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Some Natural Remedies For Headache and Migraine

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The lemon can be your best friend when you have a common headache. Simply cut a long strip of the rind and put it on your forehead  rub in the inside white part and then fasten it to your head. Sure, you will look a little nutty but who cares as long as it gets rid of the ache!

One may try this Magic Drink to stop headache instantly:
All you need is lemon juice and salt. Not many people know of this remedy, but it can be used by anyone with a migraine. You need high-quality salt, like Himalayan salt. Himalayan salt contains about 84 healthy elements. Salt increases the levels of serotonin in the blood, which will save you from headaches.

Get fresh lemons and squeeze the juice out of the lemons and add about 2 teaspoons of salt to the juice. Stir this mixture and then add water.

When the water has been added you can drink it immediately. You must drink the whole thing in order for it to work, don’t sip on it. It may not taste too great, but it will definitely get rid of your migraine.you need is lemon juice and salt. Not many people know of this remedy, but it can be used by

Also Butterbur Extract. Butterbur extract can help prevent a migraine. Scientists discovered Butterbur extract has the ability to prevent blood vessel expansion during a migraine, while also preventing inflammation which can intensify the migraine experience.

Relieving tension can often relieve migraine headaches. Tension can be relieved in many ways such as by taking a warm bath or shower, lying down in a quiet dark room to rest, putting something cold on the back of the neck (at the base of the skull) or having someone massage your neck muscles and possibly your temporal region to help relieve your tension and muscle spasms.

There are many other natural treatments available to migraine headache patients including the Soothe-A-Ciser Migraine Headaches Cushion. This pillow was designed by a chiropractor to help correct neck problems that can cause headaches.

HOME REMEDIES FOR HEADACHE AND MIGRAINES:-

* Place your thumbs right in the center of each temple Massage firmly using a circular motion for a minute or two, or until you feel relief.
* A hot water bath or shower may also help to relieve the headache.
* Eat 10-12 almonds, for a migraine headache.
* Make a compress by putting 5 drops of lavender essential oil in cold (or warm) water. Swish around a soft cloth, and then put it on your head or neck.
* Put your hands in hot water, which seems to pull the pressure out of your head.
* In some cases sleep gives relief to the headache. Sleeping on back give relief to the headache.
* Deep breathing is a great tension reliever. Deep breathing gives immediate relief to the headache.
* Tie a tight cloth around the head. It will decrease blood flow to the scalp and lessen the throbbing and pounding of a migraine.
* Avoid chocolate, aged cheese, red wine, citrus fruits. These foods all contain tyramine or other histamines which have been shown to begin migraines in people with food sensitivities.
* Prepare a paste of freshly ground clay or freshly ground sandalwood and apply to the forehead, let dry, rub off by hand and wash.
* Drink a teaspoon of honey in a glass of warm water or fill the stomach completely with water if not suffering from a cold.
* Take equal parts of natural apple cider vinegar and water place in a small pan on the stove, allowing it to boil slowly. When the fumes begin to rise from the pan, lean your head over it until the fumes are comfortably strong. Inhale for approximately 50 to 80 breaths.
* Juice of ripe grapes and is an effective home remedy for the migraine headache.
* Niacin has proved helpful in relieving migraine pain. Valuable sources of this vitamin are yeast, whole wheat, green leafy vegetables, tomatoes, nuts, sunflower seeds, liver, and fish.
* Take few leaves of the cabbage crush them, and then place in a cloth and bound on the forehead at bedtime, or when convenient during the day. The Compress should be renewed when the leaves dry out.
* Make a paste of the lemon crust. The paste should be applied, like a plaster on the forehead. It will provide great relief.
* Carrot juice along with spinach, or beet and cucumber juices, has been found beneficial in the treatment of migraine. In the first combination, 200 ml of spinach juice may be mixed with 300 ml of carrot juice to prepare 500 ml or half a litre of the combined juices. In the second combination, 100 ml each of beet and cucumber juices may be mixed with 300 ml of carrot juice.
* The patient should eat frequent small meals rather than a few large ones. Overeating should be avoided. Copious drinking of water is beneficial.
* Rutin removes toxic metals, which may cause migraines.
* Make a solution by adding half a teaspoon mustard seeds powder and three teaspoons water, put in the nostrils, it helps to decrease the migraine.
* A peppermint steam inhalation provides quick relief for sinus headaches.
* Mix 1 teaspoon finely ground cinnamon (called dalchini in India) in 1-teaspoon water and applies on the forehead. It is very effective in headache due to exposure to cold air.
* Make a paste from dry ginger with a little water or milk, apply to the forehead for relief of the headache due to sinusitis.
* Make a paste of 10-15 Basil leaves with 4 cloves and 1 teaspoon dried ginger and apply to forehead for sinus cure.
* Cut a potato into 4 pieces, place 2 in the center of your forehead and two at your temple (Hold the ones at your temples in place). Lie down in a dark room and close your eyes. It takes a while to work but it takes away the pain.

