Gestational diabetes and preeclampsia

How is vestibular migraine treated?

Treatment of vestibular migraine can include:

  • preventative medications if the regularity and severity of symptoms are interfering with your life
  • medication to relieve symptoms
  • making lifestyle changes to remove the symptom triggers, such as alcohol, not enough sleep, or stress.

Preventative medications may be prescribed and these need to be taken every day whether or not you feel unwell. Migraine episode treatments may also be prescribed, including pain relief medication and anti-nausea medication. Vestibular rehabilitation/physiotherapy has been shown to be effective if symptoms of movement-provoked dizziness, or imbalance, persists between episodes of migraine. For more information about vestibular physiotherapy, including how to access a vestibular physiotherapy service, please click here.

Living with vestibular migraine

For almost all patients, the combination of a healthy lifestyle and medication (if necessary) will lead to a good recovery from migraines and resumption of normal activities. Lifestyle changes that reduce or prevent migraines in some people include:

  • regular exercise
  • avoiding the food and drink that triggers migraine (such as caffeine or alcohol)
  • maintaining an adequate fluid intake
  • consistent sleep patterns.

Online resources

The Vestibular Disorders Association is a US-based, patient support group. Their website contains useful information about how to understand, live with and find support for balance disorders. Visit www.vestibular.org

Definition of vestibular migraine medical terms

Vestibular system: a part of the inner ear that sends information about the position of the head to the balance control centre in the brain. See How does the balance system work? for more information.

Migraine: a chronic, generally periodic, neurological disorder, which may involve headaches and a number of associated and temporarily disabling symptoms.

Vertigo: a false sensation that you or your surroundings are moving.

Tinnitus: a subjective sound in the ear (such as ringing, buzzing, hissing or rumbling) that is not associated with any external sound.

Associated symptoms

  • Hearing loss
  • Tinnitus
  • Fullness of the ear
  • Sensitivity to noise
  • Headaches
  • Eye symptoms
  • Drop attacks (Tumarkin’s otholic crisis)

Hearing loss

Some vestibular disorders have symptoms of hearing loss. There are a range of rehabilitation options available to aid listening ability. For some people counselling and straightforward communication tactics is enough; however, for others a hearing aid is needed. In a small proportion of sufferers who develop profound hearing loss in both ears and find that conventional hearing aids are not helpful, a cochlear implant may be suitable to provide a sense of hearing.

Vestibular disorders that may have symptoms of hearing loss include:

  • Ménière’s disease
  • Labyrinthitis
  • Migraine-associated vertigo
  • Perilymph fistula
  • Superior Canal Dehiscence Syndrome (SCDS)

Further information and resources (all external websites):

Tinnitus

Tinnitus comes from the Latin word meaning ‘to ring’. It is the perception of sound when no external sound exists but you hear it. Perception means the way you regard or interpret this sound; people hear a wide variety of noises such as buzzing, humming and whistling. Tinnitus affects more than 15% of the general population and is more common in older adults compared to younger adults. It is a hidden symptom which is highly distressing and can affect a person’s quality of life. Tinnitus patients also exhibit some associated factors including hearing loss, migraine, sleep disorders, discomfort, distress, anxiety and depression. Read our Tinnitus Factsheet (pdf) for more information.

Management of tinnitus

Tinnitus is often worse at quiet times for example when trying to get to sleep as there isn’t the background noise to distract you from the sound. Although there is no cure it is possible to teach people how to manage their tinnitus, reduce their awareness of the sound and reduce their distress. Many ENT departments offer a variety of treatments for managing tinnitus; this could include adjustment to medication, counselling, relaxation therapy, stress management and advice with hearing aids, white noise generators and environmental sound enrichment.

Vestibular disorders that may also have tinnitus as a symptom include:

For further information about managing tinnitus, you may wish to visit the NHS or British Tinnitus Association websites (external links).

Fullness of the ear

Some people with a vestibular condition experience the sensation of ‘fullness’ or aural pressure which can be incredibly uncomfortable. The fullness can also fluctuate and for some cause considerable distress. Some patients can gauge that their condition is starting again if they notice a change in the sensation of the ‘fullness’. For some this sensation may disappear completely however for others it can become chronic with the constant feeling of pressure. In patients with Ménière’s disease this condition can fluctuate with the acuteness of the condition.

