Still Birth Alliance Blog

Millions of Germans suffer from migraines. Nevertheless, many sufferers do not know that this type of headache is the cause of their torment. There are effective therapies. Sometimes the pain pounds from the back of the head. It thunders more strongly with every pulse beat and slowly spreads over the entire skull. Another time it pulls up from the temples to discharge in all directions like a storm of nerves in the head. Every movement then causes agony that increases by the minute. Sufferers describe their agony as if barbed wires were being pulled through their brains. Or the head was wedged in a vice that was tightened and tightened. For most of those affected, only one thing helps: absolute peace. You retire alone, close the curtains and lie in bed. But migraines are more than a devastating headache that goes away if the person concerned only lies in bed long enough. On the contrary. It is a serious neurological disorder and one of the most common chronic diseases. “The predisposition to this is already in their genes,” says Stefan Evers, chief physician at the Clinic for Neurology at the Lindenbrunn Hospital in Coppenbrügge. Unlike the brain of a healthy person, that of a migraine patient reacts much more intensely to external stimuli. It is constantly under high voltage and can no longer adequately filter pain stimuli. But that alone does not trigger a migraine attack. Only when certain factors, so-called triggers, appear in the life of a migraine sufferer, the brain gets out of control. The triggers for this are individually different. Like the drop that makes the barrel overflow, these factors set off a cascade of physiological changes in the body – until the attack rages. Correct therapy is required to alleviate them . And that requires a correct diagnosis . But of an estimated 13 million people who suffer from migraine attacks in Germany in the course of their lives, only every second person affected knows the cause of their torment. Many switch from doctor to doctor, have their cervical vertebrae straightened, the nasal septum operated, teeth pulled or the beds adjusted in the bedroom – in the hope that this will end the pain. Effective drugs and therapies can help alleviate the horror of the disease. Symptoms Often times, people with migraines know immediately that something is wrong. For many, strange harbingers signal the approaching attack. Days or just a few hours in advance, a third of those affected feel an unusually strong craving for sweets. You then eat chocolate en masse . The concentration decreases, tiredness or even depressive moods appear. Some people react extremely irritably during this time. While some are already suffering, others feel better than ever before: wide awake, extremely creative, bursting with energy and even hyperactivity. The dawn of migraines: the aura In every tenth migraine sufferer, the attack begins with a neurological phenomenon: comparable to the shimmer of an approaching day or the breath of mist after a downpour, the aura slowly draws in the head. Most of the time, the affected person perceives strange changes in the field of vision, which get stronger from minute to minute: glowing sparks or lightning bolts, shimmering zigzag lines and circles, milky veil. The visual disturbances gradually spread inward from one edge of the field of vision. Doctors call this flicker scotome. Some migraineurs are downright fascinated by these “hallucinations”. But the phenomena frighten many other affected people because they fear they will go blind. Auras that feel like ants tingling are less common. Then a numb feeling slowly moves from the fingertips to the upper arm and from there to the lower jaw and tongue. The muscles fail in only a few people: for example in the form of one-sided muscle weakness, symptoms of paralysis in the arms and legs or language disorders. As slowly as the aura is raised, it also subsides again. After an hour at the latest, everything has returned to normal. Those affected are completely symptom-free for some time. But that’s just the calm before the storm. Worse with every pulse The pain goes to the head with hammering, stabbing or pulsing. It gets worse with every pulse. Walking or climbing stairs makes the agony almost unbearable. Usually the pain only booms in one half of the head, sometimes changing sides in the course of the attack. If left untreated, it rages between four and 72 hours and lasts for a day in most migraine sufferers. Most people affected by migraines don’t just suffer from a hell of a headache during an attack. Unpleasant companions are: Loss of appetite, Nausea and vomiting, Diarrhea, Shivering, extreme sensitivity to noise and light Neck pain . Normal noises or daylight torment those affected. Combing your hair becomes a painful ordeal. Even words of encouragement or a tender touch hurt. If the pain slowly subsides or the medication begins to work, most migraineurs feel completely exhausted, tired and cannot concentrate properly. In the worst case, it will take a day or two before everything is over. Some people affected, however, are downright “high” afterwards. You get into euphoria about the easing pain and the pleasant daze of “having survived it again”. Migraines are predisposed The cause and trigger of migraines should not be confused. Medical professionals now know that people with migraines have a predisposition to these headaches in their genes. But this alone does not trigger an attack. A migraine can only develop under certain circumstances. These triggers are very different from person to person. The following situations and substances can provoke an attack: Stress: fears, excitement, overwork, time pressure in everyday life and in the relaxation phases afterwards, depressive moods, Changes in the rhythm of the day and life: on weekends, at the beginning of vacation or when traveling strong emotions: great joy, problems in the relationship, sadness, extraordinary physical strain: for example exhaustion or starvation, little or too much sleep , eating irregularly or skipping meals, hormonal changes: menstruation, fluctuations in estrogen levels , Weather change: hair dryer or heat, too much sunlight, certain luxury foods: ingredients in red wine and sparkling wine, Medicines: certain preparations for high blood pressure or allergies , appetite suppressants, Viagra and other sexual enhancers, Inhalation of chemicals: for example nitric oxide and various solvents. Many migraineurs suffer from one or two attacks a month; only about eight percent of those affected have more than three seizures. If the headache occurs over a period of three months on more than 15 days per month, doctors speak of chronic migraines. diagnosis The family doctor usually makes the first diagnosis . They should be familiar with the criteria by which the disease is defined. It is therefore advisable to ask the doctor beforehand about his competence in this area. Otherwise, you should consult a neurologist. In conversation (anamnesis)This determines the history of the complaints, asking for the typical criteria of the migraine. If the person concerned keeps a headache