Herbal Remedies for migraines headaches:-

Migraine relief using Grapes:
Migraine relief can be obtained from the juice of ripe grapes and is an effective home remedy. It is said that King Jamshed of Persia, who was very fond of grapes, once stored the juice of grapes well packed in bottles and made it public that the bottles contained strong poison so as to prevent others from taking it. It so happened that the king\’s wife was struck with migraine and having obtained no relief from any treatment, decided to end her life by taking this so-called ?poison?. She took it several times in small doses and contrary to her expectations, it gave her great relief instead of killing her.

Migraine relief using Niacin:
Niacin has proved helpful in relieving migraine pain. Valuable sources of this vitamin are yeast, whole wheat, green leafy vegetables, tomatoes, nuts, sunflower seeds, liver, and fish. Vitamin I complex tablets containing 100 mg of niacin can be taken for the same purpose.

Relieving Migraine using Cabbage Leaf Compress:
An ancient folk remedy for relieving the pain of migraine is a cabbage leaf compress. A few leaves of the vegetable should be crushed, and then placed in a cloth and bound on the forehead at bedtime, or when convenient during the day. The Compress should be renewed when the leaves dry out.

Migraine treatment using Lemon Crust:
The crusts of lemon have also been found beneficial in the treatment of migraine. These crusts should be included into a fine paste in a mortar. The paste should be applied, it plaster on the forehead. It will provide great relief.

Natural Migraine headache treatment using Vegetable Juices:
Carrot juice, in combination with spinach like, or beet and cucumber juices, has been found beneficial in the treatment of migraine. In the first combination, 200 ml of spinach juice may be mixed with 300 ml of carrot juice to prepare 500 ml or half a litre of the combined juices. In the second combination, 100 ml each of beet and cucumber juices may be mixed with 300 ml of carrot juice.

Migraine relief diet:
Fasting on orange juice and water
It is essential to undertake a thorough cleansing of the system and adopt vitality-building measures. To begin with, the patient should resort to fasting on orange juice and water for two or three days. If the orange juice does not agree with the patient, juices of vegetables such as carrots, cucumber, and celery may be taken.
Avoid foods like white flour products, sugar, tinned or preserved foods, etc
Foods which should be avoided are white flour products, sugar, confectionery, rich cakes, pastries, sweets, refined cereals, greasy foods, tinned or preserved foods, pickles, condiments, and sauces.
All-fruit diet
After the short juice fast, the patient may adopt an all-fruit diet for about five days, taking three meals a day of fresh juicy fruits.
Well-balanced diet of seeds, nuts etc.
Thereafter the patient should follow a well-balanced diet consisting of seeds, nuts, grains, vegetables, and fruits. This diet should be supplemented with milk, yoghurt, buttermilk, vegetable oils, and honey. Further short periods of the all-fruit diet may be necessary at intervals of a month or two, according to the requirement of the case.
Eat frequent small meals, Copious drinking of water is essential.
The patient should eat frequent small meals rather than a few large ones. Overeating should be avoided. Copious drinking of water is recommended.

Other migraine treatment:
Take warm-water enema to cleanse bowels
During the initial two or three days of the juice fast, a warm water enema may be taken daily to cleanse the bowels.
Hot bath, cold compress applied to head
A hot fool bath, fomentation over the stomach and spine, cold compress (4.5\JC to 15.6\JC) applied to the head, and towels wrung out of very hot water and frequently applied to the neck will go a long way in relieving migraine headaches.
Plenty of exercise and walk in fresh air is essential
The patient should also take plenty of exercise and walk in the fresh air. Get the improperly named product Sinus Buster. The company has several products which are all named Sinus Buster. This one says it’s specifically for migraines. They have another one for headaches, so it’s kind of confusing.

It’s known to rid migraine suffers of their migraine pain INSTANTLY! The nausea feeling also goes away very quickly.

Himalayan Goji Juice: In traditional Chinese medicine, headache and dizziness are often said to be caused by deficiencies in kidney yin (vital essence) and yang (function). Goji is among the most frequently used herbs for restoring yin / yang balance. For more information go to HealthWealth.gitgojionline.com

The best natural remedy for migraines is the practice called Shiatsu or Acupressure. There are a number of exercises you can use on yourself. Get yourself a book, or check out a website.I use these exercises, as the pills make me feel worse. Good Luck! Prescription For Natural Cures (Balch & Stengler) suggests:

Homeopathic Combination Headache Formula
Magnesium citrate or malate – 200 mg 2-3 times a day
Feverfew herb – 250-500 mg daily for prevention\
5-Hydroxytryptophane (5-HTP) 50-100 mg 3 times a day
B-50 vitamin complex 1-2 times daily
Omega 3-6-9 essential fatty acid supplement daily
See the excellent book mentioned above for a good discussion by experts in the field of natural medicine. Good luck!

