Wockhardt Hospital

Sleep is known to most as a period of rest and relaxation, but there are multiple disorders which are associated with sleep too. Hypersomnolence or hypersomnia is one of the most common sleep disorders. This is characterized by excessive daytime sleepiness and prolonged periods of sleep at night. They wake up fresh in the morning, but can easily go back to sleep any time of the day without feeling strained or tired. There is again no freshness associated upon waking up. Funny as it may sound, they can doze off even during a meal or in the middle of a conversation.

Causes: This condition is most common in men and in the early adolescent days.

1. There is no underlying cause that has been identified, though there is a genetic predisposition.
2. People with history of head trauma are more affected
3. People with anxiety, depression, bipolar disorders, epilepsy, and other mental disorders are also more likely to be affected
4. People with sleep apnea often are hypersomnolence
5. Restless legs syndrome, narcolepsy
6. Neurodegenerative disorders like Parkinson’s and Alzheimer’s tend to sleep more.

Symptoms:

1. Sleeping for longer hours at night time
2. Excessively sleepy during daytime
3. Able to doze off anytime during the day
4. Inappropriate and involuntary sleeping pattern
5. Having difficulty getting out of bed after waking up, even after prolonged sleep
6. Feeling of disorientation
7. Feeling agitated, anxious, lethargic, and irritated
8. Impaired cognition and memory
9. All these lead to extreme state of drowsiness
10. Increased tendency for hallucinations
11. Reduced appetite and even weight loss in some people
12. There is restlessness, reduced pace of thinking and speaking
13. Overall reduced energy levels
14. Social interactions are affected including work life, social functions, etc.

Diagnostic criteria:

1. If a person happens to sleep more at night or falls asleep during the day easily for more than 3 times a week, it is usually concerning.
2. The added feature of no tiring physical activity can also lead to suspicion
3. In acute cases, these symptoms are present for at least a month and in chronic cases, it could be seen for up to 3 months
4. It cannot be explained by lack of sleep on a regular basis
5. One or more of the above conditions could be present, which can help in making the diagnosis

Treatment:
Most cases of hypersomnia would need treatment only to improve their energy levels and improve the quality of life. Very often, treating the underlying condition can lead to improvement of hypersomnia. The tired, lethargic, restless feeling affects the overall performance of a person, leaving them with a lowered self-esteem. Brain stimulating drugs like amphetamines are used to improve daytime alertness and also reduce sleepy feeling during the day.
 

Headaches and migraines can vary drastically depending on their duration, specific symptoms and the person they are affecting. The more you know about your specific type of headache or migraine, the better prepared you will be to treat them—and possibly even prevent them. The two types of migraine are- 

1. Migraine without aura: The majority of migraine sufferers have Migraine without Aura. 
2. Migraine with aura: Migraine with Aura refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes.

Symptoms of migraine vary and also depend on the type of migraine. A migraine has four stages: prodrome, aura, headache and postdrome. But it is not necessary that all the migraine sufferers experience all the four stages.

Prodrome: The signs of this begin to appear a day or two days before the headache starts. The signs include depression, constipation, food cravings, irritability, uncontrollable yawning, neck stiffness and hyperactivity.
Migraine Aura: Auras are a range of symptoms of the central nervous system. These might occur much before or during the migraine, but most people get a migraine without an aura. Auras usually begin gradually and increase in intensity. They last for an hour or even longer and are 

• Visual: Seeing bright spots, various shapes, experiencing vision loss, and flashes of light
• Sensory: Present in the form of touch sensations like feeling of pins and needles in the arms and legs
• Motor: Usually related with the movement problems like the limb weakness
• Verbal: It is related with the speech problems

Headache: In case of a migraine attack one might experience:

• Pain on both sides or one side of the head
• Pain is throbbing in nature
• Vomiting and nausea
• Sensitivity to smells, sound and light
• Vision is blurred
• Fainting and lightheadedness

Postdrome: This is the final phase of the migraine. During this phase one might feel fatigued, though some people feel euphoric.

Red flags that the patient may be having underlying serious disorder not migraine

1. Onset of headaches >50 years 
2. Thunderclap headache - subarachnoid haemorrhage 
3. Neurological symptoms or signs 
4. Meningism 
5. Immunosuppression or malignancy 
6. Red eye and haloes around lights - acute angle closure glaucoma 
7. Worsening symptoms 
8. Symptoms of temporal arteritis

These patients require CT scan / MRI or CSF examination. Most Migraine patients do not need these tests. 

Diagnosis of Migraine: Usually migraines go undiagnosed and thus are untreated. In case you experience the symptoms regularly then talk to the doctor, who evaluates the symptoms and can start a treatment. You can also be referred to a neurologist who is trained to treat the migraines and other conditions. During the appointment the neurologist usually asks about the family history of headaches and migraines along with your symptoms and medical history.

The doctor might advise for some tests like:

1. Blood Tests: These reveal problems with the blood vessel like an infection in the spinal cord and brain.
2. CT scan: Used to diagnose the infections, tumors, brain damage, and bleeding that cause the migraines.
3. MRI: This helps to diagnose the tumors bleeding infections, neurological conditions, and strokes.
4. Lumbar Puncture: For analyzing infections and neurological damages. In lumbar puncture a thin needle is inserted between the two vertebrae to remove a sample of the cerebrospinal fluid for analysis.

Treatments

Migraine treatments can help stop symptoms and prevent future attacks.

Many medications have been designed to treat migraines. Some drugs often used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Some medications aren't recommended if you're pregnant or breast-feeding. Some medications aren't given to children. Your doctor can help find the right medication for you.