calendar in which he precisely documents the pain pattern, the doctor can find out more easily what his patient is suffering from. If the diagnosis is doubtful, the doctor checks whether the condition could not also have other causes. For example, he has to rule out the possibility of pathological changes in the brain such as epilepsy, certain inflammations, in the worst case even a brain tumor, or the headache sufferer already had a stroke. Sometimes the pain is also due to the fact that the cervical spine or the temporomandibular joints are diseased, or that the person concerned has a disease of the cardiovascular system, the eyes or the internal organs. To check this, the neurologist uses modern methods: In the electroencephalogram (EEG) it measures the brain waves , more precisely: the electrical activity of the brain. Using computed tomography (CT) or magnetic resonance imaging (MRT) , he scans the brain to identify abnormal structures – for example a tumor. The CT shows bones and cartilage particularly well. With the MRI, soft tissues can be examined better. Using positron emission tomography (PET), the neurologist can determine whether the metabolism in the brain is disturbed. Forms of migraines What makes the diagnosis so difficult: Only rarely do all the symptoms of a migraine appear completely in all sufferers. Doctors also differentiate between 22 different forms of migraine. The two main forms are migraines without aura and migraines with aura. Migraines without aura: Nine out of ten sufferers have no harbingers or perceptual disorders. With them, the attack begins with the pulsating headache that lasts for up to 72 hours. Migraines with aura: Around ten percent of sufferers experience their migraines regularly with an aura, others have alternating attacks with and without aura. The strange changes in consciousness can express themselves in different ways: Migraines with typical aura: usually associated with visual disturbances over 30 to 60 minutes, which recede completely before the headache occurs Familial hemiplegic migraines: disturbances in movement up to paralysis in the extremities. At least one first or second degree relative is already suffering from such deficits. Sporadic hemiplegic migraines: symptoms of paralysis without these symptoms having already occurred among family members Migraines with brain stem aura: dizziness, tinnitus, hearing loss, double vision, drowsiness up to unconsciousness Aura without a headache: A small proportion of those affected even experience an aura without a headache. Typical visual or speech disorders set in, but the pain afterwards does not occur. Keep a headache diary! In order for the doctor to quickly make the correct diagnosis , it is necessary to keep a headache calendar. This allows him to recognize pain patterns and assign them to a diagnosis. In particular, write down the following facts: how often the pain occurs, in what way they use how long they last how strong they are whether they gain weight with physical activity, which symptoms accompany the attack, at what time of day the symptoms occur, in which situations they express themselves. You can download the form for such a headache diary as a PDF file here . Confusingly similar to migraines Some types of headache show symptoms similar to migraines. Here the knowledge of the doctor is required to analyze the symptoms precisely and to distinguish them from the other types. The following are possible for this differential diagnosis: Tension-type headache : While the migraine throbbing, stabbing or hammering, the tension headache is more dull, pressing or pulling. The typical symptoms accompanying migraines are also absent. Nausea and vomiting do not occur. If left untreated, the pain lasts at least half an hour, and can even last for a week. But it is not nearly as violent and usually subsides when you exercise in the fresh air. Cluster headache : With a boring pain behind or above the eye, a cluster attack breaks in on the person concerned. The eye is watering on the painful half of the face, the lid pulls down and the pupil narrows. Nausea and vomiting rarely occur. Typically, the violent attacks occur more frequently over four to twelve weeks, in severe cases up to eight times a day. The pain lasts for a maximum of three hours, but often it subsides earlier. Headache due to high blood pressure: People with high blood pressure, especially when they wake up, often have a dull headache. However, neither nausea nor vomiting are noticeable. Infections or diseases of the metabolism: Here too, pulsating headache can occur at regular intervals. Misalignments of the cervical vertebrae, eye diseases such as glaucoma, inflammation of the paranasal sinuses, dental diseases or traumatic brain injury sometimes also cause migraine-like headaches. Cerebral haemorrhage: Very rarely, a cerebral haemorrhage can trigger symptoms such as a migraine. However, severe headaches occur very quickly like never before. This is an emergency that requires immediate medical examinations. The right pain therapy Anyone who has suffered from migraines for a long time knows the first signs of an impending attack very well. He knows: If the pain attack is starting, it is important to take countermeasures at an early stage and take the right medication. The best time is reached as soon as you feel the first slight tug in your head. If the pills are late, it will take much longer to control the pain. Overall, doctors recommend the following substances in particular: anti-nausea agents, over-the- counter pain relievers and special migraine drugs, the triptans . The drug groups for migraines in detail: Remedies for malaise The migraine attack often causes malaise and vomiting. Therefore, those affected should swallow an anti-nausea medication (anti-emetic) some time before the pain reliever . Doctors recommend active ingredients such as metoclopramide, domperidone or dimenhydrinate for this. If the migraine sufferer fails to take this in time, he runs the risk that the pain reliever will not even reach the site of action, but will be vomited beforehand or not ingested. Over-the-counter pain relievers Many sufferers use normal pain relievers (analgesics) such as aspirin, paracetamol, ibuprofen, diclofenac, naproxen or phenazone – even with severe attacks. It is advisable to try out what works best individually. It is important to take the medication in sufficient doses right from the start: ASA and paracetamol 1000 milligrams, ibuprofen 200 to 600 milligrams, diclofenac 50 milligrams, naproxen 500 to 1000 milligrams and phenazone 500 to 1000 milligrams. Triptans Several of these highly effective active ingredients are now available on the German market. They are available as tablets, pre-filled syringes, nasal sprays or suppositories – depending on the individual situation and the course of the attack, a differentiated selection can be made. The effect usually sets in within 30 to 240 minutes. Triptans are well tolerated. However, children under the age of twelve should not take the powerful drugs. Prevention of common migraines If the violent attacks recur frequently, doctors advise