Sensitivity to noise

Some people have especially sensitive hearing and are unable to tolerate ordinary levels of noise, this can occur with people with normal hearing as well as people with hearing loss. There are different component which can contribute to sensitive hearing such as hyperacusis, phonophobia and misophonia.

Hyperacusis

Hyperacusis is the medical term used to describe the abnormal discomfort of everyday sounds that some people experience. Hyperacusis is due to an alteration in the central processing of sound in the auditory pathways where there is an abnormally strong reaction from exposure to moderate sound levels.

Misophonia

Misophonia is the intense dislike of being exposed to a certain sound. The auditory pathways may be functioning normally, but there is an abnormally strong reaction of the limbic (emotional system) and autonomic nervous system (body control system) to which the auditory system is intimately connected. Sometimes because of the belief that it will damage the ear, or makes symptoms (sensitivity, or tinnitus) worse. If this dislike is very strong we may call it ‘phonophobia’ literally – fear of sound. Often normal environmental sounds like traffic, kitchen sounds, doors closing, or even loud speech, cannot be tolerated, even though under any circumstances they cannot be damaging to anyone. Misophonia can lead to hyperacusis (changes in central auditory processing), and a consequent persistence of abnormal loudness perception. In practice, most people with decreased sound tolerance have both hyperacusis and phonophobia/misophonia together in varying proportions.

How can the symptoms be managed?

In treating these conditions, it is important to diagnose which condition is present and which is dominant.

Avoidance of silence

Many people seek silence as a way to escape from the pressures of everyday life. However complete silence is not found in nature, and should be considered ‘unnatural’. The absence of sound stimulation leads to an increase in auditory gain (amplification) in the subconscious auditory pathways. The brain is always looking for the best way it can for auditory signals. This process is enhanced by silence which is considered to be one of the signs of possible predator activity. The auditory filters ‘open’ in an attempt to monitor the external sound environment. External sounds may then increase dramatically in their perceived intensity and intrusiveness.

Some people take to wearing ear plugs, perhaps at night, to avoid sounds becoming intrusive, and this simply worsens the sensitivity. When hyperacusis develops there is a great temptation to plug the ear to exclude unwelcome sounds. This is actually making things worse, as it encourages further increase in the amplification of sounds on their way to the auditory (hearing) cortex. When these sounds are heard in the absence of plugs, their perceived loudness is greatly increased.

Noise generators and wearable sound generators (WSGs)

Hyperacusis can be managed most effectively by using noise generators alongside a programme that aimed at reducing the fear and anxiety associated with sound exposure.

Research in the 1980s (Hazell & Sheldrake 1991) showed that the use of wide band noise applied to the ear by wearable sound generators can help in the treatment of abnormal hypersensitivity of hearing. This is particularly true in hyperacusis, where on some occasions, particularly in young children, it is all the treatment required.

The sound from the instruments needs to be applied very gently and gradually to the ear beginning at a low level, always to both ears, and under the supervision of an audiologist with experience in this process of desensitization and with training in TRT. The effect, which in some cases may be quite dramatic, results in a ‘turning down’ of central auditory gain and a reduced perception of loudness for previously distressing sounds.

Never undertake any sound therapy without proper advice. Sound tapes – e.g. pink noise, can make certain hyperacusis and phonophobic patients considerably worse. In each case carefully explanation of the mechanism of central processing must be given, so that individuals can understand and believe what has happened to them, and that the whole process is reversible with time, and the appropriate therapy.

Where misophonia (dislike) or phonophobia (fear of sound) exists, no permanent change in discomfort can be achieved without a successful behavioural programme aimed at reversing inappropriate beliefs responsible for the conditioned aversive response. This is true for any phobia (e.g. claustrophobia, arachnophobia, fear of heights etc). The whole process of desensitization can take quite a long time, commonly six months to a year, but is achievable in most cases.

