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Nearly Half of People With Migraine Don’t Seek Care



Many people with migraines were reluctant to seek treatment, mainly because they decided to self-manage or were concerned their migraines were not being taken seriously, a population-based survey found.

Nearly half (45%) of the OVERCOME (US) study participants were reluctant to get migraine treatment, and of those 42% had no migraine treatment in the past 12 months, reported Robert Shapiro, MD, PhD, from the University of Vermont at Burlington, in a presentation at the American Headache Society’s virtual meeting.

People who were reluctant to get migraine treatment said they wanted to manage the symptoms themselves (45%) or feared their migraines would not be taken seriously (35%). Many who did not receive migraine treatment showed at least moderate disability on the migraine disability assessment test (MIDAS), a measure of the effects of headache attacks on daily school, work, home, or social activities for 3 months.

“Given that nearly half of respondents are reluctant to seek migraine treatment, we urgently need to understand the rationale behind these barriers and encourage more effective dialogue between healthcare providers and migraineurs to improve their health outcomes,” Shapiro said.

OVERCOME was a prospective, web-based, multi-cohort survey conducted in 2018 and 2019 in a representative US sample. Respondents had one or more headaches or migraines in the past 12 months. Most of the respondents (94.6%) met the criteria based on a validated migraine screener using the criteria of the International Classification of Headache Disorders (ICHD-3). In addition, 60% had reported a diagnosis of migraine themselves from a healthcare provider.

Out of a total study population of 41,925 people, 39,494 respondents said they had hesitated to seek migraine treatment. The participants who were reluctant to seek help were mainly female (74%) with a mean age of 39 years. Almost half (45%) had a full-time job and about a third (32%) had a university degree. The mean BMI was 29.2 and 19.5% were currently using marijuana or cannabidiol.

About half (52%) had up to 3 migraine days a month; 21% had 4-7 days, 13% had 8-14 days, and 14% had 15 days or more. More than 80% had nausea, photophobia, or phonophobia with their attacks. Among participants who felt that their migraines were not being taken seriously, most were handicapped by migraines one or more days per week, on average.

Other main reasons people were reluctant to get migraine treatment were not believing that their migraines were severe or painful enough (29%), inability to afford treatment (29%), inadequate health insurance coverage (21 %) and the fear of being diagnosed with something serious (19%).

Of the participants who eventually consulted about migraines despite hesitation, the factors associated with their decision to seek help were a previous diagnosis of migraine, moderate or severe disability, and health insurance.

Several measures can improve migraine counseling and improve health outcomes, Shapiro suggested. “This could include making sure an accurate diagnosis of migraines is made, taking migraines seriously – that is, reducing stigma – and reducing institutional barriers and costs,” he said.

The study had several limitations. The survey data were reported themselves and are subject to a memory and selection bias. In addition, the researchers did not evaluate information about the time delay to counseling.

  • Judy George reports on neurology and neuroscience news for MedPage Today, and writes on Brain Aging, Alzheimer’s, Dementia, MS, Rare Diseases, Epilepsy, Autism, Headache, Stroke, Parkinson’s, ALS, Concussion, CTE, Sleep, Pain, and more. consequences


The study was supported by Eli Lilly.

Shapiro announced relevant relationships with Eli Lilly and Lundbeck.

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8 ways Covid has impacted teen mental health, and what we can do about it



A year and a half of bans, school closings, and social distancing have caught teens at a vulnerable stage in their emotional development, says Dr. Shelly Ben Harush Negari, a doctor who specializes in adolescent medicine.

Many children have forgotten or had no opportunity to learn how to behave outside the home. Others suffer the serious consequences of lost class time and socialization.

“Usually teenagers shift their focus from parents to friends. The social aspect is very important for their development and the creation of their own point of view. But the pandemic separates them from friends, ”says Negari, director of the Center for Adolescent Medicine at Shaare Zedek Medical Center in Jerusalem and a clinic for adolescent medicine at an HMO in Jerusalem.

How has the past 18 months affected teenagers? How can adults help them move forward as we learn to live with Covid-19 and other future pandemics?