taking certain medications as a preventive measure. The rule of thumb is: Anyone who suffers from migraines more than seven days a month needs prophylaxis. In this way it can be achieved that the attacks occur less frequently. Those affected have to take the medication regularly for several months. The effect can only be assessed after about six to eight weeks. And: The same remedies do not help everyone with the disease. Certain substances are very well researched, effective and well tolerated – that is why doctors prefer to prescribe these agents. First choice drugs include: Beta blockers , Flunarizine. If migraine sufferers cannot tolerate the first-choice remedy or if the active ingredients do not work for them, there are alternatives. These substances also work very well, but are associated with more severe side effects. Second-line drugs include: Valproate, Topiramate, For a third group, the following applies: These agents have so far proven themselves in prophylaxis, but their actual effectiveness in migraines has not yet been proven in large studies. Other medications include: Antidepressants, high-dose magnesium . Migraine attacks: what also helps Migraine Diary: By precisely recording the circumstances in which the headache occurs, you are closely monitoring your body and lifestyle. This will help you avoid triggers and prevent attacks in everyday life. Relaxation method: Every migraine sufferer should learn a relaxation technique, such as yoga or Jacobson’s progressive muscle relaxation. Biofeedback: Using this technique, migraine sufferers learn to recognize and control their own, mostly unconscious bodily functions. Wired to a computer via sensors on the head, the patient can see on the monitor during biofeedback what happens in the brain when stressed. During these applications, the migraine sufferer learns over time to control his body functions through his own willpower. Headache seminars : Pain clinics have developed special seminars. In small groups, those affected learn a lot about their illness. You will learn how to deal with an acute attack, which medication can help and how you can change your everyday life to avoid the pain. The sessions are usually chaired by doctors and psychologists who are specially trained in the field. Concordance therapy: Those affected often hide stressful thoughts behind an external facade that conveys exactly the opposite of what they are feeling to their counterpart. The concordance therapy , a developed for people with migraine behavioral training, helping patients better use of their body signals in difficult situations. They learn to express their feelings openly and to express their worries and problems instead of “eating them into themselves”. Doctors and psychologists who specialize in the treatment of headaches perform such therapies. The statutory health insurance companies usually bear the costs. Sport: It creates balance and relaxation. Attacks have been shown to occur less frequently. Endurance sports such as running, walking, swimming or cycling are best . Caution: If you train beyond your strength, you risk a pain attack. Acupuncture: This procedure helps some sufferers. The latest studies show that traditional Chinese acupuncture does not work better than sham acupuncture. However, both methods have proven to be more effective than doing without them altogether. It is questionable whether the needling actually relieves the pain or whether the success can be attributed to care and attention during therapy. Many medical professionals believe that it is still worth a try. Sauna : Going into the sweat bath relaxes and thus obviously improves your well-being. However, there are no studies on the effectiveness of sauna visits for headaches. There are also people for whom the sauna provokes migraine attacks. Kneipp therapy: treading water, alternating baths, knee, thigh, arm and face shower are recommended for headaches. Kneipp therapy has not been medically proven. Still, it can be helpful because it encompasses much more than just water applications – and it can lead to a balanced lifestyle. Tips The top priority is: Find your individual trigger. If you manage to avoid these situations, you have already gained a lot. The best way to discover the triggers is to keep a migraine diary. Make a note of when, for how long and under what circumstances you felt the pain. This will also make your doctor’s diagnosis easier . These tips can make your life with migraines easier: Take small breaks from everyday life. Start the day with a leisurely high-carbohydrate breakfast. Take a walk during your lunch break or do some relaxation training in between at work. Structure your daily routine. You can also use our daily routine checkhelp. Only plan what seems feasible to you. If necessary, create a schedule that you work through gradually. But leave some space for spontaneous decisions. Too rigid a time budget puts you under pressure rather than helping you to structure your day. Give them a reward day if you’ve followed your schedule. A regular daily rhythm is essential. If possible, go to bed at the same time, always get up at the same time, and stick to fixed meal times – even on weekends. It’s tough, but it helps against the attacks. Avoid stress in the workplace. Don’t ask too much of yourself. Learn to give up responsibility. Do you also say “no” to a task, which you feel unable to cope with or if you are reluctant to do so. Get a greater distance from the immutable things in life. Practice serenity. Do you do sports regulary. This helps you and your brain to “switch off”. Insert daily for about 15 minutesRelaxation training . You can learn that with a CD, for example. Self-confidence training helps to increase social skills and reduce fears. Be careful of what you eat. If you notice a headache after consuming a certain food, avoid this. Pay attention to the dosage of your medication. Take pain medication or triptans for a maximum of ten days a month. Otherwise, you run the risk of constant headaches. Try out which drugs will work best for you. Over-the-counter pain relieverscan also help with severe attacks. Important: Do not use any medication that you are unsure of whether it will work for you. Moderately effective drugs can increase attacks. Tips that migraine sufferers should consider are also available on the Migraine League Germany eV website expert advice Interview with Professor Stefan Evers, chief physician at the Clinic for Neurology at the Lindenbrunn Hospital in Coppenbrügge What happens in your head before an attack? All phases of a migraine occur in different regions of the brain. The patient perceives the first signs in the frontal lobe. There are centers for certain mood sensations. If these areas are activated before the actual attack, some people feel depressed, react irritated or even become downright euphoric. They often feel an irresistible craving for sweets. Some develop such cravings for it that they eat chocolate en masse. The reason: The suddenly overly activated areas of the brain need to be supplied with energy. The brain gets this in the form of carbohydrates by suggesting a strong