Health Information

ข้อมูลสุขภาพ

Articles by PhysiciansArticles by PhysiciansNewsletterVDOPodcast

Search

Insights from a Health Talk FM.102 Interview: Headaches - Assessing the Risks

Insights from a Health Talk FM.102 Interview: Headaches - Assessing the Risks   How dangerous are headaches?     The most prevalent complaint among patients admitted to the neurology department is headache, a symptom commonly associated with the nervous system. This condition can be attributed to the changes in modern society, where individuals are constantly in a rush, experiencing high levels of stress and sleep deprivation. However, it is important to note that headaches are not solely caused by stress or lack of sleep; they can also serve as a significant indicator of potentially severe ailments that may result in disability or even death.   Headaches can manifest at any age, with a higher incidence observed among individuals in the working-age bracket, as well as middle-aged and elderly populations. Each age group possesses varying susceptibility to different diseases. For instance, working-age individuals may be prone to less perilous conditions, while older adults are more likely to encounter more severe ailments. To simplify the categorization of headache symptoms, patients can be divided into two distinct groups: those exhibiting dangerous symptoms and those displaying non-dangerous symptoms.   In the category of non-threatening headaches, we commonly encounter conditions such as migraines and tension headaches (also known as headaches caused by muscle spasms or tension in the muscles). These types of headaches can be characterized as muscle tightness. Another example is cluster headaches, which may sound familiar to some. However, there are more types of non-dangerous headaches apart from these, while the dangerous group includes conditions like brain tumors, brain hemorrhage, ischemic stroke, meningitis, and occasionally shingles affecting the nerves in the brain.   In the case of non-dangerous headache conditions, such as migraines, they often exhibit distinct patterns. Generally, these headaches come and go, with a period of complete recovery in between. The duration of each specific condition varies; for instance, migraines should not last more than 3 days, while tension headaches may persist for days or weeks, depending on the triggers. Cluster headaches, on the other hand, occur for no longer than 3 hours at a time, but they can appear 2-3 times within a day, forming a series known as Cluster Migraine. The pain is typically concentrated on one side, although it can occasionally affect the other side, alternating between the right and left. Throbbing pain and significant discomfort are common characteristics, often accompanied by symptoms like nausea, vomiting, and a preference for remaining still in a quiet, dark place due to sensitivity to light, sound, and vibrations. Heat or warm temperatures can act as triggers for some individuals. Tension headaches are primarily caused by stress and sleep deprivation, and they create a sensation of pressure around the head, leading to persistent pain throughout the day. They frequently occur during working hours. Cluster headaches, however, persist on one side for an individual's lifetime. For instance, if the pain was previously experienced on the left side, it will continue to affect the left side. The pain is typically focused around the eye socket. Notably, autonomic nervous system symptoms accompany cluster headaches, such as swelling of the eyelid on the affected side, nasal congestion, and tears flowing from the same side. These symptoms disappear once the headache subsides and should not last longer than 3 hours.   The treatment approach varies depending on the type of headache. For migraines, there are specific medications available, such as triptans or ergots (although ergot usage is rare due to its side effects of excessive blood vessel constriction throughout the body). Instead, general painkillers and anti-migraine drugs are commonly used. In cases where the patient experiences frequent pain, occurring more than 2-3 times a month, continuous study and observation of the symptoms are crucial. Identifying triggers plays a significant role, and it is advisable to study and avoid these triggers.   In the case of migraines, if the pain begins, taking paracetamol can be helpful. Prompt medication intake during the aura phase (if the patient experiences aura before the onset of the headache) can lead to quick relief. Aura symptoms may include blurred vision, dizziness, and visual disturbances. For tension headaches, the focus is on reducing trigger factors, such as stress, ensuring sufficient sleep, and regular exercise. Painkillers are effective in managing the pain, and in some cases, antidepressants can also be beneficial. It is important to note that most painkillers for tension headaches are nonsteroidal anti-inflammatory drugs (NSAIDs), which can have stomach-related side effects. Therefore, if not necessary, they should not be taken for more than 5 days. If absolutely required, the maximum frequency should not exceed 15 days per month. Cluster headaches are less common but can be more intense. Oxygen therapy has shown positive results in alleviating cluster headache pain. However, it may not always be convenient for patients to always have access to oxygen, especially at home. In such cases, medications similar to those used for migraines can be employed, along with a preventive medication specific to cluster headaches. The administration of oxygen typically lasts for about 15 minutes to provide relief.   The dangerous groups of headaches can be identified through the following observations:   1. Rapid and intense onset: If the headache escalates from no pain to severe pain within a short period, such as within 1 minute, it is considered dangerous. This sudden and intense progression may indicate conditions like bleeding in the brain.   2. Late-onset headaches: Individuals who have never experienced headaches before, but suddenly develop pain after the age of 50, are at higher risk. Most non-dangerous headache conditions, such as migraines, tension headaches, or cluster headaches, typically manifest before the age of 50.   3. Altered patterns: Individuals who have had recurring headaches with a specific pattern, but suddenly experience changes in intensity, location, duration, or pain characteristics, should be cautious. These alterations, such as increased violence of the headache, shifts in pain location, longer duration, or awakening from sleep due to pain, are worrisome signs.   4. Neurological symptoms: The presence of additional neurological symptoms alongside the headache, such as sudden weakness, double vision, ringing in the ears (tinnitus), slurred speech, unsteady gait, or a stiff neck, should raise concerns about potential danger.   