Coca tea is great for migranes, it is natural, it may not taste good alone ( it needs sugar) but it helps a whole lot.

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Try massage, specifically a type called Trigger Point Therapy. It was developed by a Dr Janet Travell. She was doctor to the white house under the Kennedy administration. You could also try acupuncture.

SLEEPING
The medicine and health information post by website user , ByeDR.com not guarantee correctness , is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions.

Sources:http://www.byedr.com/Alternative-Medicine/219-Alternative-Medicine-4.html

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Cyclic Vomiting Syndrome

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In cyclic vomiting syndrome (CVS), people experience bouts or cycles of severe nausea and vomiting that last for hours or even days and alternate with longer periods of no symptoms. CVS occurs mostly in children, but the disorder can affect adults, too.

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CVS has no known cause. Each episode is similar to the previous ones. The episodes tend to start at about the same time of day, last the same length of time, and present the same symptoms at the same level of intensity. Although CVS can begin at any age in children and adults, it usually starts between the ages of 3 and 7. In adults, episodes tend to occur less often than they do in children, but they last longer. Furthermore, the events or situations that trigger episodes in adults cannot always be pinpointed as easily as they can in children.

Episodes can be so severe that a person may have to stay in bed for days, unable to go to school or work. No one knows for sure how many people have CVS, but medical researchers believe that more people may have the disorder than is commonly thought (as many as 1 in 50 children in one study). Because other more common diseases and disorders also cause cycles of vomiting, many people with CVS are initially misdiagnosed until the other disorders can be ruled out. What is known is that CVS can be disruptive and frightening not just to people who have it, but to the entire family as well.

The Four Phases of CVS

CVS has four phases:

  • prodrome
  • episode
  • recovery
  • symptom-free interval

The prodrome phase signals that an episode of nausea and vomiting is about to begin. This phase, which is often marked by abdominal pain, can last from just a few minutes to several hours. Sometimes taking medicine early in the prodrome phase can stop an episode in progress. However, sometimes there is no warning: A person may simply wake up in the morning and begin vomiting.

The episode phase consists of nausea and vomiting; inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.

The recovery phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.

The symptom-free interval phase is the period between episodes when no symptoms are present.

Triggers

Most people can identify a specific condition or event that triggered an episode. The most common trigger is an infection. Another, often found in children, is emotional stress or excitement, often from a birthday or vacation, for example. Colds, allergies, sinus problems, and the flu can also set off episodes in some people.

Other reported triggers include eating certain foods (such as chocolate or cheese), eating too much, or eating just before going to bed. Hot weather, physical exhaustion, menstruation, and motion sickness can also trigger episodes.

Symptoms

The main symptoms of CVS are severe vomiting, nausea, and retching (gagging). Episodes usually begin at night or first thing in the morning and may include vomiting or retching as often as six to 12 times an hour during the worst of the episode. Episodes usually last anywhere from 1 to 5 days, though they can last for up to 10 days.

Other symptoms include pallor, exhaustion, and listlessness. Sometimes the nausea and vomiting are so severe that a person appears to be almost unconscious. Sensitivity to light, headache, fever, dizziness, diarrhea, and abdominal pain may also accompany an episode.

In addition, the vomiting may cause drooling and excessive thirst. Drinking water usually leads to more vomiting, though the water can dilute the acid in the vomit, making the episode a little less painful. Continuous vomiting can lead to dehydration, which means that the body has lost excessive water and salts.

Diagnosis

CVS is hard to diagnose because no clear tests—such as a blood test or x ray—exist to identify it. A doctor must diagnose CVS by looking at symptoms and medical history and by excluding more common diseases or disorders that can also cause nausea and vomiting. Also, diagnosis takes time because doctors need to identify a pattern or cycle to the vomiting.

CVS and Migraine

The relationship between migraine and CVS is still unclear, but medical researchers believe that the two are related. First, migraine headaches, which cause severe pain in the head; abdominal migraine, which causes stomach pain; and CVS are all marked by severe symptoms that start quickly and end abruptly, followed by longer periods without pain or other symptoms.

Second, many of the situations that trigger CVS also trigger migraines. Those triggers include stress and excitement.

Third, research has shown that many children with CVS either have a family history of migraine or develop migraines as they grow older.

Because of the similarities between migraine and CVS, doctors treat some people with severe CVS with drugs that are also used for migraine headaches. The drugs are designed to prevent episodes, reduce their frequency, or lessen their severity.

Treatment

CVS cannot be cured. Treatment varies, but people with CVS are generally advised to get plenty of rest; sleep; and take medications that prevent a vomiting episode, stop or alleviate one that has already started, or relieve other symptoms.