In addition to Negari, ISRAEL21c interviewed clinical psychologist Batya Ludman, a member of the Psychotrauma and Crisis Response Unit of United Hatzalah and a member of the Advisory Board of Get Help Israel; clinical psychologist Stuart Chesner, director of the Israel Academy for Social and Emotional Learning (a teacher and parent education center); and clinical social worker Adimika (Mika) Smith of Positive Health Counseling.

They identified many issues that need to be addressed, but stressed that not every teenage boy suffers from the negative effects of the pandemic. Some even benefited from the extra time with their parents.

Chesner says it is a case of “the rich get richer and the poor get poorer”.

In other words, children with stable families, positive role models, and the ability to learn remotely and independently tend to be “stuck” at home. Children in the opposite situation are more at risk than ever before.

However, pandemic-related problems can affect any young person. Here are some of the concerns of our experts and practical tips for parents.


Dr. Shelly Ben Harush Negari, Director of the Center for Adolescent Medicine at Shaare Zedek Medical Center in Jerusalem. Photo courtesy of Dr. Negari

“Zoom created a situation in which young people are always looking at themselves [on screen] instead of their teacher and their classmates, ”emphasizes Negari.

“All of a sudden I got messages from kids saying they need to look better because others are looking at them and they want to look perfect when they go back to school.”

An increased obsession with body image can sometimes trigger eating disorders.

“I get calls from teachers, parents, and doctors every day about bulimia and anorexia cases, and treatment programs are flooded,” says Negari. “We’re seeing it at an earlier age and more requests for treatment, maybe because parents are more at home seeing what their kids are eating.”

Other pandemic-related factors that can lead to eating disorders include being at home all day with constant access to food and irregular sleep cycles, which distort feelings of hunger and satiety.

TIP: “Family meals are very important. Even if the children live without their familiar structures, eating together in the family makes sense to prevent eating disorders, ”advises Negari.


“Usually you have day and night and now it’s a mishmash – they sleep all day and watch Netflix and text messages with friends all night,” says Negari.

“The delayed sleep cycle has a strong influence on mood and hormones.”

TIP: When school is closed, find daytime activities that interest and stimulate your child. “You can find a buddy and get groceries for someone who’s locked up. You can try new recipes. You could make videos. Ask them what they think they can do instead of being in a doldrums, ”suggests Ludman.


Dr. Batya Ludman, clinical psychologist in Ra’anana. Photo courtesy Get Help Israel

“Some children, especially those with ADD, have a hard time maintaining interest in the face of insecurity and lack of routine and structure at home and in school,” says Ludman.

“A child I videotaped with during the day was in her pajamas under her covers. I could see that her room was a mess. I said, ‘Hey, your desk looks cool. Give me a tour of your room. ‘ She cleaned up quickly and then I engaged her. “

TIP: “We have to make sure that our children think about the future and don’t get the message from us that everything is lost and broken,” says Negari. “Teenagers’ brains are developing, and so much can be done. Encourage them to volunteer. They want to have the feeling of being part of something and doing something. “


Negari notes that quarantines and bans for teenagers with social anxiety are “like heaven”.

However, staying in their comfort zone does not give them an opportunity to practice social skills, which increases their existing anxiety in social situations.

On the flip side, teens who benefit from fellowship with their peers are afraid of not hanging out with friends.

Another fear trigger is the pandemic itself.

“I saw children who were afraid of going out, afraid of getting Covid or bringing it to their family,” says Ludman. “Some have sick family members and that scares them. Some have health problems that make them very anxious to go to school and see their friends. “

She notes that children are more afraid of not getting vaccinated than of getting vaccinated. “The vaccination gives them more freedom to get out.”

People in unsafe homes can become desperate for fear. “In a normally functioning home, it is not bad to be at home for two weeks. If the home is dangerous, two weeks are very stressful, ”adds Negari. “We’re seeing an increase in anxiety, depression, and even self-harm.”

TIP: Encourage children to express their feelings through writing, painting, or dancing, Ludman suggests. Many teens are open to learning breathing and relaxation techniques that will help them regulate themselves.


Dr. Mika Smith from Positive Health Counseling. Photo courtesy of Dr. Smith

“Parents need to limit their kids on social media and other forms of screen time,” says Smith.