desire for sweets. If the migraine attack sets in at some point afterwards, those affected often mistakenly believe that the chocolate, Only a small proportion of migraine sufferers actually experience an aura . This arises in the rear area of ​​the cerebrum, in the visual center. That is why most of them suffer almost exclusively from visual disturbances. They are caused by nerve paralysis that continues from one gray cell to the next and finally glides over the entire brain like a wave. The more severe the paralysis, the clearer the visual failures. What is going on in your head during the attack? The pain originates in the brain stem. There are centers that control the headache and filter out insignificant stimuli. This is important so that not every touch, no matter how small, hurts immediately. This filter is defective in people who suffer from migraines. While in the body of a healthy person the messenger substance serotonin ensures to dampen the innumerable pain impulses, the migraine sufferer lacks serotonin. The inhibition of pain in the brain gets so out of control that all stimuli from the face and head area reach the brain stem unhindered, where they are immediately identified as pain. Gradually the affected person becomes so sensitive that he even feels the veins pulsing in his head with excruciating pain. If the pain stimuli increase, the brainstem releases messenger substances, so-called neuropeptides. These trigger inflammation on the inner walls of the blood vessels. As a result, the pain-sensitive meninges are supplied with more blood, the blood vessels expand and become more permeable, so that the inflammatory messengers also flood into the surrounding tissue and the headache increases to the point of unbearable. It is not yet clear why the pain will stop at some point. Is the visit to the doctor so important? Migraines are easy to distinguish from other forms of headache. In order to identify them, the attending physician should be familiar with their criteria. Unfortunately, this is not always the case. Almost every second migraine patient knows their diagnosis. Many believe that their pain has other causes, such as tension headache, Back or dental problems. My advice is therefore: If you have repeated headache attacks, you should definitely consult a doctor. Since the first diagnosis is usually made by the family doctor, the patient should not hesitate to ask whether the doctor is familiar with the area. Otherwise, you should seek advice from a neurologist. He creates the anamnesis by querying the individual, internationally established criteria. Of course, a headache calendar can help. Only if the diagnosis cannot be clearly established does he use imaging tests to check whether the headache might not have other causes. What is the best way to help migraineurs? Sufferers must learn to deal with the inevitable. Because migraines cannot be cured. Those who hope for a miracle cure will be disappointed. However, medication can help alleviate the pain and annoying side effects. Doctors recommend a three-step concept: In an acute case – which medication do I take when an attack occurs so that it disappears quickly? For prevention – which medication do I take when I often suffer from attacks so that they do not arise in the first place? Prophylaxis without medication – what can I do to prevent attacks without having to take medication. When can a permanent headache develop? All drugs that are effective against acute headaches can cause persistent headaches. This applies to both over-the-counter pain relievers and prescription triptans . Under no circumstances should anyone take them for more than ten days a month, otherwise the migraine can become chronic: If the migraine sufferer stops taking the medication, he will experience withdrawal symptoms. And they are usually accompanied by severe headaches. Which therapies do you strongly advise against? Forms of treatment that destroy tissue are not recommended. Surgical cutting of the trigeminal nerve or muscles, as in so-called migraine surgery, is not advisable . In particular, the effectiveness of the transection of the forehead-facial muscle for treating migraines has not yet been scientifically proven. Is migraine a disease for women? No. Women are affected twice as often as men. So migraines also occur in men. These often even have particularly severe attacks. Many women experience migraine attacks before menstruating . Menstruation is a trigger of migraines, but not the actual cause.

The foot reflex zone therapy is an invention of the Indians. So far, however, no one has been able to prove that certain parts of the feet reflect other parts of the body. Reflexology works in a similar way to acupressure . The therapist uses finger pressure to stimulate certain points or areas on the soles of the feet. She assumes that these points are connected to the corresponding body regions, muscles or organs. This should relieve tension and help with digestive problems, headaches and back pain, for example . However, several studies did not provide any evidence that diseases can be cured with the method. If you want to try this procedure anyway, keep this in mind: Small feet are much more sensitive and delicate than adult’s. And the younger the child is, the gentler the pressure on the sole needs to be. If your offspring complains of more pain than before after the treatment, there is only one thing left: stop the therapy immediately. And you should never massage inflamed, injured, or swollen areas. That’s behind it: Even the ancient Egyptians relied on the beneficial effects of foot massage. The ancient doctors also put pressure on the sole. The foot reflex zone massage practiced today goes back to the American doctor William Fitzgerald (1872-1942). But he had found the method rather than invented it – he further developed the corresponding techniques used by North American Indians. According to Fitzgerald, examining the feet allows conclusions to be drawn about general health. Painful and grainy areas that are assigned to specific areas in the body supposedly show where the flow of energy is disturbed. If these areas are then stimulated by pressure or massage, this should harmonize the body functions. This is how it works: The assumption that certain foot zones are connected to certain organs is scientifically not tenable. There are now also different reflex zone maps, some of which contradict each other. Scientists have repeatedly studied this massage technique. Some studies also certify that foot reflexology has a positive effect – for example for headaches or multiple sclerosis. But the procedure has not been proven to cure or prevent disease. However, reflex zone therapy seems to relieve symptoms that have no organic cause.   This is what the expert says: Edzard Ernst is Head of Complementary Medicine at Exeter University in the UK. He has long been concerned with the effectiveness of alternative healing methods and has tested many procedures. His verdict: massaging the feet is definitely pleasant. The assumption that additional therapeutic effects can be expected is not supported by clinical studies.