Once a vomiting episode begins, treatment is supportive. It helps to stay in bed and sleep in a dark, quiet room. Severe nausea and vomiting may require hospitalization and intravenous fluids to prevent dehydration. Sedatives may help if the nausea continues.

Sometimes, during the prodrome phase, it is possible to stop an episode from happening altogether. For example, people who feel abdominal pain before an episode can ask their doctor about taking ibuprofen (Advil, Motrin) to try to stop it. Other medications that may be helpful are ranitidine (Zantac) or omeprazole (Prilosec), which help calm the stomach by lowering the amount of acid it makes.

During the recovery phase, drinking water and replacing lost electrolytes are very important. Electrolytes are salts that the body needs to function well and stay healthy. Symptoms during the recovery phase can vary: Some people find that their appetites return to normal immediately, while others need to begin by drinking clear liquids and then move slowly to solid food.

People whose episodes are frequent and long-lasting may be treated during the symptom-free intervals in an effort to prevent or ease future episodes. Medications that help people with migraine headaches—propranolol, cyproheptadine, and amitriptyline—are sometimes used during this phase, but they do not work for everyone. Taking the medicine daily for 1 to 2 months may be necessary to see if it helps.

In addition, the symptom-free phase is a good time to eliminate anything known to trigger an episode. For example, if episodes are brought on by stress or excitement, this period is the time to find ways to reduce stress and stay calm. If sinus problems or allergies cause episodes, those conditions should be treated.

Homeopathic Treatment Suits well for Cyclic vomiting syndrome

Cyclic Vomiting Syndrome: Alternative treatment

Medical Acupuncture as Treatment For Cyclic Vomiting Syndrome

Complications

The severe vomiting that defines CVS is a risk factor for several complications:

  • Dehydration. Vomiting causes the body to lose water quickly.
  • Electrolyte imbalance. Vomiting also causes the body to lose the important salts it needs to keep working properly.
  • Peptic esophagitis. The esophagus (the tube that connects the mouth to the stomach) becomes injured from the stomach acid that comes up with the vomit.
  • Hematemesis. The esophagus becomes irritated and bleeds, so blood mixes with the vomit.
  • Mallory-Weiss tear. The lower end of the esophagus may tear open or the stomach may bruise from vomiting or retching.
  • Tooth decay. The acid in the vomit can hurt the teeth by corroding the tooth enamel.

Points to Remember

  • People with CVS have severe nausea and vomiting that come in cycles.
  • CVS occurs mostly in children, but adults can have it, too.
  • CVS has four phases: prodrome, episode, recovery, and symptom-free interval.
  • Most people can identify a condition or event that triggers an episode of nausea and vomiting. Infections and emotional stress are two common triggers.
  • The main symptoms of CVS are severe vomiting, nausea, and retching. Other symptoms include pallor and exhaustion.
  • The only way a doctor can diagnose CVS is by looking at symptoms and medical history to rule out any other possible causes for the nausea and vomiting. Then the doctor must identify a pattern or cycle to the symptoms.
  • CVS has no cure. Treatment varies by person, but people with CVS generally need to get plenty of rest and sleep. They may also be given drugs that may prevent an episode, stop one in progress, speed up recovery, or relieve symptoms.
  • Complications include dehydration, loss of electrolytes, peptic esophagitis, hematemesis, Mallory-Weiss tear, and tooth decay

For More Information

Information about cyclic vomiting syndrome is also available from

Cyclic Vomiting Syndrome Association
3585 Cedar Hill Road, NW.
Canal Winchester, OH 43110
Phone: 614–837–2586
Fax: 614–837–2586
Email: waitesd@cvsaonline.org
Internet: www.cvsaonline.org

National Organization for Rare Disorders Inc. (NORD)
55 Kenosia Avenue
P.O. Box 1968
Danbury, CT 06813–1968
Phone: 1–800–999–6673 or 203–744–0100
Fax: 203–798–2291
Email: orphan@rarediseases.org
Internet: www.rarediseases.org

Sources:http://digestive.niddk.nih.gov/ddiseases/pubs/cvs/index.htm

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Human Urine May Cure Blood Pressure

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A study has identified a hormone from human urine, a xanthurenic-acid derivative, which might help safely flush sodium out of the body and could be harnessed to develop more effective and safer treatments for high blood pressure, or hypertension.

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The Cornell and the Boyce Thompson Institute for Plant Research (BTI) study, co-authored by Frank Schroeder, an assistant scientist at BTI, developed a new technique for analysing complex mixtures of small molecules, making it possible to finally identify the natural hormone.

In the rat-model based study, Schroeder developed an approach based on nuclear magnetic resonance (NMR) spectroscopy of partially purified urine.