“Research shows that people who look at a screen for more than eight hours change their brain waves. You have to do something physical outside to stimulate your brain and get off your screens. “

A study by the Hebrew University of Jerusalem, the University of Haifa, and Reichman University (formerly the Interdisciplinary Center) in Herzliya found that 83 percent of children and adolescents became screen addict during the pandemic.

Negari adds that teenagers can put themselves at risk by making connections with people in the virtual world, and parents should closely monitor these types of activities.

TIP: Parents need to investigate their children’s virtual encounters, says Smith. “Don’t be afraid to ask questions. They may be angry with you, but your questions show that you love them and could even save your child’s life. “


Dr. Stuart Chesner, director of the Israel Academy for Social and Emotional Learning. Photo by Shaya Chesner

“The main effect on emotional well-being is related to isolation,” says Chesner, who specializes in teenagers at risk.

“Isolation can be detrimental to anyone, but especially to teenagers who struggle to establish their identity and who really need role models to do so,” he explains.

“Because they are so isolated, teenagers have been prevented from interacting with many key role models such as counselors, teachers, and even athletes,” says Chesner.

He notes that children in lower socio-economic circumstances tend to have less positive role models in their personal sphere.

“When real role models are not available, they withdraw more into their fantasy world, create fantasy identifications – for example with a gangster rapper – and internalize values ​​that are unproductive and separate from them and their world. That increases all risk factors for any kind of bad outcome. “

TIP: Find ways in which positive role models are virtually present at home, says Chesner. “While we are used to using digital technology to make our interactions more efficient, we never thought of using it to improve the intimacy of our interactions, and now we need to find out. One idea is to schedule a Zoom meeting with a positive role model, perhaps a distant family member, where the meeting itself is the goal. “


While adults think more about the future, adolescents focus on the here and now, explains Negari. This fact should impact how parents communicate their expectations during the pandemic.

“To say that it is dangerous to go out with friends because they could get infected – it is too far away for them. Trying to make them afraid of the future doesn’t work. You need information about what is expected in the next two weeks. “

TIP: Tell the teenagers exactly what to expect in terms of mouthguards, hygiene, and distancing. “You can say, ‘I want you to be able to play basketball with your friends, and for that you have to do 1, 2 and 3,’” suggests Negari. Ludman encourages parents to reward following the rules and to draw conclusions for breaking the rules.


Many teenagers tell Negari that they filter what they tell their parents so their parents don’t worry.

“Parents can tell their children, ‘I am the adult and I am responsible for you. Do not worry about me; I’ll manage.'”

However, Ludman adds, “It’s okay to let her know when you’re having a difficult time. And when parents get the help they need, it helps the children.

“Even in these uncertain times, let’s get the message across that we can get through this together and make positive progress.”

TIP: Plan weekly “dates” with each child individually. Let them choose where to go for an hour and sit down and listen to what they have to say.

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‘Anomie in post-Covid world reason for more urban suicides’ | Nagpur News