Headaches

Another possible symptom is headache or pains over the scalp. As the balance is also involved with maintaining the correct position of the head, the muscles of the neck and scalp are constantly being brought into play to achieve this. Some abnormalities of balance will cause this reflex to be triggered at the wrong time, resulting in spasm often in small areas of the head and neck musculature. This can present a quite severe pain which may move about in its location and cause distress and concern to sufferers.

Eye symptoms

Some people experience eye symptoms that include the inability to focus, rapid eye movement and blurred vision. This can occur because the balance mechanism is linked with the control of the eye movement and stability. Therefore the balance mechanism enables us to keep our eyes fixed on some object while we are walking about moving our head. Any loss of this eye control by the balance mechanism can result in a completely uncontrolled eye movement. In the worst case, the eyes move rapidly from side to side (referred to by doctors as nystagmus) and this produces a sensation of rotation of the environment rather like being spun round rapidly on a swing or roundabout. Blurring of vision, although it may be due to other eye problems, can often be the result of a balance disturbance.

Drop attacks (Tumarkin’s otholic crisis)

Drop attacks, known as Tumarkin’s otolithic crisis, are when a person falls to the ground with no warning. The person remains awake and does not lose consciousness.

Who is affected by Tumarkin’s otholithic crisis?

Drop attacks are sometimes experienced in the later stages of Ménière’s disease. They do not affect everyone.

How does Tumarkin’s otholithic affect you?

A drop attack feels as if you are being pushed violently and suddenly, causing you to fall. Symptoms are usually gone as quickly as they appear, and you can get up straight away and carry on with whatever you were doing (unless you get a drop attack at the same time as an acute attack of vertigo). During these attacks, the hair cells on your otoliths are suddenly activated, causing your balance to be severely disrupted. Experts do not know how or why this happens.

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Tinnitus is commonly described as a ringing in the ears, but some people also hear it as a roaring, clicking, hissing or buzzing. It may be soft or loud, and it might affect both of your ears or only one. For some people, it’s a minor annoyance. For others, it can interfere with sleep and grow to be a source of mental and emotional anguish.

Each year about 1 in 10 adults nationwide has an episode of tinnitus that lasts longer than 3 months. Tinnitus isn’t a disease. Instead, it’s a symptom that something is wrong with your auditory system. The problem may exist somewhere in your ear, in the nerve that connects the inner ear to the brain or in the parts of the brain that make sense of sounds.

Scientists still aren’t entirely sure what happens in the auditory system to cause tinnitus. But somehow, the networks of nerve cells that process sounds have been thrown out of balance in a way that creates the illusion of sound where there is none. Because tinnitus can arise from so many conditions, ranging from hearing loss to high blood pressure to medications, diagnosing the cause or causes can be a challenge. For many people, the ringing in their ears begins for no obvious reason.

Several conditions can lead to tinnitus, including:

  • Noise-induced hearing loss
  • Diseases of the heart or blood vessels
  • Ménière’s disease, a disorder of the inner ear that causes severe dizziness
  • Certain types of tumors
  • Excess earwax
  • Certain medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.
  • Ear and sinus infections

Although there’s no cure for tinnitus, several treatments can make it easier to cope. Hearing aids may help those who have hearing loss along with tinnitus. Behavioral therapy with counseling helps people learn how to live with the noise. Wearable sound generators—small electronic devices that fit in the ear—use a soft, pleasant sound to help mask the tinnitus and offer relief.

Some people with tinnitus use tabletop sound generators to help them relax or fall asleep. Antidepressants and antianxiety drugs may be prescribed to improve mood and sleep patterns. Most doctors offer a combination of these treatments, depending on the severity of the tinnitus and the daily activities it affects the most.

Researchers have been working on new ways to treat tinnitus. One NIH-sponsored study has just begun recruiting active and retired military personnel of the U.S. Armed Forces to test the effectiveness of an experimental tinnitus therapy. Soldiers exposed to loud noise, including bomb blasts, can develop tinnitus due to tissue damage in hearing-related areas of the brain and ear. In fact, tinnitus is one of the most common service-related injuries among military personnel returning from Iraq and Afghanistan. The experimental treatment in this study combines educational counseling with a sound-generation device.