5. Underlying congenital diseases: Individuals with certain congenital conditions, especially those associated with low immunity, should be particularly cautious. For example, individuals with systemic lupus erythematosus (SLE) who are taking immune-suppressing medications should be suspicious of a potentially dangerous headache, as it could indicate an infection-related complication. These cases require closer attention due to the increased vulnerability. These observations help identify dangerous headache groups, which can include various conditions ranging from brain tumors to cerebrovascular diseases and meningitis. If the pain prevents sleep, it is particularly concerning, as sleep is typically considered a protective factor in non-dangerous headache conditions, often providing relief.   The location of pain plays a significant role in assessing the nature and progression of a disease. When seeking medical attention, doctors often inquire about the location of pain and its characteristics to aid in diagnosis. Specific pain locations can provide valuable information. For instance, pain concentrated in the eye sockets may indicate conditions like glaucoma, cluster headaches, or migraines. Patients should also take note of pain in other areas such as the forehead, temples, occiput (back of the head), or the middle of the head, as these positions can help the doctor make a more accurate diagnosis. Some diseases may cause pain throughout the entire head or in specific regions. However, patients' observations and descriptions can significantly assist in the diagnostic process. If there are signs of potential danger, such as worrisome symptoms or indications, a brain scan will likely be conducted to confirm any abnormalities in the brain. In cases where symptoms resemble meningitis, such as fever, generalized headache, nausea, vomiting, and a stiff neck, a lumbar puncture may be necessary to collect cerebrospinal fluid for further analysis. In certain situations, where there is suspicion of cerebral masses or cerebral ischemia, a detailed brain scan like an MRI (Magnetic Resonance Imaging) may be preferred, as it offers more comprehensive visualization. An MRI can include MRA (Magnetic Resonance Angiography) to assess the arteries or MRV (Magnetic Resonance Venography) to evaluate venous constriction that can cause headaches. Conversely, if there is a suspicion of bleeding, a brain CT scan may be performed, potentially accompanied by MRA or MRV to provide additional information.   The nature of the disease can be classified into three basic types based on the description of the pain:   1. Throbbing: A pulsating sensation synchronized with the heartbeat, indicating possible conditions related to vascular issues or migraines.   2. Sharp: A distinct, acute, and piercing pain, which may be associated with peripheral neuropathy.   3. Squeezing or tightness: A sensation of pressure or constriction, as if something is pressing on the head. This type of pain can be attributed to various causes, ranging from normal muscle tension to more serious conditions such as brain tumors.   The duration of the disease is an important factor to consider. Most benign conditions follow a pattern of recurring episodes with periods of complete recovery. The duration of each disease varies. For example, migraines typically last no more than 3 days at a time, with pain resolving before a new episode begins. Cluster headaches usually do not exceed 3 hours per episode, but multiple episodes can occur in a single day. Tension headaches may persist for days or weeks before subsiding. In contrast, the most dangerous diseases often have pain that does not go away completely, even with the use of pain medication like paracetamol. Symptoms associated with tumors may gradually worsen over time, while bleeding-related pain may have distinct characteristics, such as rapid onset and intensity that may stabilize but not fully disappear after taking pain medication. Noting what triggers or alleviates the pain can also aid in diagnosis. Patients should pay attention to activities or circumstances that improve or worsen their symptoms. For example, resting or getting adequate sleep may alleviate migraines for some individuals, while others may experience relief after vomiting, which often signals the end of a migraine episode. Therefore, these observations can provide valuable insights into the likely diagnosis.   Additionally, ensuring a good night's sleep is crucial, with at least 7 hours of uninterrupted sleep and high-quality sleep without disturbances. Poor sleep quality, such as snoring, can contribute to more frequent migraines. Patients should also be mindful of activities that worsen their symptoms, such as coughing, sneezing, or straining, as these may suggest increased intracranial pressure. Joint symptoms are important to consider as well. If fever, stiff neck, and generalized headaches are present, meningitis may be suspected.   The occipital area, located at the back of the head, can be associated with various diseases and conditions causing pain. Migraines, for example, can sometimes manifest as pain in the back of the head. Tension in the muscles of the neck can result in neck pain that radiates to the occipital region. Occipital pain can also be attributed to degenerative cervical spondylosis or even brain tumors. Apart from considering the location of the pain, other common symptoms and the nature of the disease are taken into account during the diagnostic process. Observing how the pain responds to certain actions or positions and assessing overall bodily symptoms are also important factors.   When seeking relief for muscle or cervical pain, it is crucial to exercise caution when receiving massages. Massages, particularly those involving stretching techniques, can be beneficial and provide relief. However, it is essential to ensure that the massage techniques used are correct. Improper methods, such as excessive twisting of the neck, can lead to blood vessel tears, which can be dangerous.   Certain benign headaches, like migraines, may improve as we age, potentially due to lifestyle changes. However, most of these headaches tend to persist in our lives. They can reoccur when triggered by certain factors. For instance, migraines may be triggered by consuming certain foods like coffee, alcohol, cheese, foods with high MSG content, or nitrates found in Chinese sausages. Lack of sleep or living in excessively hot weather can also act as triggers. It is crucial to be mindful of these triggers and make necessary lifestyle adjustments. When the pain occurs, specific pain medications may be required. Taking the medication promptly when sensing the onset of a migraine can help alleviate symptoms quickly and reduce the need for excessive painkillers. Monitoring the frequency of migraines is important. If they occur too often, preventive or control medications may be necessary. These medications aim to reduce the frequency and intensity of migraines, making them more manageable.   Some individuals may prefer non-medication approaches. For instance, for tension headaches or tight muscles, physical activities and stretching exercises can be beneficial. Engaging in physical stretching routines not only helps with muscle relaxation but also alleviates these types of headaches.   In terms of self-care, it is essential to pay attention to the characteristics of our headaches to determine whether they are indicative of a more serious condition. Seeking prompt treatment can increase the chances of healing and prevent potential complications associated with brain diseases.   Pongsakorn Tanayapong, M.D., Neurology Physician