Many of those affected are older, but children also get rheumatism. Diagnosis is difficult, especially at a young age. Parents need to know this in order to give their child the best possible support.   By Emily Linow Usually rheumatism is only known from one’s grandparents or old great aunt, but children can also get it. Around 1.5 million people across Germany are affected by rheumatism. Most are adults or very old, but according to the German Rheumatism Research Center (DRFZ) around 20,000 of them are children and adolescents – the number of those affected is rising steadily. It is difficult to recognize the disease, especially in young children. Most of the time, they cannot speak openly about it and it is up to the parents to recognize whether the child is in pain in order to prevent permanent damage. What is rheumatism anyway? Rheumatism is a generic term for many different inflammatory diseases. This inflammation occurs because the immune system is misdirected and then directed against the body’s own structures. Immune cells migrate to the joints and organs and produce substances that promote inflammation. The joint becomes inflamed and starts to hurt. Why the immune system goes crazy and attacks your own body is still unknown. A cure is also not yet in sight. The possibilities for combating the consequences and acute pain have advanced far in recent years, but the disease cannot be cured causally. Various factors control the risk of disease. A combination of genetic predisposition and environmental factors could probably lead to rheumatism – such as a stressful and stressful phase of life, an injury or illness. So some people are simply more prone to rheumatism than others. If they then get into a stressful phase, injure themselves while exercising or get sick, this can trigger acute inflammation. In children, the prognosis is usually much better than in adults. Occasionally the disease may be brought under control and become inactive. The clinical pictures are very different: Joints, vessels and connective tissue can be affected. Joint rheumatism is most common among these rheumatic-inflammatory diseases in children. Juvenile Idiopathic Arthritis (JIA for short) affects about one in 1,000 children nationwide. In JIA, the joint inflammation occurs before the age of 16, the cause is unclear. The inflammation manifests itself in a variety of ways.  AFTER THE SPECIALIST MARATHON Dry eyes, sore knees – only a specialist found the reason for my suffering According to the DRFZ, around every second JIA patient is affected  by  oligoarthritis  (oligo = few joints, arthritis = joint inflammation). The characteristics are: Usually only one or a few affected joints are affected, usually the knee joint at the beginning the disease occurs in infancy. The  Systemic arthritis  usually manifests itself: Fever and reddish skin symptoms In addition to inflammation of joints, internal organs are also affected. The  psoriatic arthritis (psoriasis = psoriasis) is a psoriasis advance – usually by several years. In the case of  arthritis with a  tendency to enthesitis (entheses = tendon attachments), the following are inflamed: Ankle and ankle joints as well as the tendon attachments – often on the heel. It mostly occurs in boys of school age. In  polyarthritis  (poly = many) more than four joints become inflamed. There are two versions: One of them has a rheumatoid factor in the blood,  for the other, the factor cannot be proven. Most often this disease develops in young girls. According to the DRFZ, about 19% of all JIA patients suffer from this manifestation. In addition to the joints that are often affected, such as knees, hips, hands and feet, inflammation can also affect the jaw in any of the manifestations. Inflammation of internal organs can also be associated with JIA, although this is particularly common in systemic arthritis. The children’s eyes are particularly at risk. A visit to the ophthalmologist  should clarify this. All forms of JIA are difficult to identify – especially when the child is still small. Any child, of any age, from small babies to adolescents can be affected. Many small children do not complain about the pain, but simply adopt a protective posture. Even with adolescents it can happen that they only mention their pain in passing and instead try to find relief for their painful joint. Most of the time, they do this pretty well, even if only for a short time. The symptoms differ from person to person. Many children have pain in their joints – when moving and when they are at rest. The joints sometimes show no external features at all. But there is also swelling, strong warmth and reddish tint. Children can also develop a fever. Sometimes the child has difficulty opening their mouth fully or complains of pain when chewing. These clues provide further information: Does the child limp while walking? Does it relieve a leg? Is it different or does it support itself differently than before? Are the joints overheated, swollen or stiff after getting up? Does the child want to hug again, even though they have been walking for a long time? Does the child complain of pain when moving? These could all be the first signs of rheumatism. Of course, the child could only have been injured while exercising. However, if the symptoms occur regularly and with increasing frequency, a doctor should be consulted. The diagnosis – a (often) long road The first way is to see a pediatrician or an orthopedic surgeon. The search for traces begins here. It is particularly difficult to make a clear diagnosis in children and adolescents, as there are usually no clear markers in the blood at the onset of the disease. The imaging is also usually not very meaningful. X-rays rarely show anything and other imaging techniques, such as magnetic resonance imaging or sonography, are difficult to interpret. The diagnosis is like a giant puzzle made up of the patient’s complaints, clinical, laboratory, imaging findings and the previous medical history. If there is even the slightest suspicion of children’s rheumatism, a child and adolescent rheumatologist is involved in the diagnosis. Supply map of the Rheumatism League . The therapy – remedy for pain and inflammation Once the diagnosis has been made, everyone involved needs to breathe a sigh of relief, because even if rheumatism is not yet curable, there are very successful therapy methods that promise rapid pain relief. The aim of the therapy is to combat inflammation in the joints, relieve pain and remedy the restrictions on movement as quickly as possible. There should be no permanent damage to joints or organs. For this, the therapy is based on various building blocks, which all together drive the path to the goal. The first building block is the medication. Treatment for rheumatoid arthritis in children usually begins with prescribing nonsteroidal anti-inflammatory drugs (NSAIDs). These are cortisone-free drugs that are said to relieve pain, reduce inflammation and lower fever. In the case of acute inflammation, cortisone can also be administered, which is supposed to intensify the reduction in inflammation and pain. Systematic cortisone therapy can take the form of tablets or injections of a liquid containing cortisone directly into the affected joint. High doses over a long period of time come here due to side effects such as weight gain (“full moon face”), increased body hair, growth disorders and bone decalcification, only used in the case of particularly severe disease processes. In addition, children who take a dose of cortisone higher than ten milligrams per day have an up to three times higher risk of infection than children without cortisone therapy. With the short-term administration of cortisone in acute therapy, however, there