Called tinnitus retraining therapy, the approach has shown promise in earlier trials and appears to ease the annoyance of tinnitus and its impact on people’s lives. Learn more about the study athttp://clinicaltrials.gov/ct2/show/NCT01177137.

Talk to your doctor if you’ve had ringing in your ears for more than 3 months. Your physician will ask about your symptoms and look into your ear to search for possible causes. You may be referred to an otolaryngologist (a doctor who specializes in conditions of the ear, nose and throat) for further evaluation.

Preeclampsia and Gestational Diabetes

Gestational diabetes and preeclampsia are both conditions that only occur during or just after pregnancy. Gestational diabetes is caused by an inability to use sugar properly during pregnancy, and may result in giving birth to a large baby. One of the potential complications of gestational diabetes is the development of preeclampsia. This condition, which may also be called toxemia of pregnancy or pregnancy-induced hypertension, occurs in about 10 to 30 percent of women with gestational diabetes.

What Is Preeclampsia?

Preeclampsia is defined as the presence of protein in your urine and high blood pressure occurring after the 20th week of your pregnancy. The condition affects about 5 to 8 percent of all pregnancies. In the United States, preeclampsia rarely causes the death of a mother or infant, but worldwide pregnancy-induced high blood pressure still causes 76,000 maternal deaths and 500,000 infant deaths every year.

The cause of preeclampsia remains a mystery. We do know that you are at higher risk if you have gestational diabetes, a family history of preeclampsia, are overweight, or if you had high blood pressure or kidney disease before your pregnancy. Preeclampsia is more common during your first pregnancy, if you are carrying twins, and if you are over age 40 or a teenage mother.

What Are the Signs and Symptoms of Preeclampsia?

The signs and symptoms of preeclampsia are caused by the sudden increase in your blood pressure, retention of fluids in your body, and kidney damage that allows proteins to pass into your urine.

  • High blood pressure. You may have high blood pressure during your pregnancy without swelling or protein in your urine, so high blood pressure alone doesn’t mean you have preeclampsia. Your doctor may suspect preeclampsia if you have a sudden increase in blood pressure after your 20th week of pregnancy. Some symptoms related to high blood pressure include headaches, dizziness, blurred vision, or ringing in your ears.
  • Fluid retention. Some swelling is normal in pregnancy, but if your swelling doesn’t go away with rest or if you are retaining enough fluid to cause a gain of five pounds in one week, it may be a sign of preeclampsia. Fluid retention can be experienced as tightness of your shoes or your rings and is usually most notable in your hands and face.
  • Laboratory signs. Your kidneys normally filter out waste products from your blood but keep important proteins in. Your doctor will check your urine for proteins, as this is one of the most important signs of preeclampsia. Other lab findings may include elevations of your liver enzymes and decreased numbers of blood clotting cells. These can be measured by blood tests.
  • Other symptoms. Abdominal pain, agitation, nausea and vomiting, fever, decreased amounts of urine or blood in the urine, drowsiness, and sudden loss of vision can all be symptoms of preeclampsia.

Treating Preeclampsia

Untreated preeclampsia can prevent your baby from getting enough blood and nourishment through the placenta in your womb. Preeclampsia can also lead to eclampsia, which is high blood pressure plus seizures, a very serious condition for both you and your baby.

  • Delivery. The only cure for preeclampsia is delivering your baby. There is an increased chance that your doctor will induce labor to help you deliver and there is an increased likelihood of having to deliver by cesarean section. These decisions will be made by you and your doctor based on your symptoms, your health, and the baby’s health. If you have severe preeclampsia, delivery is the best treatment after 32 weeks of your pregnancy. If your doctors can control your preeclampsia, it is best to wait until 37 weeks.
  • Before delivery. Managing your preeclampsia until it is safe for your baby to be delivered may involve bed rest, medications to control your blood pressure, and sometimes hospitalization. It will be necessary for your doctors to closely monitor your blood pressure, weight, urine, and the baby. Calcium and aspirin have been found to be of benefit during this time, and your doctor may also prescribe magnesium sulfate to prevent the seizures of eclampsia.