See More

Heatstroke – An Illness of Summer

Global warming has become a major concern for everyone as the Earth’s temperature rises every day. As for Thailand, the weather is becoming hotter and hotter every year, which puts the public at risk of various disease and illnesses such as foodborne illnesses caused from consuming contaminated food and water. One illness that is not much talked about but is common during hot weather is "heatstroke". Symptoms of Heatstroke Heatstroke is a condition that occurs when the body becomes too hot, causing the core temperature to rise above 40 degrees Celsius. Symptoms typically include fatigue, weakness, loss of appetite, nausea, vomiting, agitation, confusion, headache, low blood pressure, fainting, and increased sensitivity to stimuli. It can also affect the circulatory system, leading to dehydration, seizures, loss of consciousness, liver cell death, rapid breathing, pulmonary edema, irregular heartbeat, muscle breakdown, shock, and fibrin accumulation in small blood vessels, which can cause organ failure and even death if left untreated. The causes of heat stroke can be categorized into two types as follow: Classical Heatstroke – occurs when the body is exposed to excessive heat from the environment, usually during hot weather or heat waves. It is more common in older individuals and those with chronic illnesses and is often related to central nervous system abnormalities. The key symptom is a high body temperature with absence of sweating. It can occur mostly when individuals are in enclosed spaces with poor ventilation during the heat waves. Exertional Heatstroke - caused by excessive and strenuous exercise, which often occurs during hot weather, especially among laborers and athletes. The symptoms are similar to classical heat stroke, but the difference is that this type of patients will have excessive sweating at first, before they stop sweating. Additionally, there may also be muscle breakdown with possible complications such as high blood potassium, high blood phosphate, low blood calcium, and presence of myoglobin in urine. This can lead to acute kidney failure, loss of consciousness, and severe bleeding from all organs. High Risk Group Individuals at risk of developing heatstroke include soldiers who undergo training without proper physical conditioning for hot weather conditions, as well as amateur athletes, workers in hot and humid environments, the elderly, bedridden individuals, heavy drinkers, as well as people with high blood pressure. Signs and Symptoms The main symptoms of heatstroke include a lack of sweat, progressively increasing body temperature, excessive thirst, dizziness, headache, confusion, nausea, rapid breathing, and vomiting. These symptoms are different from those of typical heat exhaustion. If such symptoms occur, immediate rest is necessary. If you encounter someone with heatstroke, you can provide basic assistance by: • Moving the person into the shade, laying them down, raising both legs, and removing their clothing. • Applying a damp, cool cloth or ice pack to their forehead, neck, armpits, joints, and the soles of their feet, along with using a fan, misting with water, and providing ventilation to help cool them down. • Pouring cold water on them to help reduce their body temperature as quickly as possible, and before quickly transporting them to the hospital. Prevention If you know you'll have to work in hot weather, you should prepare by regularly exercising outdoors at least three times a week for at least 30 minutes, over a period of two weeks (Heat Acclimatization) to acclimate your body to the hot weather. Before leaving home on hot days, drink 1-2 glasses of water and if you have to work or exercise in hot weather, drink 1 liter of water per hour, even if you don't feel thirsty. Wear light-colored, lightweight, and breathable clothing. Apply sunscreen with SPF15 or higher. Avoid being in the sun and avoid exercising in hot weather. Drink plenty of water during exercise. Avoid taking allergy or cold medication, especially before exercising or long exposure in hot weather. Avoid alcohol and narcotic-containing beverages. Small children and elderly should be in a well-ventilated room and not to be left alone in a closed car. Best wishes from Vibhavadi Hospital

