Thursday, May 6, 2021

If Your Brain Feels Foggy And You're Tired All The Time, You're Not Alone May 6, 2021 RHITU CHATTERJEE

 THE CORONAVIRUS CRISIS

If Your Brain Feels Foggy And You're Tired All The Time, You're Not Alone

Feelings of exhaustion, irritability and mental fogginess are our bodies' normal response to an abnormal year of pandemic life.

Wenjin Chen/Getty Images

In recent weeks, Dr. Kali Cyrus has struggled with periods of exhaustion.

"I am taking a nap in between patients," says Cyrus, a psychiatrist at Johns Hopkins University. "I'm going to bed earlier. It's hard to even just get out of bed. I don't feel like being active again."

Exhaustion is also one of the top complaints she hears from her patients these days. They say things like, "It's just so hard to get out of bed" or "I've been misplacing things more often," she says.

Some patients tell Cyrus they've been making mistakes at work. Some tell her they can "barely turn on the TV. 'All I want to do is stare at the ceiling.' " Others say they are more irritable.

Mental health care providers around the U.S. are hearing similar complaints. And many providers, like Cyrus, are feeling it themselves.

This kind of mental fog is real and can have a few different causes. But at the root of it are the stress and trauma of the past year, say Cyrus and other mental health experts. It's a normal reaction to a very abnormal year.

And while many people will likely continue to struggle with mental health symptoms in the long run, research on past mass traumas suggests that most people will recover once the coronavirus pandemic ends.

"We know that the majority of people tend to be resilient," says Lynn Bufka, a psychologist with the American Psychological Association. "They may have struggled during the time of the challenges but generally come out OK on the other end."

In the meantime, Bufka and other experts say that there are things we can do now to fight the mental fog and exhaustion.

How stress and sleep are linked

"Exhaustion can be a symptom of many things," says Cyrus.

For one, it can be a symptom of stress.

"We know from other research that people will talk about fatigue as something that they experience when they're feeling overstressed," says Bufka.

recent survey by the American Psychological Association found that 3 in 4 Americans said that the pandemic is a significant source of stress.

Millions of people have lost loved ones, have become ill themselves and/or have lost income as a result of the pandemic. The threat of COVID-19 alone has been stressful for most people, as has all of the upheaval that the pandemic has brought, says Bufka.

Stress "keeps our mind vigilant and our nervous system vigilant, and that uses more energy," says Elissa Epel, a psychologist at the University of California, San Francisco. That's one reason that prolonged stress can leave us feeling drained.

Another way that chronic stress makes us feel exhausted is by interfering with sleep, says Bufka. "When we're feeling stressed, our sleep can get disrupted, which naturally leads to feelings of tiredness and exhaustion," she says.

"We really rely on sleep to recover each day," explains Epel. "And so for many of us, even though we might think we're sleeping the same number of hours, it's not the same quality. It doesn't have the same restorative ability, because we're getting less deep sleep, and we think that is tied to this chronic, subtle uncertainty, stress."

Chronic stress also triggers low-grade inflammation, she adds.

"We have this inflammatory response when we're feeling severe states of stress that can last. It's subtle, it's low grade and it can absolutely cause fatigue and a worse mood."

A year of anxiety, grief and trauma

The fatigue and fog so many are feeling now also could be symptoms of other mental health issues that flared over the last year, says Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. "After this long, most people have had some degree of anxiety, depression, trauma, something," she says.

As studies have shown, rates of anxiety and depression in the population have gone up during the course of the pandemic.

Long-term anxiety can also exhaust the body, says Gold.

"We evolved as creatures, people that run from predators in the animal kingdom, right? To have anxiety as a way to predict and run from threat," she says.

When we're anxious, our hearts race and our muscles tense up as we prepare to fight a predator or run from it. But "you can only run a 100-yard dash for a short amount of time. Not a year, and not a year where they keep moving the finish line," says Gold. "We can't do that. Eventually our muscles and our body say, 'No, I'm tired.' "

The rise in symptoms of anxiety and depression, which include exhaustion, is a predictable response to the trauma of the pandemic, says Dr. Sandro Galea, dean of the School of Public Health at Boston University.

"The definition of a trauma is an event that threatens people's sense of safety and stability," which this pandemic is, he adds.

Nearly all of us are grieving the loss of life as we knew it, says Dr. Jennifer Payne, director of the Women's Mood Disorders Center at Johns Hopkins. "We're just in a completely different world right now," she says. "A lot of things are not going to go back to the way they were. And so that causes grief and is a normal reaction to a big change."

However, the trauma is much bigger for individuals directly affected by the pandemic, says Galea — for instance, those who've lost loved ones or who had COVID-19, lost a job or housing, or struggled with child care.