is little need to worry about undesirable side effects at high doses. If NSAIDs and cortisone do not have a sufficient effect, rheumatologists usually resort to so-called basic drugs. These are supposed to bring the disease to a standstill. Methotrexate (MTX) is used here particularly frequently: an agent from cancer therapy that is dosed 1000 times lower. This can also be taken as a tablet or injected. Most of the time, despite the fear of injections, the children do not take the pill, as this can cause nausea and, if taken weekly, can severely restrict everyday life. With its poison green color, the syringe does not necessarily make the feeling better, but it does not cause nausea. If MTX does not have the desired effect either, biologics are usually added. These drugs are based on a natural group of substances. They inhibit the body’s own messenger substances of the immune system. In rheumatoid arthritis, the messenger substance TNF-alpha is blocked and the transmission of the inflammation can be prevented. The inflammation of the joints will decrease. The onset of action is often quick and with impressive results. Nevertheless, the side effects of biologics cannot be completely neglected: The weakening of the immune system must be considered, especially with regard to vaccinations. With so-called passive vaccinations and dead vaccines there is usually nothing to consider, with live vaccines (such as measles, mumps, Movement therapy is another component of the therapy. Physiotherapy releases tension in the muscles, strengthens them and relieves the joints. The movement stimulates the metabolic exchange in the blood and inflammation – as far as possible – is fought by the body itself. Even acutely inflamed joints should be moved carefully and without strain. Occupational therapy is not recommended for everyone with rheumatism. If it is recommended by the attending physician, you should definitely take advantage of the therapy and take the chance. The aim here is to maintain and improve joint functions. Children learn how to take part in games with other children that is as gentle on their joints as possible, how to avoid improper stress and how to avoid overloading. For this one takes various exercises, but also rails to help. And what does rheumatism mean for the family? Rheumatism in a child or adolescent is not just a big change for their own life. It is also a major turning point for the family. Trips have to be canceled or rescheduled, you can’t just frolic outside, meet friends or take long walks. Those affected often suffer from permanent pain and nothing is able to provide them with relief. When it rains, the pain gets worse, so the child stays inside. This can be a major limitation, especially in the rainy autumn or winter months. TV HOST Diagnosis of rheumatism – Jörg Pilawa’s daughter is seriously ill The therapy determines the daily routine of the entire family: taking medication in the morning, doing physiotherapy, going to physiotherapy or occupational therapy, taking medication. Everything accompanied by the usual pain. Every day the child’s condition can get worse or better. It can go steeply uphill or downhill overnight. Often, from the time of diagnosis, one parent only takes care of the sick child. The other parent goes to work. Both can feel misunderstood and left alone. It is not uncommon for unspoken allegations to appear. The most important thing in such a time would be to stick together and support one another. Open communication and maybe a little support from outside help here: A therapist for the family can perhaps resolve the problem quickly. It can also happen that siblings feel neglected and take a back seat. The parents often don’t mean it badly at all. You are simply just busy with the rheumatoid child all the time. Many siblings not only receive less attention, but are often asked to show understanding and show consideration. Many understand that. They too want to help and support and, above all, not be an additional burden on the parents. Open communication with the siblings is particularly important here. So you can step in early enough if a child feels neglected. The sick child should also play a role. Because it must also understand that although it is not well, During this time, siblings can develop an even closer bond, because the sick child will not necessarily, but very likely, lose many of his friends to the illness. With persistent pain, the child is often unable to play with other children as often and exuberantly as they would like. Depending on the age of the child and the friends, it can also happen that the other children do not understand the child’s illness at all and show no empathy. Many children do not want to suppress their urge to move. In summer they prefer to race outside instead of watching a movie inside just because a single child friend cannot play outside. In order to counteract this development, however, one can seek a conversation with the parents of the friends,  If the loss of friendships can be absorbed by the bond of siblings, it is the greatest gain one can have in this situation.  Children don’t want “outsider” status School is often the only place of social contact that children with rheumatism have, and this is where there is a lot of potential for conflict. Many children do not want to be seen as outsiders by their classmates because they wear a splint or get more time for class work. You want to take part in physical education classes and not sit on the sidelines. Go out during the break and romp around with the others – ticking or playing tag. Before the child goes back to school, parents should make sure that they are no longer ashamed of their illness. After all, the child is not to blame for their condition and should never feel bad about it. It can be very helpful to explain the illness to the child as clearly as possible – as graphically as possible. The child can then explain it to their classmates in the same way. Children with rheumatism usually know a great deal about their condition, but cannot explain it well.  For example, it would be possible to describe the child’s immune system as a kind of army. The army of the other children only has good soldiers, but that of the rheumatoid child also has bad soldiers in its ranks. These evil soldiers turn against your own body and destroy it. In order to fight the bad soldiers, the good soldiers still need the help of other soldiers. That is why the child has to take so much medication. It is only allowed to do sports and romp around after the evil soldiers have been defeated. Can Diet Help? There is no nutritional plan and no recipe for success as to how diet can best support therapy, but there are a few good tips that are worth trying out. HOW NUTRITION CAN HEAL Eat yourselves healthy! In general, the diet of rheumatism sufferers should be as varied as possible – whole grain products and fresh fruit and vegetables should not be missing. Scientific studies show that many animal foods exacerbate the inflammation. Arachidonic acid is found in meat and dairy products. From this, inflammation-promoting messenger substances are later formed, which can intensify the inflammation. Reducing your meat product consumption to a few times a week or a month is a great way to lower your dietary fatty acid intake. However, it is important to continue to consume fish. The eicosapentaenoic acid (EPA) contained in fish has exactly the opposite effect as the arachidonic acid contained in meat. EPA has shown slight improvements in joint swelling and pain intensity according to clinical tests. The components of EPA are also found in many different oils, such as rapeseed and linseed oil. A third tip for the diet are spices: ginger, curry, caraway seeds and garlic prevent the formation of inflammatory substances from arachidonic acid and can also lead to a significant improvement in pain with regular use. In many circles, nutrition tips are considered a miracle weapon. Vegetarianism and veganism are particularly popular. However, there is no scientific evidence as to whether this diet can fight rheumatic diseases in the long term. Here everyone has to listen to their own feelings and try different things. Everyone is different and everyone can digest different foods differently.  