See More

Hemorrhage in the Brain

Hemorrhage in the Brain   Dr. Prompong Peeraboon Neurological Surgeon, Vibhavadi Hospital Cerebral hemorrhage, also known as bleeding in the brain, is a condition that can lead to disabilities or even life-threatening situations. The majority of cerebral hemorrhages occur due to three main causes:   1.Small blood vessel rupture in the brain caused by vascular damage, high blood pressure, or diabetes. 2.Alteration of the cerebral ischemic state leading to bleeding. 3.Abnormal conditions such as arteriovenous malformation (AVM) or certain types of brain tumors.   Treatment Approach: Typically, when cerebral hemorrhage occurs, initial treatment involves medication. However, a significant number of patients require surgical intervention. There are two commonly used surgical methods: 1.Open craniotomy, which involves removing the blood clot from the brain through a surgical opening in the skull. 2.Stereotactic aspiration, a technique in which a special device is used to puncture and drain the blood clot in the brain. This method minimizes patient trauma, promotes faster recovery, and allows for a smaller incision. Regardless of whether the patient receives medical treatment or undergoes surgery, physical therapy and rehabilitation are often crucial for restoring normal physical function. The rehabilitation process is usually time-consuming and requires the patient's perseverance and cooperation.   Risk Factors for Cerebral Hemorrhage: 1.Hypertension. 2. Disorders affecting blood coagulation due to medication preventing blood from clotting properly. 3.Poorly controlled diabetes. 4.High levels of blood lipids.   It is evident that the aforementioned diseases often do not exhibit noticeable symptoms or only present mild symptoms. Therefore, regular physical examinations play a vital role in reducing the risk of cerebral hemorrhage. Treating these underlying risk factors not only reduces the chances of bleeding in the brain but also decreases the likelihood of other complications such as heart and kidney diseases.

See More

See More

Cerebrovascular Disease

Cerebrovascular Disease Cerebral Vascular Disease (CVD) is the second most common disease that occurs acutely, after heart disease. This type of disease usually affects the elderly or young people who cope with stress and engage in smoking behaviors, which often come with other illnesses such as hypertension, diabetes, and high blood lipids. When left untreated for a long time, or if someone has abnormal blood vessels or aneurysms, they can experience impaired blood flow to the brain, constriction, or even rupture. However, this does not mean that everyone with a stroke or rupture due to CVD will know they have this history or risk, unless they have an annual health check.   Symptoms Cerebrovascular disease is a potentially fatal or disabling disease caused by fat or blood clots in the cerebral arteries, leading to destruction of brain cells due to lack of oxygen. Symptoms of this disease often come on suddenly, and patients should pay close attention to their symptoms, as they can be unpredictable and may be fatal if overlooked. This silent threat should not be taken lightly.   Dangerous Signs 1. Walk: Not straight, staggering 2. Talk: Cannot pronounce clearly or cannot speak 3. Reach: Unable to reach and grab, lack strength, numbness of hands, arms, legs 4. Vision: Blurred, double vision 5. Feel: Severe headache or dizziness   Diagnosis By focusing on the detection of specific lab values that could indicate a risk of stroke, we can identify people who may never have appeared in medical records before. However, stress or behavior in life can also result in a stroke, and the critical moment of the brain cannot be known for sure. To determine the constriction of blood vessels in the brain that caused the symptoms, or the location of any ruptures, a computerized medical x-ray device or an MRI scan is necessary in order to receive prompt treatment.   Treatment   Stage 1: If a patient is showing symptoms of thromboembolism such as body numbness, loss of consciousness, relatives should bring the patient to a doctor within the first 2-3 hours. In this case, if it is not more than 3 hours, the doctor can give medicine to dissolve the blood clot in the brain, which is more effective than if the patient does not receive the drug.   Stage 2: If the patient has cerebral hemorrhage, they will need treatment and surgery. Key Hole Surgery is an innovation that can be used, which involves making a small hole in the head to drain the blood from the brain. This has many advantages, as it has a very small surgical wound and doesn't take long to recover. However, this group of patients is at risk of disability or may recover more slowly than the first group.   The best advice for patients is that if they are showing symptoms, they should see a doctor as soon as possible within 3 hours by choosing a hospital that has a team of specialists with expertise in cerebrovascular disease and closely caring for the patient (Fast Stroke Tract). They should also do rehabilitation medicine and observe themselves regularly, as it is hard to predict when a stroke may occur. The only proper answer to alleviate these crisis symptoms is to reach a doctor as soon as possible.   Caring for the Disease Taking care of yourself to protect from disease should start at a young age. Regular exercise is important to stay healthy and fit, and it is also important to check risk factors such as blood pressure, blood lipids, and liver values regularly. Additionally, it is important to check your heart regularly. Eating nutritious foods, avoiding stress, and getting enough sleep are also important for overall health and to help prevent disease. Dr. Prompong Peerabul Neurosurgeon, Vibhavadi Hospital