NMR spectroscopy is the most powerful tool chemists used to determine the structures of unknown compounds. It has only been used for the analysis of purified compounds.

In the study, the usage of the technique revealed three completely new compounds, each of which was subsequently synthesized and injected into rats. The rats’ urine was then monitored.

Two of the identified compounds, derivatives of a common metabolite xanthurenic-acid, raised sodium levels in the rat’s urine but kept potassium levels constant.

Schroeder said that while aldosterone was a steroid hormone, the newly discovered molecule was structurally more similar to such amino acid-derived neurotransmitters as dopamine and serotonin and, therefore, might also play other roles in the body.

“Now, we want to know what other functions these compounds have and whether they directly influence blood pressure,” Schroeder said.

The study is published in Proceedings of the National Academy of Sciences.

Source: The Times Of India

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Headaches

I have a headache.   Everyone   from children, teenagers and adults to the elderly   has said this at some time or the other. The statement may be true, or it may simply be an excuse to avoid an unwelcome conversation, person or venture. After all, the pain is in the  head  (no pun intended) and it cannot be objectively verified or measured.

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The brain itself is actually devoid of nerves and cannot feel pain. The sensations arise from receptors in the nerves in the surrounding structures such as the eyes, teeth, sinuses, facial muscles, scalp and the meninges (covering of the brain).

Acute pain may be due to an infection in any of these structures. If the headache is chronic and recurrent, it is probably due to tension or migraine, with an overlap between the two conditions.

During such a headache, biochemical analysis of the blood shows a drop in the levels of a neurochemical called serotonin and the trace element magnesium. This, in turn, stimulates the trigeminal nerve (one of the cranial nerves) and results in the release of substances called neuropeptides. Their action is dilatation and inflammation of the blood vessels of the covering of the brain. The result is a throbbing or dull, aching sensation in the head.

Tension headaches may not be confined to the head. There may be pain in the scalp, neck, jaw or shoulder. It may be associated with non-headache symptoms like insomnia, fatigue, irritability, loss of appetite or lack of concentration.

Migraines are the other type of recurrent headaches. They occur in 12 per cent of the population and are three times commoner in women. The headache may be familial, with many members of the family complaining of a similar indisposition. A typical migraine may be preceded for a few days by vague symptoms of drowsiness, irritability, depression, craving for sweets or increased thirst. A few hours before the onset of the headache, there is usually a typical aura with flashing lights, a feeling of lightening bolts in the head, tingling and numbness. (This differentiates migraines from tension headaches, which typically do not have an aura.) The headache that follows is throbbing and unbearable. It may last for a couple of hours or a whole day. It usually subsides with vomiting, leaving a physically and emotionally drained individual who has effectively lost a full working day.

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Migraine attacks are usually preceded by a typical aura with flashing lights, lightning bolts in the head, numbness, etc.

Devastated by the ailment, most sufferers learn to recognise and avoid triggers which precipitate the headache. Migraine may be due to  hormones, especially fluctuating levels of oestrogen and progesterone. This is the reason why migraines are commoner in women. They are also aggravated at the time of hormonal surges and changes like menarche, pregnancy and menopause.

Foods containing monosodium glutamate (an additive in Chinese food) and tryptophan (found in chocolates, oats, bananas, poultry and red meat) and some preservatives. This has lead to the coining of the term   Chinese restaurant headache.

Stress at home or at work, which can cause the release of chemicals.

Scents and perfumes or even the smell of paint.

Insomnia as well as excessive sleep.

Change in the weather.

Headaches are a source of anxiety, especially if they are severe and recurrent. There may also be the persistent nagging fear of a sinister diagnosis like a brain tumour. If you are worried,

Keep a   headache calendar, so that when you consult the physician you have precise documentation of the type, frequency and duration of the ailment.

Have an ENT (ear, nose and throat) evaluation to rule out sinusitis and an eye check-up for refractory errors or glaucoma.

If these are normal and the headache is still worrying, you need to consult a physician. You may require further tests like a CT scan or an MRI, especially if the headache is non-typical.

A physician needs to be consulted if :

The onset of the headache is abrupt and severe,

If it is associated with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties,

If it has occurred after a head injury or has suddenly appeared after the age of 50 years.

Most headaches respond well to a simple paracetamol or an NSAID (non-steroidal anti-inflammatory drug) like ibubrufen or tolfenamic acid preceded by an antiemetic like domperidone or stemetil. Lying in a darkened room also helps. Anecdotal evidence suggests that acupuncture or pressure are helpful.