Once in rehab – please! In the case of acute and very severe inflammation or difficulties in being adjusted to the right medication, it is possible to go to a clinic that specializes in rheumatism patients. Intensive support is very important here. Patients are properly adjusted to their medication, receive physiotherapy and occupational therapy, can try out new therapy methods, manage their pain in pain therapy and get to know like-minded people. Especially for children who feel lonely with their suffering, this can be the most helpful point in a pediatric rheumatology clinic. Rehabilitation is very useful in order to escape from everyday life and to repair the subsequent damage after an acute attack. The aim of rehabilitation is to maintain or restore joint functions. Here it is particularly important that the child comes to a specialized institution. Appropriate psychological care, patient training and qualified pediatric rheumatoid treatment should be provided. Here, too, the social factor is great – children feel less alone. Such a facility is best selected with the treating rheumatologist, who knows exactly what to look out for and whether the clinic or rehab is suitable. The rehabilitation facilities and clinics can also be found on the care map of the Rheumatism League. What tips and tricks are there? Rheumatism comes in many different forms, so there are many different tips and tricks: some help, some less. However, they are always worth a try for acute pain. Parents can relieve their child with simple home remedies, because every warm or swollen joint can be cooled. Simply wrap an ice pack in a towel and use it as a cooling wrap around the joint. The cold removes excess heat from the joint, which can lead to inhibition of inflammation and relief of acute pain. Not every child reacts positively to the cold. Here it is time to try it out. With luck you have discovered the miracle cure! EXCLUSIVE RANKING Service, staff, expert judgment – these are the 150 best hospitals in Germany The child does not have to go to a rheumatism clinic straight away to make contact with children and adolescents who are also affected by rheumatism. A rheumatism forum offers a platform for the exchange of topics about JIA. On social media such as Instagram, many young people share their experiences and exchange ideas about their situations. Even if it is only virtual contact, affected children and young people no longer feel so alone with their problems. You can also find further tips from other sufferers here. Open communication with and in school can also be very helpful. Parents can speak openly with class teachers and school principals. Perhaps the class can be moved to a different classroom so that there are fewer stairs to walk. It is possible to order a second set of school books so that the child does not have to drag heavy school books to school every day. Compensating for the handicap can add more time to classwork or get a computer to write with if writing with your hands is painful. If the water in the swimming pool is too cold during swimming lessons, a certificate can remove the child from class, but perhaps a grade can still be achieved through open communication with the teachers.  What if nothing wants to help? There is no cure for rheumatism. Medicine is far and has made many advances in recent years, but therapy only combats the symptoms of the disease – not its cause. In most cases, timely therapy can completely reduce joint inflammation, prevent permanent damage, and reduce movement restrictions. Juvenile idiopathic arthritis has a significantly better prognosis than that of adult rheumatism patients. It is not uncommon for the disease to come to a standstill in children and adolescents and become inactive. There is always a little bit of rheumatism slumbering in everyone affected, but the renewed outbreak is in the stars. The rheumatism may never return. The likelihood that the pain and inflammation will flare up again after stopping medication is around 50 percent – which does not mean that you have to take medication forever. In any case, after successfully combating the inflammation, it is helpful to listen to the doctor and agree to stop taking the medication, even if there may be great fear that the pain will return. In any case, it is particularly important not to lose hope of recovery. There is no recipe for success here, as every person and every disease is different, but many children and adolescents have managed to get the disease under control and many more will follow. Optimism is not the only real road to improvement, but not losing hope is a good place to start.

The tragic case of a four-year-old in Bad Hersfeld shows that measles is no kid’s thing. It becomes dangerous when the pathogens enter the brain. Experts therefore recommend vaccinating children. A four-year-old in Bad Hersfeld is dying . She suffers from an inflammation of the brain, a long-term consequence of a measles infection. The tragic case shows that measles is not a child’s thing. The star says what you need to know about the disease and how you can protect your children. We have a case of measles! “You should take such warning signs on the door of daycare or school seriously: The disease is extremely contagious and not without danger. Watch your child carefully, the first clues are coughs, sniffles, watery eyes, fever – as with a thick cold . the only sure sign that it is measles, you can find in your child’s mouth: then sit red spots on the buccal mucosa, emblazoned in the middle of a white dot the rash on the body does not appear until days later.. Viruses are to blame for measles, more precisely: Paramyxo viruses. They fly through the air, well packed in droplets of saliva. Your child may be infected because they coughed or sneezed. Viruses switch from one victim to another even when talking wetly. The pathogens enter the body through the mucous membrane of the mouth, nose and throat. The tricky thing: Before a sick child is recognized as sick because his skin is covered all over with red dots, it has long since infected others. Measles can become a disability The rash all over the body looks dramatic but is the least of a problem. The measles viruses weaken the immune system and also attack internal organs such as the lungs, liver or intestines. If the germs nest in the brain, the nerves there ignite. This so-called measles encephalitis can, in the worst case, lead to permanent mental and physical disability or even death. The following applies to measles : whoever has it once will never get it again. Because the immune system knows the germ that is causing the problem and has suitable defense substances, so-called antibodies, ready to counteract them. This is how it can successfully fight the virus should the pathogen slip into the body again. Measles parties are dangerous To celebrate their child against measles, some parents send their offspring to measles parties. The offspring should be infected there in order to be protected from the disease once and for all. Experts think this is a bad idea. Because measles is no kid’s thing – a mental or physical disability is no fun. Many parents are unsettled by the claim that vaccinating against measles