Category Archives: Neuro

Healthy posture and good lifestyle habits can prevent most cases of back pain and other spinal disorders, say doctors. With highly improved technology, spine surgery has become much safer and effective today; so have diagnostic procedures

Do you know that a large number of cases of back ache and other spinal disorders such as ruptured disc can be avoided if one adopts a good posture and regular exercise in his/her daily life?

“Spinal disorders are among the most common causes of hospital visits around the world. Most common spinal disorders include low back pain, neck pain, scoliosis and disc disease, to name a few. Spinal pain and disability can have a profound effect on a person’s overall health, sometimes preventing them from working or even doing simple daily activities. Over 80 per cent of adults will suffer back pain at some point in their lives. 50% of the working population will experience back or neck pain symptoms at least once per year. Age is one of the most common risk factors for spinal pain, and the greatest effects of population ageing are predicted in low- and middle-income countries. Back and neck pain is one of the most common reasons for workplace sick leave,” said Dr. Rahul Gupta, Senior Spine and Brain Surgeon, Fortis Hospital, Noida.

The good aspect is that many of these common problems can be avoided by undertaking simple lifestyle changes and adopting healthy habits.

Poor posture and inactivity are major contributors to the development of back pain and other spinal disorders. According to the World Health Organization, one in four adults is not active enough and over 80% of adolescent population is not active enough. Healthy posture and habits can help to maintain healthy back and healthy spine. Surgery is required in selective patients only else majority of spinal disorders can be managed by non surgical management under guidance of an experienced spine surgeon.

The good news is that 80- 90 % of the spine disorders can respond to life style changes, proper Ergonomics and physiotherapy. It’s the remaining patients who require surgical intervention.

Non surgical managements include proper posture while sitting, reading, writing, lifting weight,  using mobile etc. Regular walk, yoga, exercises, physical activities and sports help in  maintaining a healthy spine. In fact, by maintaining a good posture and ensuring a daily  physical exercise of at least 30 minutes can prevent a number of spinal problems,.

Another important part of maintaining good spine health is controlling weight as excessive weight is among the leading causes of spinal injuries such as slipped disc.

With the advances in anaesthesia, spine surgery can be performed safely including on patients suffering from blood pressure, diabetes, heart disease and other co morbidities. Also with availability of techniques such as like fluoroscopy and neuro-monitoring, execution of spinal surgery has become much safer today. CT scan navigation, O arm has increased the precision with which instrumentation in spine can be done. Patient undergoing spine surgery, are mobilized within 24 to 48 hrs after surgery. In case of patients presenting with spinal cord injury, mobilization depends on the severity of spinal cord injury and its recovery seen post surgery.

