Malnutrition
of nutritional

A balanced diet should provide enough nutrients like calories, protein and vitamins, to keep you healthy. Without this, you may not be getting all the nutrients you need and this can lead to malnutrition.

Malnutrition can result in:

unplanned weight loss muscle loss a low body mass index (BMI) vitamin and mineral deficiencies

This can leave you feeling tired, weak and affect your ability to recover from an illness.


Malnutrition can result in:

unplanned weight loss muscle loss a low body mass index (BMI) vitamin and mineral deficiencies

This can leave you feeling tired, weak and affect your ability to recover from an illness.


unplanned weight loss muscle loss a low body mass index (BMI) vitamin and mineral deficiencies

This can leave you feeling tired, weak and affect your ability to recover from an illness.

Symptoms

Malnutrition can be difficult to recognise. It can happen very gradually, which can make it very difficult to spot in the early stages.

Common signs and symptoms of malnutrition include:

loss of appetite and lack of interest in food or fluids unplanned weight loss – this might cause clothing, rings, watches or dentures to become loose tiredness or low energy levels reduced ability to perform everyday tasks like showering, getting dressed or cooking reduced muscle strength – for example, not being able to walk as far or as fast as usual changes in mood which might cause feelings of lethargy and depression poor concentration poor growth in children increased risk of infection, recurrent infections, taking longer to recover and poor wound healing difficulty keeping warm dizziness

Speak to your GP if: you have any of the symptoms of malnutrition you notice a drop in weight or you’ve lost weight without trying

Causes

Sometimes, medical conditions cause your body to need more nutrients. Some medical conditions can lead to your body being unable to absorb or use nutrients. These may include:

cancer and liver disease that can cause a lack of appetite, persistent pain or nausea COPD, pulmonary fibrosis and emphysema, which cause your body to need more nutrients but can reduce your appetite mental health conditions, like depression or schizophrenia, which may affect your ability to look after yourself Crohn’s disease, ulcerative colitis or cystic fibrosis that disrupt your body’s ability to digest food or absorb nutrients burns, fractures and post major surgery, due to increased demand for nutrients dementia – people with dementia may be unable to communicate their needs, may use up a lot of calories pacing or may experience a loss of appetite dysphagia – a condition that makes swallowing difficult or painful persistent vomiting or diarrhoea

Some types and combinations of medication can increase your risk of developing malnutrition. Always check your medicines information and speak to a healthcare professional for advice if you have a concern. Do not stop taking your medication without advice from a healthcare professional.

Other causes of malnutrition

Physical, social and ageing issues can also cause malnutrition.

Physical issues Physical issues can contribute to malnutrition. For example: if your teeth are in a poor condition, if your dentures do not fit, or if you have a sore mouth, eating can be difficult or painful you may lose your appetite as a result of losing your sense of smell and taste you may have a physical disability or other physical impairment that makes it difficult for you to cook or shop for food yourself

Social factors Social issues that can contribute to malnutrition include: living alone and being socially isolated having limited knowledge about nutrition or cooking reduced mobility alcohol or drug use low income or poverty reliance on food banks

Ageing As we get older we might become more likely to experience malnutrition. This might be because of how we feel, and physical and social factors. The risk also increases because we’re more likely to have one or more medical conditions as we get older.

Diagnoses

A healthcare professional can assess you for malnutrition using a screening tool like ‘Malnutrition Universal Screening Tool’ (‘MUST’).

Screen yourself for malnutrition

Treatments

If you’ve lost weight or your appetite is poor, you can make simple changes to your meals, snacks and drinks to help treat malnutrition.

Choosing nutrient-dense food and drinks can help improve your calorie intake. This might not be suitable for everyone, especially those with other conditions like dysphagia. Ask your GP, dietitian or nurse for further advice if you’re unsure.

You should speak to a healthcare professional if you’ve had to limit the fat and sugar you eat in the past due to a health condition like high cholesterol or diabetes.

Ways to increase your calories

Try the following ideas to help you to increase the amount of calories and protein in your diet.