See More

โรคลมชัก (epilepsy)

Epilepsy Pongsakorn Tanayapong, M.D. Neurologist, Vibhavadi Hospital Epilepsy is a prevalent disorder of the central nervous system. It is caused by an unexpected and simultaneous surge of electrical activity that passes through different portions of the brain. This can cause seizures in various forms, such as convulsions or confusion, among others. If a person has more than one seizure without a clear cause, they are considered to have epilepsy. Seizures can be divided into two categories: generalized seizures which affect the entire brain, and partial seizures which affect only a single area of the brain. Generalized Seizures, commonly referred to as epileptic, are seizures that affect all parts of the brain and can manifest without warning. The most common type of generalized seizure is a generalized tonic-clonic seizure, during which the patient will experience spasticity and rhythmic contraction and relaxation of muscles. After a seizure, the patient will often experience postictal symptoms such as confusion and headache before returning to normal. In addition to generalized seizures, there are other types of seizures that can be caused by malfunction of all parts of the brain, such as absence seizures. Partial Seizures are seizures that affect only a portion of the brain. The effects of the seizure vary depending on which brain area is affected, and these seizures can be divided into two categories based on the patient's level of consciousness: Simple Partial Seizures and Complex Partial Seizures. If the patient is alert during the seizure, it is classified as a Simple Partial Seizure. Depending on which area of the brain is affected, symptoms can include convulsions, flashes of light, or numbness in the face or body. If a patient experiences Complex Partial Seizures, which involve changes in perception and automatisms such as grabbing clothing or objects, muttering, or repetitive chewing, they may have little to no recollection of the event during the seizure. Partial Seizures, which affect only one part of the brain, can spread to affect all parts of the brain, at which point they become known as Secondarily Generalized Seizures. If the symptoms progress quickly, the patient may not be aware that they have had a Partial Seizure, making information from people close to the patient very useful in determining what occurred during the seizure. Especially with generalized seizures or complex partial seizures, the patient may not remember the events that have happened.                                                                                                                                                                                                                                                                                                                                                             Causes of Epilepsy  