Some people have been hit so hard — and are so worn down — that "they are having trouble coming back from this," says Cyrus, the Johns Hopkins psychiatrist, whose patients are mostly people of color and/or queer. Black and Latino communities in particular have been disproportionately affected by the pandemic and its fallout.

And people in these communities will likely struggle with more mental and physical health issues in the long run, notes Galea, and need access to mental health care and greater support to recover.

Steps to take now

For many people, the relaxing social activities that can help buffer against stress and anxiety — like seeing friends or going out to dinner — are not yet reality, due to uneven vaccination rates. So what can we do now to help recharge?

Payne, of Johns Hopkins' Women's Mood Disorders Center, encourages people to keep in mind all of the usual things that help during stressful times: exercise, a healthy diet, going outdoors and limiting news consumption. And engage in relaxing activities often, like a hobby you love, listening to or watching something funny, or reading books you enjoy.

If these diversions aren't working for you now, she recommends trying a change of scenery if you can.

For Payne, who lives in Baltimore, that meant staying at her parents' home in West Virginia for three nights.

"It was not a very exciting trip, but we got away and it was a completely different environment. And I didn't have any projects around the house that I could do other than reading or listening to a podcast, sleeping, eating," Payne says. "And that was really, really renewing for me."

However, Cyrus, who is also at Johns Hopkins, says some of her patients say their normal coping strategies aren't working.

That's because we are running on an emptier gas tank than usual, she says. "Your coping strategies that might be able to refill you a certain percent, [but now] you're starting lower. So it's not quite getting you where you need to be."

If that's the case for you, try changing up your routine, Payne says. "If you're walking every day and that's no longer helping, you try biking."

Self-care is important, notes Gold of Washington University. "Take the vacation time you need," she recommends. "Make sure that you're taking care of yourself in the short and long term."

And, she adds, "there's no wrong time to go talk to someone." If you can't get an appointment with a therapist, talk to a friend or co-worker, she suggests.

"I think that because so many people are struggling with this and because it is so normal, everybody has something to say," says Gold. "If we could just get to the point where we could be talking about the stuff more openly, we'd feel a lot less alone."

Feeling more connected can help ease some of our stress and related exhaustion.

Also, Payne encourages trying to find things to be grateful for. Research shows that gratitude journaling lifts your mood and is good for your mental health.

"We can always find things to be grateful for," says Payne. "It's springtime and the days are starting to be beautiful and the trees are blossoming, and really thinking about that and admiring the trees, for example, can make you feel really grateful."

Acceptance and self-compassion will also help, notes Gold. "We have to be able to give ourselves a little bit of grace," she says. In other words, accept that you might not work as efficiently or get as much done right now.

For most of us, the brain fog will likely fade away when we are able to resume some normalcy in our lives, say Gold and others.

"Most people are resilient to traumatic events, and we should always keep that in mind," says Galea of Boston University. "Most people bounce back fairly quickly once the trauma resolves."

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Could Your Headache Be Dangerous? 5 Signs To Watch For May 5, 2021 KRISTEN KENDRICK

 

Could Your Headache Be Dangerous? 5 Signs To Watch For

A woman with a temperature stays home, wrapped in a scarf while drinking hot tea.
martin-dm/Getty Images

Of all the aches and pains I spend my days investigating as a family doctor, none seem to be as anxiety-provoking as a headache. And that's often true, both for patients wondering, "Could this be something dangerous?" and for clinicians trying to get to the root of pain that can be totally unexplained and yet completely debilitating.

Concerns about headaches in my practice have picked up over the past year as we've seen them as a symptom in acute COVID-19 infections and among long-haulers — and more recently when news broke about the (very, very few) brain clots linked to the Johnson & Johnson vaccine.

Though we're all one Google search away from assuming a worst-case scenario when a headache strikes, the odds are overwhelmingly in our favor here. Research shows that the vast majority of headaches are what's known medically as "primary," meaning they're not the result of some other underlying condition. In other words, your headache is unlikely to be caused by a serious or life-threatening problem.

Dangerous headaches also tend to have some distinctive features and patterns – and they can be hard to ignore. Here's an overview of those red flag symptoms, and when you need same-day or emergency care:

The worst headache, in no time flat

You may have been told to be wary of a sudden headache, but just how sudden does it have to be to be a red flag? It's a lot quicker than you'd think.

We're talking in terms of seconds – the headache comes on fast with an intensity that stops you in your tracks, feels downright unbearable, and the pain peaks within less than a minute or so (although the headache may continue for longer). This is called a thunderclap headache, and patients tend to describe it as explosive, or "the worst headache I've ever had."

Mia Minen, a neurologist and chief of headache research at NYU Langone Health, says it's like "the snap of the finger: 10 out of 10 pain."