Do eat ‘little and often’ – 3 small meals a day with 2-3 snacks in-between meals include protein like meat, fish, chicken, eggs, beans or lentils in each meal add high calorie ingredients like full cream milk, cheese, butter, ghee, olive oil and cream to meals and drinks include puddings after your lunch and dinner like creamy yoghurts, custards, rice pudding, milk puddings or ice-cream try ready meals if you don’t feel like cooking choose nourishing milky drinks like malted drinks, hot chocolate, milky coffee and milkshakes choose high sugar drinks like fruit juice, smoothies, fizzy drinks or squash (you can also add egg powder to juice to increase its nutrients) try including 1 pint of full cream milk each day – you can fortify (add extra nutrients to) this by adding 4 tablespoons of dried milk powder – and use this in drinks, cooking, cereals and puddings

Don’t do not have drinks just before meals because this can make you feel fuller quicker do not choose low fat, sugar-free, diet foods and drinks – for example skimmed milk

If you’re using vegan alternatives to cheese, butter, cream or milk, try to choose the highest calorie option.

How to add extra nutrients to milk Watch this video to find out how to fortify your milk with milk powder. You can then use this instead of your usual milk.

How to add extra nutrients to juice Watch this video to find out how to fortify your juice using egg powder.

Easy ways to fortify your food

There are ways you can use every day food and drinks to fortify (add extra nutrients to) your food.

Butter Add extra butter to: sandwiches or toast mashed potatoes vegetables sauces baked potatoes snacks like pancakes, crumpets and scones biscuits or crackers

Sugar, jam and honey Add sugar, jam or honey to: puddings hot drinks milkshakes or smoothies glazed vegetables creamy yogurts fruit porridge or cereal

Cream, chocolate spread, peanut butter or nuts Add cream, chocolate spread, peanut butter or nuts to: porridge fruit sauces soups smoothies or milkshakes snacks (toast, pancakes, crumpets, scones, waffles, rice cakes) ice cream or puddings

Vegetarian and vegan food If you follow a vegetarian or vegan diet, you can use the following foods to fortify your diet: nut butters vegan cheese vegan cream dairy free milks like oat, soya and nut milks (try to choose the sweetened options that provide the most calories) hemp and pea protein powders avocado plant based spreads Try to choose the highest calorie and protein options available.

Snacks Try to eat high calorie and protein snacks like: crackers or oatcakes with cheese, pate, hummus or avocado crumpets, scones and pancakes with butter and jam thick and creamy yoghurts soya yoghurts or desserts milk jelly, chocolate pots and mousses custard, trifle and rice pudding pots dried fruit nuts and seeds cereal bar and flapjacks mini pork pie, sausage roll, scotch egg and spring rolls chocolate, biscuits, pastries and cakes crisps with dip fruit with chocolate spread or peanut butter

Food fortification video Watch this video for ideas of how to add extra nutrients to your food.

The British Dietetic Association (BDA) Malnutrition factsheet provides more useful practical advice.

Watch this video on Vimeo for more tips on how to fortify your food

Oral nutritional supplements

Oral nutritional supplements (ONS) are a range of liquid and powder products that help support better nutrition.

They contain calories, protein, vitamins and minerals to help increase your intake. They’re designed to be taken alongside your diet and the ‘food first’ advice above to promote progress with your weight.

Tube feeding (enteral feeding)

Depending on how severe your symptoms are, your healthcare professional might recommend a “feeding tube”.

There are different types of tubes. Which one is best for you depends on your diagnosis and symptoms.

The most common types of feeding tube include:

nasogastric – through your nose and into your stomach nasojejunal – though your nose and further into your digestive tract percutaneous endoscopic gastrostomy (PEG) – a tube is placed directly into the stomach via your abdomen

Depending on your condition alternative routes of nutrition may be considered.

Measles
of infections and poisoning

Anyone can get measles if they haven’t been vaccinated or they haven’t had it before. It’s most common in young children.

Measles usually clears in around 7 to 10 days.


Measles usually clears in around 7 to 10 days.