Healthy posture and good lifestyle habits can prevent most cases of back pain and other spinal disorders, say doctors. With highly improved technology, spine surgery has become much safer and effective today; so have diagnostic procedures
Do you know that a large number of cases of back ache and other spinal disorders such as ruptured disc can be avoided if one adopts a good posture and regular exercise in his/her daily life?
“Spinal disorders are among the most common causes of hospital visits around the world. Most common spinal disorders include low back pain, neck pain, scoliosis and disc disease, to name a few. Spinal pain and disability can have a profound effect on a person’s overall health, sometimes preventing them from working or even doing simple daily activities. Over 80 per cent of adults will suffer back pain at some point in their lives. 50% of the working population will experience back or neck pain symptoms at least once per year. Age is one of the most common risk factors for spinal pain, and the greatest effects of population ageing are predicted in low- and middle-income countries. Back and neck pain is one of the most common reasons for workplace sick leave,” said Dr. Rahul Gupta, Senior Spine and Brain Surgeon, Fortis Hospital, Noida.
The good aspect is that many of these common problems can be avoided by undertaking simple lifestyle changes and adopting healthy habits.
Poor posture and inactivity are major contributors to the development of back pain and other spinal disorders. According to the World Health Organization, one in four adults is not active enough and over 80% of adolescent population is not active enough. Healthy posture and habits can help to maintain healthy back and healthy spine. Surgery is required in selective patients only else majority of spinal disorders can be managed by non surgical management under guidance of an experienced spine surgeon.
The good news is that 80- 90 % of the spine disorders can respond to life style changes, proper Ergonomics and physiotherapy. It’s the remaining patients who require surgical intervention.
Non surgical managements include proper posture while sitting, reading, writing, lifting weight, using mobile etc. Regular walk, yoga, exercises, physical activities and sports help in maintaining a healthy spine. In fact, by maintaining a good posture and ensuring a daily physical exercise of at least 30 minutes can prevent a number of spinal problems,.
Another important part of maintaining good spine health is controlling weight as excessive weight is among the leading causes of spinal injuries such as slipped disc.
With the advances in anaesthesia, spine surgery can be performed safely including on patients suffering from blood pressure, diabetes, heart disease and other co morbidities. Also with availability of techniques such as like fluoroscopy and neuro-monitoring, execution of spinal surgery has become much safer today. CT scan navigation, O arm has increased the precision with which instrumentation in spine can be done. Patient undergoing spine surgery, are mobilized within 24 to 48 hrs after surgery. In case of patients presenting with spinal cord injury, mobilization depends on the severity of spinal cord injury and its recovery seen post surgery.
Usual presentation of spine problems:-
Pain in neck / back.
Radiating pain or tingling / numbness in arms or legs.
Weakness in hands or legs.
Imbalance while walking.
Decrease in walking speed & distance due to leg pain / heaviness.
Difficulty in standing, sitting, walking due to back or leg pain.
Difficulty to control urine / stool.
Bone TB— affecting vertebrae.
Spinal tumor.
Fracture vertebrae & spinal cord injury.
Deformity of spine–scoliosis, kyphosis.

Dr. Sonia Lal Gupta

Migraine headaches are one of the most common conditions which can affect us.  It is more common in women than men.  Having a family history of migraines increases the chances of having them too.

Migraine headache is a unilateral or bilateral headache which is typically pulsating and throbbing in nature accompanied by nausea/vomiting, light and noise sensitivity.  These headaches can last for 4 hours upto 72 hours.  Typically, patients with migraines like to stay in a dark room and try to sleep, hoping for some relief.

Migraines can be of 2 types:

1. Migraines with aura
2. Migraines without aura.

Aura’s are neurological symptoms that appear before the headache pain and occur in mostly about 40% of the patients.  Most common aura`s are visual changes (seeing colored lights or rainbow colors) but may also include speech disturbances or numbness in the arm lasting for 5- 60 minutes.  These aura’s are followed by headache which can last upto 72 hours.  Even after the pain is gone, a lot of patients complain of fatigue which can last upto 24 hours.

If migraine headaches occur for more than 15 days a month- they are known as chronic migraines. Chronic migraines can be debilitating for the patient as they affect the day to day life, both personal and professional. Hence it is very important to treat migraines before they become chronic and debilitating.

Migraine headaches can be caused by various triggers which include food triggers like red wine, chocolate, Monosodium glutamate (MSG). Other triggers can be lack of sleep, stress, weather changes, hot weather, bright lights and dehydration.  Some women, have migraines around their periods as well.

It is very important to recognize these triggers. Once the triggers are known, the treatment can vary and also preventing these triggers can avoid migraine attack.

Migraine diaries can be very useful in documenting these triggers and migraine attacks when patients seek medical help.

Prior to meeting the doctor, it is very helpful for patients to note the following in their migraine diaries:

1. Symptoms :Write their migraine symptoms and be prepared to provide information about the pain location, character, and associated symptoms (e.g., nausea, vomiting, light sensitivity)
2. Patterns and characteristics: Follow the onset and history of their headache symptoms over time. This will help determine any patterns or triggers, such as menstruation, travel, allergies or stress.
3. Medications: Record all medications (both prescription and over-the-counter) that they are taking and recall past treatments and their outcome that they take or have taken for headache. Also record other possible triggers that may impact headache such as caffeine, vitamins, or dietary supplements.
4. History: Learn about any possible family history of headache. Migraine often runs in families and this will help confirm a diagnosis.
5. Illnesses: Provide the necessary information about other medical conditions that may influence their headaches—such as depression, sleep irregularities or eating disorders.