See More

Happy&Healthy, Health Talk FM.102 every Saturday 9:00–10:00 a.m.: Sleep Apnea

Happy&Healthy, Health Talk FM.102 every Saturday 9:00–10:00 a.m.: Sleep Apnea   Sleep Apnea   Snoring is a symptom that can affect individuals of all genders and ages, and it is important to recognize it as an early warning sign of potential health risks. It can have various negative impacts on our well-being, such as morning headaches and excessive daytime sleepiness. Prolonged and loud snoring can even have adverse effects on the brain and heart. It increases the risk of developing conditions like sleep apnea, high blood pressure, coronary heart disease, and cerebrovascular diseases, including stroke and paralysis.   Obstructive sleep apnea is a specific type of sleep disorder characterized by the narrowing of the airway passages. This narrowing leads to breathing difficulties, including shallow breathing or complete cessation of breathing. When breathing stops, the oxygen levels in the blood decrease, impacting the functioning of other organs in the body.   Sleep apnea commonly occurs in individuals with excessive tissue in the neck or sagging tissue that narrows the airway. Certain risk groups are more prone to this condition, including overweight individuals, those with abnormal facial structures like small jaws, older adults with brain diseases or muscle weakness, individuals who consume alcohol or use sleep-inducing medications like benzodiazepines. Men are often at higher risk than women, although women post-menopause can experience a resurgence of risk due to changes in muscle tightness. Additionally, individuals with cerebrovascular diseases or heart conditions may experience sagging of the pharyngeal muscles or thickening of tissues around the neck, further narrowing the airways.   Symptoms that indicate the presence of sleep apnea include:   1. Loud snoring. 2. Interruptions in snoring followed by complete silence, or occasional abrupt awakenings due to gasping or choking for air. 3. Frequent headaches upon waking. 4. Feeling unrefreshed after sleep, as if not having had a restful night. 5. Experiencing a sore throat or dry throat upon awakening. 6. Excessive daytime sleepiness, often leading to unintentional napping in inappropriate situations, such as while driving. 7. Individuals with poorly controlled underlying conditions, such as high blood pressure, may require at least three types of blood pressure medication.   If left untreated, sleep apnea can have direct impacts on the brain and cardiovascular system. In the initial stages, it can lead to persistent daytime sleepiness, decreased concentration, mood changes, irritability, or even depression. In older individuals, it can contribute to the development of dementia. The effects on the heart and blood vessels occur during episodes of respiratory arrest, where the body experiences a lack of air. As a compensatory response, the heart works harder and faster, leading to potential complications such as irregular heartbeat, heart attack, arterial hardening, high blood pressure, or cardiovascular diseases like myocardial infarction and cerebrovascular diseases, including paralysis.   Diagnosing sleep apnea involves a comprehensive approach that includes obtaining a detailed medical history, conducting a thorough physical examination, and performing sleep monitoring tests, such as polysomnography or sleep tests. These tests help assess the severity of the condition and guide treatment recommendations. During sleep examinations, devices are used to monitor various bodily changes, including brain waves, oxygen levels, heart waves, and muscle activity. Before undergoing the examination, patients are advised to abstain from stimulants like tea, coffee, cocoa, or other substances that can disrupt sleep, as well as certain medications that may affect sleep.   The severity of sleep apnea is typically determined by the Apnea-Hypopnea Index (AHI), which measures the number of breathing interruptions per hour. AHI values ranging from approximately 5 to 15 are considered mild, while 15 to 30 are classified as moderate. AHI values exceeding 30 are considered severe, requiring immediate treatment due to the potential negative long-term effects associated with the condition.   Treatment   1. Continuous Positive Airway Pressure (CPAP): This is the primary and most effective treatment for sleep apnea. It involves wearing a mask connected to a machine that delivers a continuous flow of air pressure to keep the airway open while sleeping. CPAP helps prevent breathing interruptions, fainting, and snoring.   2. Dental devices: These are custom-made oral appliances that are fitted by dentists. The dentist will assess if there are any contraindications, such as jaw joint disease or suitability based on the number of teeth. These devices work by keeping the airway open during sleep and are only worn while sleeping.   3. Surgical interventions: Surgical options are considered when CPAP and dental devices are ineffective or not suitable for the individual. An otolaryngologist specializing in sleep disorders will evaluate the underlying cause of airway narrowing. For example, in some cases, the tonsils may be removed, or excess tissue behind the uvula and soft palate may be corrected. The decision to pursue surgical intervention is made on a case-by-case basis.   To prevent the disease, it is important to maintain a healthy weight and avoid becoming overweight. It is also essential to treat any nasal diseases, such as nasal allergies, rhinitis, or deviated nasal wall, to prevent narrowing of the airway in the future. Avoiding alcohol consumption is also recommended as it can cause the muscles to relax. Smoking can cause swelling of the nasal mucosa and should be avoided. Individuals using benzodiazepine sleeping pills should consult a sleep doctor to adjust their medication to prevent the occurrence of obstructive sleep apnea. Additionally, allowing excessive weight gain can increase the risk of developing obstructive sleep apnea and other related diseases. Therefore, if an individual or their spouse and child snore loudly on a regular basis, they should visit a doctor for advice and appropriate treatment.   by Dr. Pongsakorn Tanayapong, Neurological Pathologist

See More

Discover the Power of Transcranial Magnetic Stimulation (TMS) in an Exclusive Interview on Health Talk FM.102's Happy & Healthy Program