Symptoms

The first symptoms of measles develop around 10 days after you’re infected. These can include:

cold-like symptoms, such as a runny nose, sneezing, and a cough sore, red eyes that may be sensitive to light watery eyes swollen eyes a high temperature (fever), which may reach around 40°C (104°F) small greyish-white spots in the mouth aches and pains loss of appetite tiredness, irritability and a general lack of energy

The measles rash appears around 2 to 4 days after the initial symptoms and normally fades after about a week. The rash:

is made up of small red-brown, flat or slightly raised spots that may join together into larger blotchy patches usually first appears on the head or neck, before spreading outwards to the rest of the body is slightly itchy for some people

Measles rash

Go to A&E or phone 999 if: You or your child have measles and: shortness of breath a high temperature that does not come down after taking paracetamol or ibuprofen is coughing up blood drowsiness confusion fits (convulsions)

Phone your GP urgently if: you think you or your child might have measles you’ve been in close contact with someone who has measles and you’ve not been fully vaccinated (had 2 doses of the MMR vaccine) or haven’t had the infection before – even if you don’t have any symptoms you’ve been in close contact with someone who has measles and you’re pregnant – measles can be serious in pregnancy you have a weakened immune system and think you have measles or have been in close contact with someone with measles If your GP is closed, phone 111.

You should phone your GP first before visiting. They can make arrangements to reduce the risk of spreading the infection to others.

Treatments

There are things you can do to help relieve your symptoms.

Do take paracetamol or ibuprofen to relieve fever, aches and pains – aspirin should not be given to children under 16 years old drink plenty of water to avoid dehydration close the curtains to help reduce light sensitivity use damp cotton wool to clean the eyes

In severe cases, especially if there are complications, you or your child may need to be admitted to hospital for treatment.

Preventions

Measles can be prevented by having the MMR vaccine.

This is given in 2 doses as part of the NHS childhood vaccination programme.

You can be vaccinated at any age if you haven’t been fully vaccinated before.

If the MMR vaccine isn’t suitable for you, a treatment called human normal immunoglobulin (HNIG) can be used if you’re at immediate risk of catching measles.

Meningitis
of infections and poisoning

Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges).

It can affect anyone, but is most common in babies, young children, teenagers and young adults.

Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves.

A number of vaccinations are available that offer some protection against meningitis.

Symptoms

Symptoms of meningitis develop suddenly and can include:

a high temperature (fever) over 37.5C (99.5F) being sick a headache a blotchy rash that doesn’t fade when a glass is rolled over it (this won’t always develop) a stiff neck a dislike of bright lights drowsiness or unresponsiveness seizures (fits)

These symptoms can appear in any order and some may not appear.

Causes

Meningitis is usually caused by a viral or bacterial infection.

Viral meningitis is the most common and least serious type. Bacterial meningitis is rare but can be very serious if not treated.

Several different viruses and bacteria can cause meningitis, including:

meningococcal bacteria – there are several different types, called A, B, C, W, X, Y and Z pneumococcal bacteria Haemophilus influenzae type b (Hib) bacteria enteroviruses – viruses that usually only cause a mild stomach infection the mumps virus the herpes simplex virus – a virus that usually causes cold sores or genital herpes

A number of meningitis vaccinations provide protection against many of the infections that can cause meningitis.

Diagnoses

Several tests may be carried out to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.

These tests may include:

a physical examination to look for symptoms of meningitis a blood test to check for bacteria or viruses a lumbar puncture – where a sample of fluid is taken from the spine and checked for bacteria or viruses a computerised tomography (CT) scan to check for any problems with the brain, such as swelling

As bacterial meningitis can be very serious, treatment with antibiotics will usually start before the diagnosis is confirmed and will be stopped later on if tests show the condition is being caused by a virus.

Treatments

You should get medical advice as soon as possible if you’re concerned that you or your child could have meningitis.

Trust your instincts and don’t wait until a rash develops.

Phone 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you think you or your child might be seriously ill.

Phone 111 or your GP practice for advice if you’re not sure if it’s anything serious or you think you may have been exposed to someone with meningitis.


People with suspected meningitis will usually have tests in hospital to confirm the diagnosis and check whether the condition is the result of a viral or bacterial infection.

Bacterial meningitis usually needs to be treated in hospital for at least a week. Treatments include:

antibiotics given directly into a vein fluids given directly into a vein oxygen through a face mask

Viral meningitis tends to get better on its own within 7 to 10 days and can often be treated at home. Getting plenty of rest and taking painkillers and anti-sickness medication can help relieve the symptoms in the meantime.