is dangerous. It is correct: Every vaccination can have side effects, including the measles vaccination. These include, for example, swelling at the injection site or allergic reactions. It is also correct: Two percent of vaccinated children develop so-called vaccinated measles. This is measles in a light version, in which the symptoms are much more harmless: moderate fever , a little rash, cough and runny nose . The vaccination can even inflame the brain. However, this happens much less often than with real measles: out of a million vaccinated children, one gets this dreaded measles encephalitis. If, on the other hand, a child is infected with real measles, the risk of encephalitis is much higher: one child in a thousand is affected. The risk of vaccination is therefore many times lower. Symptoms If your child has contracted measles, it will take a while for you to notice. Usually around eight to ten days, that’s how long it takes to visibly react to the virus. The disease has two phases: First comes the fever, along with symptoms that look like a bad cold. Measles only leave clear traces in the oral cavity. It wasn’t until days later that she got sick too, she was covered with red spots. Phase 1: fever, cough and red spots in the mouth First your child will have a fever of up to 39 degrees. It feels dull, its nose is runny, it coughs, its eyes water, its face looks puffy. The symptoms at this stage are reminiscent of a severe cold . In addition, your daughter or son can be sensitive to light. This is not typical of a cold. You can be absolutely sure that it is the measles if you discover the so-called Koplik spots on the cheek mucosa during this phase: red spots with a white dot in the middle. After three to four days the fever drops again and the body temperature drops to values ​​that are almost normal. Phase II: rash and fever again Then it starts behind the ears: the rash blooms. The red spots then spread over the face and back to the arms and legs. The fever is also back – and sometimes even rises to over 40 degrees. Your child is really bad at this stage: he lies in bed listless, is tearful, has no appetite, is tormented by a runny nose and watery eyes, he has coughs and diarrhea . By the fourth day of this phase, the rash has reached the feet and the fever has subsided. If the temperature drops, the child will feel better quickly; the disease is over after about ten to fourteen days. If the fever does not go away, the viruses attack vital organs. Then you should go to the doctor. Blood from the nose and bottom, bacteria in the ear and lungs Sometimes the viruses damage the mucous membranes so much that tissue is destroyed in the process. Then your child will bleed from the nose, mouth or bottom. The measles virus can put such a strain on the immune system that bacteria that would otherwise have no chance can attack the body. Experts then speak of a superinfection. For example, bacteria can settle in the middle ear because the body’s defenses are so weak. Your child will then develop an otitis media. Pneumonia, hepatitis or bronchitis can also result from measles infection. The worst consequence: the child dies A serious, albeit rare, complication is the dreaded encephalitis. One out of about a thousand sick children gets this so-called measles encephalitis. Then your child is partially unconscious, has convulsions and epileptic seizures, some muscles are paralyzed, and your daughter or son can no longer move properly. In a few cases the symptoms do not go away: some children remain paralyzed or mentally handicapped. In the worst case, they will die of measles encephalitis. diagnosis The pediatrician usually recognizes the typical symptoms of measles immediately. In the first phase of the disease, the so-called Koplik spots appear on the mucous membrane of the cheeks: red marks with a white point in the middle. In the second stage, the doctor identifies the disease based on the unmistakable rash. Therefore, she does not need a blood test for her diagnosis, which would put additional stress on the sick children. Only if the symptoms are not quite as clear – for example at the very beginning – will the doctor draw blood from your child. therapy Unfortunately, there is no drug against measles virus. The pediatrician can only alleviate the symptoms. She will only recommend strict bed rest. The children usually comply with this by themselves because they feel really sick. If your child has a fever , they should especially drink a lot. The pediatrician can prescribe suppositories with the active ingredient paracetamol or ibuprofen against the high temperature. If the red spots on the skin become inflamed or if the child even gets pneumonia because bacteria have also infected the diseased tissue, antibiotics help. These drugs can destroy the causative agent, the bacilli. Vaccination helps the body’s defenses to train Experts advise getting children vaccinated against measles. The standing vaccination commission recommends the first vaccination between the 11th and 14th month of life. Before that, the baby is still protected by the mother’s antibodies, which circulate in its blood. Doctors usually also vaccinate against two or three other typical childhood diseases: against mumps and rubella (MMR vaccination) or against mumps, rubella and chickenpox  The virus components in the vaccine stimulate the formation of defense substances – antibodies – against the intruders. In order for the protection to last for life, a second vaccination must be given. The recommended period is between the 15th and 23rd month. Only then is the body’s own immune police strong enough to fight the viruses itself for a lifetime. Tips Measles are extremely contagious. If your child is infected, please notify the daycare center or school. And your offspring should of course stay at home, preferably in bed. Because the disease is draining, in order to get well, the child needs all his strength. If he has a high fever , his body needs a lot of fluids. So give him a good drink. In some children, the conjunctivae of the eyes also become inflamed, so they become very light-shy. Darken the nursery and pull up the curtains. Moist air helps against this. Hang up wet towels in the nursery at night, this calms the mucous membranes. expert advice Gerhard Gaedicke, Professor of Pediatrics and Director of the Clinic for General Pediatrics at the Berlin Charité, answers: Why is measles not yet eradicated in Germany – as in other European countries?Measles is still too common in Germany. Epidemics flare up again and again, for example in North Rhine-Westphalia and southern Germany. Often this is because parents do not allow their children to be adequately vaccinated. Many of them get their first vaccination as planned. However, parents miss the second revaccination, which is so important for complete protection. The result: vaccinated children do not build up safe vaccination protection and can become infected later. In some regions, more than half of the children vaccinated are missing the important second vaccination. How safe is the vaccination? An appropriately vaccinated child is protected from measles for life. So-called vaccination breakthroughs are extremely rare: only one percent of children who have been vaccinated twice will later be attacked by the pathogen again . In such cases, however, they are only slightly ill. I therefore recommend that all parents have their children fully vaccinated. Should a child have measles? I advise against that. It is generally better to prevent the disease than to go through it. Measles is one of the typical childhood diseases, but it is very stressful and can lead to complications. If the disease breaks out later, in adolescence or adulthood, it is even worse.