That stands out from a typical headache that tends to creep up over several minutes or an hour, linger a while and get worse as time wears on. Even though other non-life-threatening headache syndromes such as migraine or cluster headaches might still usher in the same pain intensity, those tend to build more gradually or may even be preceded by an aura (sensory symptoms such as tingling or spots in your vision).

Thunderclap headaches are a sign of something serious until proven otherwise, given their link to brain bleeds — things such as ruptured aneurysms or other hemorrhages, though they can be related to other masses or lesions in the brain as well.

Do not delay medical care with a headache such as this – it's an emergency, so call 911 or have someone help you to an emergency room. That is true for people of any age, with or without a history of headaches, and whether or not it's accompanied by other symptoms such as vomiting or passing out.

Nervous system symptoms

My patients and their families will tell you I often belabor the same list of stroke symptoms that we all need to be ready to recognize early. If a headache accompanies one of these symptoms, don't stop to think about the timing or severity, or really anything at all regarding that headache – just call 911.

The list of symptoms to watch for includes: abrupt weakness overall or in an arm or a leg, new numbness, changes in speech, confusion or trouble understanding and expressing thoughts clearly, facial droop or sudden trouble walking. It's also critical you get immediate care for changes in consciousness such as difficulty waking up, being in a stupor, passing out or having a seizure.

Changes from motion

This next group of symptoms deserve same-day attention by your primary care provider. If you don't have one, or can't get a prompt appointment, go to an urgent care clinic.

One of the most important questions they will ask you about the headache is what's making the pain better or worse. Take notice if the ache sharpens intensely with day-to-day movements — things such as bending over, rolling over in bed or even bearing down when you're having a bowel movement.

And along the same lines, it may not be an ordinary headache if the pain gets much worse when lying flat and better with sitting or standing. We call that a "postural" headache, and it can be a sign of masses putting pressure on the brain or spinal cord, and has been known to happen with blood-clotting events in the brain. This type can also present as a new morning headache that's severe and might come with vomiting.

There's a familiar alternative to this: a headache that gets subtly worse standing up and is better lying down. This can be an indicator of dehydration (or low blood pressure, often caused by dehydration and medicines, among other things). It's really no different than a hangover headache, though I hear complaints of this all the time from patients who admit they live off dehydrating drinks such as coffee or soda. Fortunately there's a quick fix: Drink more water.

But if this type of pain pattern is particularly pronounced with a dramatic increase in pain when you stand up, or you can't reasonably attribute it to being a little dehydrated (i.e., thirsty, with dry lips and scant or darker urine), it's important to get checked out.

Stiff neck

Another sign to watch for: Along with the start of your headache, your neck feels so stiff that it's difficult, even painful, to move. This could be a sign that something's brewing in the brain, spinal cord or the fluid surrounding it – meningitis being the big one, and this is worth a same-day medical exam, even if there's no other sign of infection, such as fever.

Deviation from your patterns

Don't get too focused on the pain level of your headache, cautions Peter Goadsby, a UCLA neurologist and president of the American Headache Society.

Instead of fixating on pain severity, think about whether any feature of your headache is out of the ordinary for you. Compare the headache with others you've had over the course of the last few days, weeks or months.

"People have a common misconception that if it feels really bad, you're going to die or something dreadful is always happening, and that's just wrong," Goadsby says. He notes common headache disorders – such as migraine, his specialty – can cause terrible pain but aren't necessarily suspicious.

It may be helpful to ask yourself, "Is this new for me?" If the answer is yes, it's important to follow up with your doctor.

New headache features could be a change in the timing of headache, pain in one area that never switches sides, a new or different aura beforehand or symptoms such as nausea or vomiting that you've never had before. And the same is true for headaches that get progressively worse over time, don't respond to medicines, or any type of headache that keeps coming back for someone who hasn't had trouble with them in the past.

Even so, just remember pain level can still signal an emergency if you get that thunderclap-style headache mentioned above, which Goadsby likens to "a baseball bat to the back of the head."

Trust your gut

For doctors, perhaps the most important factor when we're investigating a headache is nothing to do with the headache itself but instead the person experiencing it.

What seems like an innocent headache in a healthy person could be something critical for people with chronic illnesses such as HIV, cancer or even a history of cancer — if this is your situation, you should have a lower threshold to reach out to a doctor with any type of headache that's new. Likewise, it's OK to be more guarded about headaches if you're pregnant, over age 50, have disabilities or have suffered recent trauma such as a fall or concussion.

As with most things in the human body, it doesn't help to be too rigid when you're thinking about what's "serious enough" to worry about. When a headache gives you the feeling that something's not right, trust your gut — either get immediate, urgent care or write down all the details in a headache log, take it to your doctor and start asking questions.

Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

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