Read more about how meningitis is treated


People with suspected meningitis will usually need to have tests in hospital and may need to stay in hospital for treatment.


Treatment in hospital is recommended in all cases of bacterial meningitis, as the condition can cause serious problems and requires close monitoring.

Severe viral meningitis may also be treated in hospital.

Treatments include:

antibiotics given directly into a vein fluids given directly into a vein to prevent dehydration oxygen through a face mask if there are any breathing difficulties steroid medication to help reduce any swelling around the brain, in some cases

People with meningitis may need to stay in hospital for a few days, and in certain cases, treatment may be needed for several weeks.

Even after going home, it may be a while before you feel completely back to normal.

Additional treatment and long-term support may also be required if any complications of meningitis occur, such as hearing loss.


You’ll usually be able to go home from hospital if you or your child has mild meningitis and tests show it’s being caused by a viral infection.

This type of meningitis will normally get better on its own without causing any serious problems. Most people feel better within 7 to 10 days.

In the meantime, it can help to:

get plenty of rest take painkillers for a headache or general aches take anti-emetic (anti-sickness) medicine for any vomiting


Additional treatment and long-term support may be required if you or your child experience complications of meningitis.

For example:

cochlear implants, which are small devices that are inserted into the ears to improve hearing, may be needed in cases of severe hearing loss – read more about treatment for hearing loss prosthetic limbs and rehabilitation support may help if it was necessary to amputate any limbs – read more about recovering after an amputation counselling and psychological support may help if the trauma of having meningitis causes problems such as disturbed sleep, bedwetting, or fear of doctors and hospitals

You may also find it useful to get in touch with organisations such as the Meningitis Research Foundation or Meningitis Now for support and advice about life after meningitis.

Preventions

The risk of someone with meningitis spreading the infection to others is generally low. But if someone is thought to be at high risk of infection, they may be given a dose of antibiotics as a precautionary measure.

This may include anyone who has been in prolonged close contact with someone who developed meningitis, such as:

people living in the same house pupils sharing a dormitory a boyfriend or girlfriend

People who have only had brief contact with someone who developed meningitis won’t usually need to take antibiotics.


Meningitis can be caused by a number of different infections, so several vaccinations offer some protection against it.

Children should receive most of these as part of the NHS vaccination schedule. Speak to your GP if you’re not sure whether your or your child’s vaccinations are up-to-date.

Complications

Most people make a full recovery from meningitis, but it can sometimes cause serious, long-term problems and can be life threatening.

This is why it’s so important to get medical help as soon as possible if you think you or your child has symptoms of meningitis, and why meningitis vaccinations are offered to certain groups.

It’s estimated up to 1 person in every 2 or 3 who survives bacterial meningitis is left with 1 or more permanent problems.

Complications are much rarer after viral meningitis.


Some of the most common complications associated with meningitis are:

hearing loss, which may be partial or total – people who have had meningitis will usually have a hearing test after a few weeks to check for any problems recurrent seizures (epilepsy) problems with memory and concentration co-ordination, movement and balance problems learning difficulties and behavioural problems vision loss, which may be partial or total loss of limbs – amputation is sometimes necessary to stop the infection spreading through the body and remove damaged tissue bone and joint problems, such as arthritis kidney problems

Overall, it’s estimated up to 1 in every 10 cases of bacterial meningitis is fatal.

Later years (around 50 years and over)
of

Mesothelioma
of cancer, cancer types in adults

Mesothelioma mainly affects the lining of the lungs (pleural mesothelioma), although it can also affect the lining of the tummy (peritoneal mesothelioma), heart or testicles.

Most cases are diagnosed in people aged 60 to 80 and men are affected more commonly than women.

Unfortunately, it’s rarely possible to cure mesothelioma, although treatment can help control the symptoms.


Most cases are diagnosed in people aged 60 to 80 and men are affected more commonly than women.

Unfortunately, it’s rarely possible to cure mesothelioma, although treatment can help control the symptoms.


Unfortunately, it’s rarely possible to cure mesothelioma, although treatment can help control the symptoms.