Transcranial Magnetic Stimulation (TMS)            Individuals living with paralysis caused by cerebrovascular disease often face disabilities and challenges related to speech, swallowing, and self-care. Traditionally, physical therapy has been the primary approach for muscle rehabilitation, aiming to restore some functionality, albeit not to the level experienced before. However, over the past two decades, a team of doctors and researchers in the United States has made significant advancements in the field. They have developed a technique known as Repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of brain disorders. This technique involves using magnetic waves to stimulate the brain, effectively adjusting its function from a distorted state to a more stable one. By inducing nerve impulses using magnetic waves, this method is non-invasive and safe for patients.            Advancements in treating brain disorders through the use of magnetic fields continue to evolve. In more recent developments, individuals may be familiar with brain-stimulating batteries being implanted to address conditions like Parkinson's disease. However, the current technology allows for the treatment of brain abnormalities without the need for invasive procedures like craniotomy. This non-invasive approach, known as Non-Invasive Brain Stimulation (NIBS), not only reduces the risk of complications but also offers significant cost savings.           Magnetic therapy, known as magnetic resonance therapy, involves the conversion of electric current into magnetic waves. In the field of medicine, this treatment is referred to as Transcranial Magnetic Stimulation (TMS). It offers potential benefits for various conditions, particularly those affecting the brain system, such as paralysis, paresis, Parkinson's disease, and psychiatric disorders, including depression.           One significant advantage of magnetic brain stimulation is its high safety profile, as it does not involve the use of electricity. Consequently, the risk of side effects is minimized. The procedure relies solely on magnetic waves and is conducted under the close supervision of specialist doctors, utilizing computer-controlled high-precision techniques. Prior to treatment, a medical professional carefully diagnoses the patient and reviews their medical history. It is important to avoid magnetic therapy in patients with metal implants in the brain, individuals with electronic implants, and those with a history of epilepsy.            Before undergoing magnetic brain stimulation treatment, certain preparations may be necessary. The doctor may conduct a preliminary examination on the same day or schedule an appointment for a later time. Typically, there is no need to fast or restrict food and water intake, but ensuring an adequate amount of sleep is recommended. It is important for the patient's relatives and caregivers to be aware of the nature of the patient's condition and how best to support them. The treatment duration for magnetic brain stimulation is typically around 20 minutes per session. During the procedure, the doctor may provide advice or inquire about any symptoms experienced. Possible side effects, such as lightheadedness or dizziness, may occur but usually resolve after a brief period of sitting. Patients are usually able to return home afterward and do not require overnight hospital stays.            The magnetic brain stimulation procedure begins with the patient wearing a hat. The doctor positions the magnetic stimulator and performs a test on the patient's arms and legs to ensure proper functioning of the equipment. Then, the treatment process commences by applying the device to the head area and emitting magnetic waves. The number of sessions and frequency of treatment depend on the specific condition of the patient. Treatment can be conducted daily, or if more convenient, it can be scheduled for two or three times a week. However, the total duration of treatment typically consists of ten sessions.   Brain magnetic stimulation (TMS) is an exceptionally safe treatment method with minimal side effects. Consistency in receiving the treatment is crucial for achieving optimal results. If the patient or their relatives have any concerns or doubts, it is encouraged to have a detailed discussion with the doctor. The doctor will provide a thorough explanation to assure that undergoing the treatment is safe and can contribute to improving the patient's condition.   by Samart Nithinan, M.D. Neuropathic physician

See More

Unraveling the Link Between Snoring and Serious Illnesses: Understanding the Risk of Sleep Apnea

Snoring presents challenges for both the individuals who snore and those around them. Snorers are at risk of developing various health issues, including high blood pressure, heart disease, and brain disorders. Snoring occurs when airflow is restricted due to narrowing of the airway, leading to vibrations in the throat tissues like the soft palate and uvula, resulting in the characteristic snoring sound. While snoring can also affect children, the causes differ from those in adults. In children, snoring is often attributed to an abundance of tissue in the throat, and the narrowing of the airway can be triggered by various factors.   Causes of snoring: 1. Excessive tissue in the pharynx, such as enlarged tonsils. 2. Being overweight, leading to fat accumulation in the abdominal area and around the tissues in the throat. 3. Narrowing of the airway due to a small facial structure, which is more common in Asian populations. 4. Weak muscles, which can occur naturally with age or be influenced by neurological or brain diseases. Certain medications like sleeping pills and alcohol can also contribute to muscle relaxation. 5. Gender: Males tend to experience snoring more frequently than females, as female hormones contribute to muscle tone.   Characteristics of snoring: Snoring is the production of noise during sleep. In normal sleep, there should be minimal or no snoring. If snoring is loud, it can be considered dangerous. Snoring severity can be categorized into three levels:   1. Level 1: General snoring that occurs infrequently and is not very loud. It typically doesn't affect breathing during sleep but may disturb the sleep partner. 2. Level 2: Frequent snoring that happens more than three days a week. This level of snoring can partially obstruct breathing during sleep, leading to daytime sleepiness and fatigue. 3. Level 3: Persistent and loud snoring daily. Snoring at this level often accompanies sleep apnea, where the airway is partially or completely blocked for approximately 10 seconds, resulting in insufficient oxygen supply to the brain. This can significantly impact daily life.   Treatment process: 1. CPAP (Continuous Positive Airway Pressure) Machine: This treatment involves using an air compressor, known as a CPAP machine, to generate sufficient air pressure that opens the airway during inhalation and exhalation. The machine delivers the air into the respiratory tract through a mask worn over the nose or mouth. 2. Oral Appliance: Dental equipment, also called an Oral Appliance, can be used to hold the upper and lower jaws together and advance the lower jaw forward. This helps prevent the tongue and jaw from falling back due to gravity, thereby widening the upper airways while sleeping. Oral appliances are suitable for patients with normal snoring or intermittent sleep disorders, including both non-threatening snoring and dangerous snoring. 3. Surgery: Surgery is considered when other treatments or conventional methods have not been effective. It aims to expand the airway by using laser technology to reshape the soft palate, uvula, base of the tongue, and nasal mucosa to an appropriate size. This surgical procedure improves breathing and reduces snoring. After the surgery, patients can typically return home immediately, although they may experience some soreness for about a week.            Snoring can cause various complications. When the airway closes or breathing is stopped during snoring, the oxygen levels in the body decrease, which can lead to oxygen deprivation. This may cause the brain to wake up and resume breathing, leading to fragmented sleep and causing various health problems such as stress, depression, and dementia. Additionally, decreased oxygen levels can put extra strain on the heart, causing it to work harder and potentially leading to high blood pressure, cardiac arrhythmias, and other cardiovascular problems.   By Dr. Pongsakorn Tanayapong Brain and Nervous System Specialist