CLICK & SEE:  Some Natural Remedies For Headache and Migraine

Lifestyle modifications help to reduce the severity and frequency of attacks. Triggers should be avoided. Aerobic exercise for 40 minutes a day like walking, jogging, running or stair climbing releases protective mood-boosting chemicals from the calf muscles in the leg. Regular yoga, Tai-Chi, meditation and relaxation also lessen the levels of tension causing chemicals, thus reducing attacks and improving the quality of life.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Source:The Telegraph (Kolkata,India)

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Carpal Tunnel Syndrome

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Definition:
Carpal tunnel syndrome (CTS) is a median entrapment neuropathy that causes paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The mechanism is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.  It appears to be caused by a combination of genetic and environmental factors. Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools. There is, however, little clinical data to prove that lighter, repetitive tasks can cause carpal tunnel syndrome. Other disorders such as bursitis and tendinitis have been associated with repeated motions performed in the course of normal work or other activities. Though considered a condition of modern times, carpal tunnel syndrome has actually been recognized since the 1880s…...CLICK & SEE

The carpal tunnel is an anatomical compartment located at the base of the palm. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. The median nerve provides feeling or sensation to the thumb, index finger, long finger, and half of the ring finger. At the level of the wrist, the median nerve supplies the muscles at the base of the thumb that allow it to abduct, or move away from the fingers, out of the plane of the palm. The carpal tunnel is located at the middle third of the base of the palm, bounded by the bony prominence of the scaphoid tubercle and trapezium at the base of the thumb, and the hamate hook that can be palpated along the axis of the ring finger. The proximal boundary is the distal wrist skin crease, and the distal boundary is approximated by a line known as Kaplan’s cardinal line. This line uses surface landmarks, and is drawn between the apex of the skin fold between the thumb and index finger to the palpated hamate hook. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both. Simply flexing the wrist to 90 degrees will decrease the size of the canal.

Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes atrophy of the thenar eminence, weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, as well as sensory loss in the digits supplied by the median nerve. The superficial sensory branch of the median nerve, which provides sensation to the base of the palm, branches proximal to the TCL and travels superficial to it. Thus, this branch spared in carpal tunnel syndrome, and there is no loss of palmar sensatio.

Symptoms
Numbness or tingling in the thumb and the first three fingers.
Shooting pains in the wrist and forearm, which may radiate into the shoulder and neck.
Weakness in the hand; difficulty picking up and holding objects.
Feeling that the fingers are swollen when no swelling is visible.

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one’s side, might be an associated factor. It can be relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction (see carpometacarpal joint §?Movements).

People with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index, middle fingers, and radial half of the ring fingers, which are innervated by the median nerve. Less-specific symptoms may include pain in the wrists or hands and loss of grip strength (both of which are more characteristic of painful conditions such as arthritis).

Some suggest that median nerve symptoms can arise from compression at the level of the thoracic outlet or the area where the median nerve passes between the two heads of the pronator teres in the forearm, but this is debatable. This line of thinking is an attempt to explain pain and other symptoms not characteristic of carpal tunnel syndrome. Carpal tunnel syndrome is a common diagnosis with an objective, reliable, verifiable pathophysiology, whereas thoracic outlet syndrome and pronator syndrome are defined by a lack of verifiable pathophysiology and are usually applied in the context of nonspecific upper extremity pain.

Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.
Causes:
Most cases of CTS are of unknown causes, or idiopathic. Carpal tunnel syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies.

Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. Carpal tunnel syndrome often is a symptom of transthyretin amyloidosis-associated polyneuropathy and prior carpal tunnel syndrome surgery is very common in individuals who later present with transthyretin amyloid-associated cardiomyopathy, suggesting that transthyretin amyloid deposition may cause carpal tunnel syndrome.

The median nerve can usually move up to 9.6 mm to allow the wrist to flex, and to a lesser extent during extension. Long-term compression of the median nerve can inhibit nerve gliding, which may lead to injury and scarring. When scarring occurs, the nerve will adhere to the tissue around it and become locked into a fixed position, so that less movement is apparent.

Normal pressure of the carpal tunnel has been defined as a range of 2–10 mm, and wrist flexion increases this pressure 8-fold, while extension increases it 10-fold. Repetitive flexion and extension in the wrist significantly increase the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel.

Work related:...click & see
The international debate regarding the relationship between CTS and repetitive motion in work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. The relationship between work and CTS is controversial; in many locations, workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation.

Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations, but it is unclear as to whether this refers to pain (which may not be due to carpal tunnel syndrome) or the more typical numbness symptoms.

A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors has been found to improve comfort in some studies. A 2010 survey by NIOSH showed that 2/3 of the 5 million carpal tunnel cases in the US that year were related to work. Women have more work-related carpal tunnel syndrome than men.

Speculation that CTS is work-related is based on claims such as CTS being found mostly in the working adult population, though evidence is lacking for this. For instance, in one recent representative series of a consecutive experience, most patients were older and not working. Based on the claimed increased incidence in the workplace, arm use is implicated, but the weight of evidence suggests that this is an inherent, genetic, slowly but inevitably progressive idiopathic peripheral mononeuropathy.