By giving all the above information to the doctor, it can effectively help diagnose the type of headache the patient has and hence effectively treat the headache.

Migraines occur due to the release of neuro-chemicals in the brain which causes over-activity or excitation of the brain. This “over-activity” causes the migraine attacks. Hence it is important to treat these headaches with the right medications, which can help lower the activity and chemicals and hence decrease the headache.

There are 2 types of treatments which have to be given for migraine control.

1. Acute treatment of migraine: This means to effectively treat the pain and other symptoms of the migraine when they occur. There are multiple medications like paracetamol or ibuprofen which are available over-the-counter which can be used for treating the pain. The most important feature to treat the migraine attack is to treat it early. The longer you take for treating the headache, the more difficult it is to get the pain under control.

There are “migraine-specific” medications called triptans which the doctor can prescribe for treating the pain. Triptans specifically work on the chemicals released during an attack and is very effective in getting the symptoms under control is taken in time. They are not recommended to patients with a history of heart disease or stroke.

Medications for nausea and vomiting can also be used along with the other acute medications to effectively control the symptoms.

2. Migraine prevention :

Migraine patients do not want to suffer from an attack, so prevention is important, even if they suffer from only one attack a year. Those who suffer from frequent attacks will need more aggressive prevention strategies that sometimes include medication. This decision is made by discussing treatment and management options with the doctor.

Migraine prevention is indicated if the patient has

1. Disabling attacks despite appropriate acute treatment
2. Frequent attacks (>1 per week)
3. Insufficient or no response to acute drug treatment
4. Poor tolerance or contraindications for specific acute pharmacological treatments
5. History of long-term, frequent, or excessive use of pain medications (analgesics) or acute medications that make headaches worse (or lead to decreased responsiveness to other drug therapies)

The goal of the migraine preventive therapy is to:

1. Reduce frequency, severity, and duration of attacks
2. Improve responsiveness to treatment of acute attacks
3. Reduce level of disability
4. Maintain cost of care for migraine treatments
5. Reduce excessive or overuse of acute medications

When migraine preventive therapy is started, it may take 2-3 months before the patient may notice the decrease in frequency of headaches.  Hence, it is important to be diligent in taking the medications as prescribed by the doctor.  If there are any side effects, the doctor should be told right away, so an alternative can be used.

Treatment with Botulinum toxin injections is of the only approved treatment for chronic migraines.  In these, we inject the Botox medication in various muscles along the forehead, head and neck muscles, which are frequently involved in the migraine attack.  The treatment is given every 3 months and at-least 3 treatments are recommended to see the gradual lowering in the frequency and intensity of the headaches.  This is a good option for patients who have daily headaches and who have side effects from other preventive therapy as these injections are localized and hence have very few side effects.

Non –pharmacological treatments like meditation, Biofeedback and physical therapy are also effective for decreasing the migraine frequency and should be done along with the above treatments.

Migraine headaches can be treated effectively and it is important for patients to go to their physician and let them know about your headaches.  Proper management and treatment of these headaches can help improve the quality of life effectively.

(Dr. Sonia Lal is one of the world`s youngest and most qualified neurologist.  She was formerly Asst. Professor of Neurology at Loyola University, Chicago.   She is a Diplomate from American Board of Neurology, American Board of Vascular Neurology, United Council of Neurological Subspecialities – Headache Medicine and American Society of Neuro Imaging – Transcranial Doppler. Special Interest in Botox Injection for Migraine.)

Consultant Neurologist (Headache & Stroke Specialist)

Metro Center for Neurosciences, Noida.