See More

Vertigo

Vertigo Vertigo refers to a type of dizziness characterized by a sudden sensation of spinning or movement, even when one is stationary. It can be caused by various factors related to the nervous system and balance organs in the inner ear. Let's explore the common causes of vertigo: – Disorders of the nervous system in the brainstem and cerebellum –  Abnormalities of balance organs in the inner ear   1. BPPV (Benign Paroxysmal Positional Vertigo):    This is the most common cause of vertigo. It occurs when tiny calcium crystals dislodge and enter the wrong part of the semicircular canals. Symptoms include dizziness when changing positions, such as bending down, lying down, or sitting up. Episodes typically last less than a minute, resolve spontaneously, and recur with position changes. 2. Stroke:    Found primarily in individuals over 45 years old with risk factors for stroke (such as hypertension, diabetes, and hyperlipidemia). Dizziness associated with stroke often persists for an extended period, lasting hours or even days. It is not related to changes in posture and is frequently accompanied by other neurological abnormalities like double vision, facial asymmetry, slurred speech, tongue deviation, weakness, or paralysis. Due to the potential severity and complications, immediate medical attention is necessary. 3. Meniere's Disease:    This condition involves intermittent dizziness lasting minutes to hours, often accompanied by ringing in one ear (occasionally both). It may be associated with hearing loss. The exact cause is unknown, although some cases are linked to middle ear infections. Symptoms can be triggered by consuming excessive salt. 4. Vestibular Neuritis:    Vestibular neuritis presents with prolonged dizziness lasting hours or days. It does not typically cause hearing problems or ringing in the ears. This condition is believed to result from a viral infection directly affecting the nerves or an autoimmune disorder. It is more common in younger individuals, with a higher prevalence in females. Headaches may also occur episodically. 5. Migraine:    Some individuals experience dizziness as a component of their migraines. For some, dizziness may occur without headache or may occur separately from migraines triggered by factors like specific foods, caffeine intake, sudden cessation of caffeine, bright lights, strong odors, or menstruation.   Symptoms of dizziness that warrant a doctor's consultation at home: - Dizziness accompanied by blurred vision - Vertigo accompanied by limb weakness - Dizziness associated with limb numbness - Dizziness accompanied by speech difficulties - Dizziness accompanied by hearing problems   Home diagnosis of vertigo may involve: 1. Hearing assessment (audiogram) 2. Evaluation of inner ear balance organ function (Video Electronystagmography: VNG) 3. Measurement of inner ear fluid pressure (Electrocochleography: ECOG) 4. Assessment of auditory nerve function (Evoked Response Audiometry) 5. Brain imaging such as CT scan 6. MRI to provide detailed images of the brainstem and cerebellum, which may be inconclusive in CT scans alone.   Basic self-care measures for individuals with vertigo at home: 1. Avoid postures or movements that trigger dizziness during episodes, such as sudden position changes or quick head turns. 2. Refrain from activities prone to accidents, like driving, while experiencing symptoms. 3. Take prescribed medications to alleviate dizziness, such as Betahistine or Dimenhydrinate. 4. Identify and avoid factors that contribute to dizziness, including inadequate sleep, stress, strong odors, and allergens. 5. Reduce or eliminate smoking and coffee consumption. 6. If symptoms persist or worsen, seek medical attention promptly.   For further information, please contact the Brain and Nervous System Center at Vibhavadi Hospital (Tel. 02561-1111 ext. 1214).   Dr. Kamolrat Phonwai, MD. Neurologist at Vibhavadi Hospital.

See More

Find a doctor

Make an appointmen

Jab & Go Clinic