Other Associated conditions:
A variety of patient factors can lead to CTS, including heredity, size of the carpal tunnel, associated local and systematic diseases, and certain habits. Non-traumatic causes generally happen over a period of time, and are not triggered by one certain event. Many of these factors are manifestations of physiologic aging.
Examples include:

*Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons.
*With hypothyroidism, generalized myxedema causes deposition of mucopolysaccharides within both the perineurium of the median nerve, as well as the tendons passing through the carpal tunnel.
*During pregnancy women experience CTS due to hormonal changes (high progesterone levels) and water retention (which swells the synovium), which are common during pregnancy.
*Previous injuries including fractures of the wrist.
*Medical disorders that lead to fluid retention or are associated with inflammation such as: inflammatory arthritis, Colles’ fracture, amyloidosis, hypothyroidism, diabetes mellitus, acromegaly, and use of corticosteroids and estrogens.
*Carpal tunnel syndrome is also associated with repetitive activities of the hand and wrist, in particular with a combination of forceful and repetitive activities
*Acromegaly causes excessive growth hormones. This causes the soft tissues and bones around the carpel tunnel to grow and compress the median nerve.
*Tumors (usually benign), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. This is exceedingly rare (less than 1%).
*Obesity also increases the risk of CTS: individuals classified as obese (BMI > 29) are 2.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS.
*Double-crush syndrome is a debated hypothesis that compression or irritation of nerve branches contributing to the median nerve in the neck, or anywhere above the wrist, increases sensitivity of the nerve to compression in the wrist. There is little evidence, however, that this syndrome really exists.
*Heterozygous mutations in the gene SH3TC2, associated with Charcot-Marie-Tooth, confer susceptibility to neuropathy, including the carpal tunnel syndrome

Diagnosis:
There is no consensus reference standard for the diagnosis of carpal tunnel syndrome. A combination of described symptoms, clinical findings, and electrophysiological testing is used by a majority of hand surgeons. Numbness in the distribution of the median nerve, nocturnal symptoms, thenar muscle weakness/atrophy, positive Tinel’s sign at the carpal tunnel, and abnormal sensory testing such as two-point discrimination have been standardized as clinical diagnostic criteria by consensus panels of experts. A predominance of pain rather than numbness is unlikely to be caused by carpal tunnel syndrome no matter what the result of electrophysiological testing.

Electrodiagnostic testing (electromyography and nerve conduction velocity) can objectively verify the median nerve dysfunction. Normal nerve conduction studies, however, do not exclude the diagnosis of CTS: waiting for nerve tests to become positive may well prejudice the eventual duration and completeness of recovery, particularly of the thenar motor branch is involved.

Clinical assessment by history taking and physical examination can support a diagnosis of CTS.

Phalen’s maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms.  A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition. Phalen’s sign is defined as pain and/or paresthesias in the median-innervated fingers with one minute of wrist flexion. Only this test has been shown to correlate with CTS severity when studied prospectively.

Tinel’s sign, a classic — though less sensitive – test is a way to detect irritated nerves. Tinel’s is performed by lightly tapping the skin over the flexor retinaculum to elicit a sensation of tingling or “pins and needles” in the nerve distribution. Tinel’s sign (pain and/or paresthesias of the median-innervated fingers with percussion over the median nerve) is less sensitive, but slightly more specific than Phalen’s sign.

Durkan test, carpal compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed.
Hand elevation test The hand elevation test has higher sensitivity and specificity than Tinel’s test, Phalen’s test, and carpal compression test. Chi-square statistical analysis confirms the hand elevation test is not ineffective compared with Tinel’s test, Phalen’s test, and carpal compression test.

As a note, a patient with true carpal tunnel syndrome (entrapment of the median nerve within the carpal tunnel) will not have any sensory loss over the thenar eminence (bulge of muscles in the palm of hand and at the base of the thumb). This is because the palmar branch of the median nerve, which innervates that area of the palm, branches off of the median nerve and passes over the carpal tunnel. This feature of the median nerve can help separate carpal tunnel syndrome from thoracic outlet syndrome, or pronator teres syndrome.

Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if history and physical examination suggest CTS, patients will sometimes be tested electrodiagnostically with nerve conduction studies and electromyography. The goal of electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. When the median nerve is compressed, as in CTS, it will conduct more slowly than normal and more slowly than other nerves. There are many electrodiagnostic tests used to make a diagnosis of CTS, but the most sensitive, specific, and reliable test is the Combined Sensory Index (also known as Robinson index). Electrodiagnosis rests upon demonstrating impaired median nerve conduction across the carpal tunnel in context of normal conduction elsewhere. Compression results in damage to the myelin sheath and manifests as delayed latencies and slowed conduction velocities However, normal electrodiagnostic studies do not preclude the presence of carpal tunnel syndrome, as a threshold of nerve injury must be reached before study results become abnormal and cut-off values for abnormality are variable. Carpal tunnel syndrome with normal electrodiagnostic tests is very, very mild at worst.