Dr. Abhishek Somani, Professor, Department of Psychiatry, Indira Gandhi Government Medical College and Hospital, invokes the concept of “anomie” by French sociologist Emile Durkheim to explain the state of despair and hopelessness that many face after rounds of limitations and Go through isolation. An increasing sense of dejection is a very strong indicator of suicidal intent, adds a widespread sense of fear about the unpredictability of the disease, economic problems due to lockdown, an increase in alcohol and other substance use, resulting health problems, and verbal and physical violence added home. All of these are an important mix in leading a person to suicidal intent. In an interview with TOI, Dr. Somani, who is also the past president of the Psychiatric Society of Nagpur, elaborates on this burning issue.
Excerpts …
Q. What are your general observations on the upward trend in suicides?
A. The social fabric is getting weaker. The earlier concepts of shared families and extended families are now seen in fewer and fewer cases. That important safety net is now missing. With the world at your fingertips with the Internet, a Pandora’s box has been opened. So you are not only influenced by what is good, but also by things that are not so good. The Blue Whale game is a good example. The internet also draws attention to the lack of sophistication in one’s life. And since everyone publishes photos of the best time ever, a doubt creeps in: “Why am I not as happy as you are? Maybe I’m a failure. People got through the pandemic without any significant increase in suicide gestures in the immediate period. But the stress of the pandemic and its social, economic and personal effects will increase mental health problems in the long run, and we will see an increase unless urgent action is taken to alleviate these problems.
Q. Has the lockdown and Covid phase increased suicidality?
A. Surprisingly not. There was an immediate period of escalation in anxiety and depression as the pandemic level began to decline, but the incidence of self-harm and committed suicide was lower than expected. We can speculate that maybe everyone was in trouble together, so people drew strength from misery.
Q. Why are middle class people and even the financially secure people at the end of their lives?
A. Overall, the suicide rate tends towards cities. Large cities account for nearly 25% of suicide deaths in urban areas, according to NCRB 2019 data. The same data suggests that over 90% of suicides are committed by people from the lower social classes, but common sense suggests that it can be disgusting to have suicides reported by those who are better at hiding a shameful death .
Q. How do you justify this underreporting claim?
A. The French sociologist Emile Durkheim’s concept of “anomie” comes to mind. Anomie is a state of society in which generally accepted values ​​and meanings lose their acceptance, but new values ​​(with common consensus) have yet to be developed. People at risk develop a sense of senselessness and emotional emptiness. This feeling of helplessness and hopelessness is a strong indicator of suicidal intent. Financial stability is by no means a protection against psychological stress. Peace of mind emerges from feeling satisfied with everything one has. So money doesn’t do much to prevent suicide, but it definitely helps to hide it. Anomie can develop in the post-covid world where normal interactions and communication have become a risky activity. So putting on a mask and maintaining physical distance are not a natural part of our behavior.
Q. Are you suggesting that the mask and physical distancing need to go at some point?
A. We cannot maintain physical distance for life. You can see that people don’t put on their masks. Few of those who are very cautious or paranoid about Covid still adhere to the norms. Quiet, everyone has left. This is a kind of anomie that happens when normal social rules are given up or broken but nothing else could be picked up. This created a “I don’t know what to do” feeling. The normal structure of life is disturbed and there is no alternative. The mind cannot exist in an ambivalence. This ambivalence causes fear and fear has suicide as one of the results. You have to take sides, yes or no. There is a lot of indecision due to Covid. You don’t know when the pandemic will end, who will survive if you get infected.
Q. Is the pandemic the only cause of mental health problems?
A. All of the previous factors related to suicide have been accelerated by the stress caused by Covid and Lockdown. 33% of suicides are due to family problems, 17% to illness, 6% to addiction and 10% to money problems. Each of these factors increased during the lockdown. Some families have grown closer, but domestic violence has increased dramatically as any police officer will tell you. Alcohol consumption has risen sharply. Covid’s hospital stay has severely impacted the family’s savings. So overall, the pandemic has accelerated the fire of the mental health problems that people will face over the next few years. An increase in mental disorders would increase the number of episodes of self harm, unless we can make people aware of the importance of seeking help in a timely manner.
Q. What are the early signs and indicators of mental illness?
A. A noticeable change in a person’s behavior over a period of typically 2 weeks or more. He / she becomes more moody, loses interest in ordinary activities, appears withdrawn or aloof, sloppy looking, suddenly crying or flying in anger, talking about how better it would be if he / she wasn’t around, etc. But it requires a really keen eye to see that we often give a long rope to those who have recently suffered a traumatic event. We consider this part of normal sadness. Conversations about dying are not. The number of violent and homicidal offenses is increasing significantly, which can also be seen in the context of the lockdown-associated anomie, in which social rules and values ​​lose importance.
Q What are the solutions?
A. Prevention is easier said than done. It will take years of effort to create mental health professionals capable of meeting India’s tremendous needs. There are currently fewer than 10,000 psychiatrists in India, the overwhelming majority of whom serve urban areas. In the meantime, a sustained campaign in the media to highlight symptoms of mental illness, support and recognition from well-known personalities and simple things like a break from ambition, changes in a more balanced lifestyle, and sustainable life goals will help.


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She fought to save her child from an eating disorder. Now, she combats the misconceptions.



Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette


National Association for Eating Disorders –
Families supports and supports the treatment of eating disorders (FEAST):
UC San Diego Center for Treatment and Research for Eating Disorders –
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit –
EQUIP virtual family-based treatment program –
Parent and patient coaching by JD Ouellette:

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