can feel better and better perceive reality.

Bipolar Disorder

Bipolar disorder is an illness that can cause dramatic shifts in people’s mood, energy levels, and ability to think clearly. These individuals experience extreme highs and lows, much different than the ordinary person’s normal ups and downs in life. The highs are known as mania, and the lows are known as depression. If left untreated this condition can worsen, however this mental illness is very treatable. With the right combination of medication, therapy, and a healthy lifestyle people can live well with bipolar disorder.
Symptoms and severity change with everyone. Some people may go years between having symptomatic phases, while others may have very distinct manic or depressive episodes. These episodes can also happen simultaneously, or in rapid succession which is known as rapid cycling bipolar. Being aware of your symptoms and achieving the correct diagnosis will help you to maintain your stability and your lifestyle.
To be diagnosed with bipolar disorder a person must have at least one episode of mania, or hypomania. Hypomania is exhibiting most of the same symptoms as mania but does not include psychosis. The down depression portion of bipolar disorder is often so debilitating to people that they may not be able to get out of bed, or function in their normal daily activities. Being aware and ensuring that you are treated early will give you the best outcome possible!!

Alarm Clock Headaches

Do you experience headaches only during sleep that causes you to wake up and lasting for up to 4 hours? If so, you may have what is called “Hypnic Headache” or ‘Alarm Clock Headache’. This is an uncommon headache disorder that occurs predominantly in females over 50 years old.

Pain is commonly on both sides of the head, but can also be on one side. Usually a dull or throbbing quality, but no restlessness as seen in patients who have cluster headaches.

Most patients engage in some activity after waking up (eating, drinking, showering, reading etc.) Some patients report improvement with a cup of coffee.

Before this diagnosis is given, other causes of headache developing during and causing awakening from sleep should be ruled out, such as sleep apnea, nocturnal hypertension, low blood sugar and medication overuse.

If you are awaken from sleep frequently due to a headache, please call us for a consultation.

Borderline Personality Disorder

Borderline personality disorder is a mental illness characterized by a cyclical pattern of varying moods, self-image, and behaviors. People with this diagnosis may experience intense episodes of anger, depression, and anxiety that can last from a few hours to a few days. They also tend to view things only in extremes, as in things are only extremely negative and bad, or things are extremely wonderful and good. Opinions of themselves, as well as other people, can change very quickly.
Historically Borderline personality disorder has been hard to treat, but newer evidenced based treatments are proving helpful. Cognitive behavioral therapy (CBT) helps people with this disorder change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others. Dialectical behavioral therapy (DBT) was developed specifically for those with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help control intense emotions, reduce self-destructive behaviors, and improve relationships.
If you or someone you know has been diagnosed with borderline personality disorder schedule a consultation at The Manhattan Center for Headache and Neurology. Our caring providers want to help you!