The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome is not very clear.

Differential diagnosis:
Carpal tunnel syndrome is sometimes applied as a label to anyone with pain, numbness, swelling, and/or burning in the radial side of the hands and/or wrists. When pain is the primary symptom, carpal tunnel syndrome is unlikely to be the source of the symptoms. As a whole, the medical community is not currently embracing or accepting trigger point theories due to lack of scientific evidence supporting their effectiveness.

Treatment:
Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.
Generally accepted treatments include: physiotherapy, steroids either orally or injected locally, splinting, and surgical release of the transverse carpal ligament. There is no or insufficient evidence for ultrasound, yoga, lasers, B6, and exercise therapy.

The American Academy of Orthopedic Surgeons recommends proceeding conservatively with a course of nonsurgical therapies tried before release surgery is considered. Early surgery with carpal tunnel release is indicated where there is evidence of median nerve denervation or a person elects to proceed directly to surgical treatment. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks. However, these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, and carpal tunnel syndrome in the workplace.

How Supplements Can Help
Several studies have suggested that a vitamin B6 deficiency can make you susceptible to the numbness and pain of carpal tunnel syndrome. This vitamin is important in maintaining healthy nerve tissue, relieving inflammation, and improving circulation. It also may increase the brain’s production of the nerve chemical GABA (gamma-aminobutyric acid), which helps control pain sensations. If you don’t notice any improvement after taking vitamin B6 for three weeks, switch to pyridoxal-5-phosphate (P-5-P), a form of the vitamin that the body eventually produces as it breaks down vitamin B6. Some people find this form works better for them.
Taking vitamin C supplements may leave you vulnerable to carpal tunnel-unless you also get enough vitamin B6. One study involving 441 participants found that those deficient in B6 who took vitamin C daily were more likely to develop carpal tunnel syndrome than those who were B6 deficient but did not use vitamin C supplements.

In addition to B6, bromelain, a powerful anti-inflammatory enzyme found in pineapple, is very effective in treating the inflammation and any resulting pain. The combination of bromelain and vitamin B6 works better than either supplement alone. Turmeric, a member of the ginger family, is another useful herb. When turmeric is taken with bromelain, they enhance each other’s anti-inflammatory properties and together may help relieve the pain of carpal tunnel syndrome. Though turmeric is safe to use over the long term, cut the dose in half once your symptoms subside. (This herb can be expensive.)

What Else can be done:
Take frequent breaks when performing any repetitive hand activity, such as typing, knitting, or playing an instrument. Stop at least once an hour to flex your fingers and shake your hands.
Apply ice to your wrists when pain strikes. Use a flexible ice pack — or even a bag of frozen peas — and put it on for 10 minutes every hour to ease the pain and reduce the inlammation.
Elevate your wrists with a pillow when you lie down.
Salt promotes water retention, which can contribute to swelling and may aggravate the symptoms of carpal tunnel syndrome. Try reducing the amount of salt in your diet and see if it helps.

Supplement Recommendations
Vitamin B6
Bromelain
Turmeric

Vitamin B6
Dosage: 50 mg 3 times a day until symptoms subside.
Comments: 200 mg daily over long term can cause nerve damage.

Bromelain
Dosage: 1,000 mg twice a day during acute phase. Reduce to 500 mg twice a day when symptoms subside. Take between meals.
Comments: Provides 8,000 GDU or 12,000 MCU in acute phase.

Turmeric
Dosage: 400 mg 3 times a day.
Comments: Standardized to contain 95% curcumin. Should be used with bromelain.

Prognosis:
Most people relieved of their carpal tunnel symptoms with conservative or surgical management find minimal residual or “nerve damage”. Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent “nerve damage”, i.e. irreversible numbness, muscle wasting, and weakness. Those that undergo a carpal tunnel release are nearly twice as likely as those not having surgery to develop trigger thumb in the months following the procedure.

While outcomes are generally good, certain factors can contribute to poorer results that have little to do with nerves, anatomy, or surgery type. One study showed that mental status parameters or alcohol use yields much poorer overall results of treatment.

Recurrence of carpal tunnel syndrome after successful surgery is rare. If a person has hand pain after surgery, it is most likely not caused by carpal tunnel syndrome. It may be the case that the illness of a person with hand pain after carpal tunnel release was diagnosed incorrectly, such that the carpal tunnel release has had no positive effect upon the patient’s symptoms

Resources
Your Guide to Vitamins, Minerals, and Herbs
http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome

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