The key to a healthy pregnancy if you have pregnancy-induced high blood pressure is good medical care and monitoring. The good news is that most women who have gestational diabetes or gestational diabetes complicated by preeclampsia are still able to deliver healthy babies. There is no way to completely prevent these conditions of pregnancy, but being aware of the risk factors and knowing the symptoms can help you and your doctor identify these conditions early and start working together toward a successful pregnancy for you and your baby.

Gestational Diabetes: Signs and Symptoms

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Chances are you’ll sail through pregnancy without trouble, but even if you’re feeling great, you should still seek regular prenatal care. That’s because some health problems that could hurt your baby are symptomless, including gestational diabetes.

Gestational diabetes occurs when pregnancy hormones interfere with the body’s ability to use insulin, the hormone that turns blood sugar into energy, resulting in high blood sugar levels. Each year, 2 to 10 percent of pregnancies in the United States are affected by gestational diabetes according to the Centers for Disease Control and Prevention.

With early detection and treatment, however, you can still have a healthy baby. Here’s what you need to know about signs and symptoms of gestational diabetes:

  • RELATED: Gestational Diabetes: Causes, Complications and Treatment

Early Signs You’re At Risk

One in 100 women develop diabetes before pregnancy. Unfortunately, women with poorly controlled preexisting diabetes are three to four times more likely than non-diabetic women to have babies with birth defects of the heart or neural tube.

Women with preexisting diabetes also have an increased risk of miscarriage and stillbirth. Fortunately, you can significantly reduce these risks by controlling your blood sugar before pregnancy. If you have preexisting diabetes, speak with your doctor before you attempt to conceive.

Other early warning signs that you are at risk for gestational diabetes include the following according to March of Dimes:

  • You’re older than 25.
  • You’re overweight or you gained a lot of weight during pregnancy.
  • You have a family history of diabetes. This means that one or more of your family members has diabetes.
  • You’re African-American, Native American, Asian, Hispanic or Pacific Islander. These women are more likely to have gestational diabetes than others.
  • You had gestational diabetes in a past pregnancy.
  • You had a baby in a past pregnancy who weighed more than 9 pounds or was stillborn.

Symptoms of Gestational Diabetes

While most women with gestational diabetes have no symptoms, a small number may experience extreme hunger, thirst, or fatigue.

  • RELATED: Signs of Preeclampsia Every Pregnant Woman Should Know

Your doctor will probably screen you for gestational diabetes between your 24th and 28th weeks of pregnancy. If you have certain risk factors, your doctor may opt to screen you sooner. During your screening, you’ll drink a sugary liquid, then take a blood test. If your blood sugar levels appear high, you’ll need to take a longer test, during which you’ll drink more liquid and your blood sugar will be tested several times to determine whether you have gestational diabetes.

  • RELATED: What to Expect from a Glucose Tolerance Test

Risks of Gestational Diabetes

Women who fail to seek treatment for gestational diabetes run the risk of giving birth to big babies (9 pounds or more), since much of the extra sugar in the mother’s blood ends up going to the fetus. Larger babies are more likely to suffer birth injuries during vaginal delivery, as they’re more apt to get stuck in the birth canal.

Because of this, large babies are often delivered by c-section, and they have an increased risk of developing breathing difficulties and jaundice as newborns.

  • RELATED: What is Preeclampsia and Can I Prevent It?

Treating Gestational Diabetes

Many women who develop this condition can control their blood sugar levels with diet and exercise. Your doctor or dietitian may design an individualized diet that takes into account your weight, stage of pregnancy, and food preferences.

Of this diet, 10 to 20 percent of your calories should come from protein, 30 percent from fats, and the remainder from complex carbohydrates such as whole-grain breads or cereals. If you’ve been on the diet for two weeks and your blood sugar level hasn’t returned to normal, you may need to take insulin shots for the rest of your pregnancy.

Studies have found that women who develop gestational diabetes may also be at risk of developing preeclampsia, though the reason is still unknown.

  • RELATED: What to Eat: A Gestational Diabetes Diet Plan
  • By Richard H. Schwarz, MD

American Baby

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