Symptoms

The symptoms of mesothelioma tend to develop gradually over time. They typically don’t appear until several decades after exposure to asbestos.

Symptoms of mesothelioma in the lining of the lungs include:

chest pain shortness of breath fatigue (extreme tiredness) a high temperature (fever) and sweating, particularly at night a persistent cough loss of appetite and unexplained weight loss clubbed (swollen) fingertips

Symptoms of mesothelioma in the lining of the tummy include:

tummy pain or swelling feeling or being sick loss of appetite and unexplained weight loss diarrhoea or constipation

Speak to your GP if you have any persistent or worrying symptoms. Tell them about any exposure to asbestos you may have had in the past.

Causes

Mesothelioma is almost always caused by exposure to asbestos, a group of minerals made of microscopic fibres that used to be widely used in construction.

These tiny fibres can easily get in the lungs, where they get stuck, damaging the lungs over time. It usually takes a while for this to cause any obvious problems, with mesothelioma typically developing more than 20 years after exposure to asbestos.

The use of asbestos was completely banned in 1999, so the risk of exposure is much lower nowadays. However, materials containing asbestos are still found in many older buildings.

Read more about asbestos and people at risk of exposure and avoiding exposure to asbestos.

Diagnoses

If your GP suspects mesothelioma, they will refer you to a hospital specialist for some tests.

A number of different tests may need to be carried out, including:

an X-ray of your chest or tummy a computerised tomography (CT) scan – a number of X-ray images are taken to create a detailed image of the inside of the body fluid drainage – if there’s a build-up of fluid around the lungs or in the tummy, a sample may be removed using a needle inserted through the skin so the fluid can be analysed a thoracoscopy or laparoscopy – the inside of your chest or tummy is examined with a long, thin camera that’s inserted through a small cut (incision) under sedation or anaesthetic; a sample of tissue (biopsy) may be removed so it can be analysed

These tests can help diagnose mesothelioma and show how far it has spread.

Treatments

The best treatment for mesothelioma depends on several factors, including how far the cancer has spread and your general health.

As mesothelioma is often diagnosed at an advanced stage, treatment is usually focused on controlling the symptoms and prolonging life for as long as possible. This is known as palliative or supportive care.

Possible treatments include:

chemotherapy – this is the main treatment for mesothelioma and involves using medicine to help shrink the cancer radiotherapy – this involves using high-energy radiation to kill cancer cells and it may be used to slow the cancer down and keep it under control surgery – an operation to remove the cancerous area can be done if mesothelioma is detected at a very early stage, although it’s not clear whether surgery is helpful

You’ll also probably have treatment for your individual symptoms to help you feel as comfortable as possible. For example, regularly draining fluid from your chest may help your breathing and strong painkillers may help relieve your pain.

Sometimes, a procedure is carried out to stop the fluid coming back again by making the outside of the lungs stick to the inside of your chest (pleurodesis), or a tube is put in your chest to drain the fluid regularly at home. Your doctors should discuss these treatments with you.

Middle ear infection (otitis media)
of ears nose and throat

Otitis media is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.

Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.

It’s estimated that around one in every four children experience at least one middle ear infection by the time they’re 10 years old.

Symptoms

In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and resolve in a few days. This is known as acute otitis media. The main symptoms include:

earache a high temperature (fever) being sick a lack of energy slight hearing loss – if the middle ear becomes filled with fluid

In some cases, a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, which is caused by the build-up of fluid stretching the eardrum, then resolves.

Signs in young children

As babies are unable to communicate the source of their discomfort, it can be difficult to tell what’s wrong with them. Signs that a young child might have an ear infection include:

raised temperature pulling, tugging or rubbing their ear irritability, poor feeding or restlessness at night coughing or a runny nose unresponsiveness to quiet sounds or other signs of difficulty hearing, such as inattentiveness loss of balance

Causes

Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.

This mean mucus can’t drain away properly, making it easier for an infection to spread into the middle ear.

An enlarged adenoid (soft tissue at the back of the throat) can also block the Eustachian tube. The adenoid can be removed if it causes persistent or frequent ear infections. Read more about removing adenoids.

Younger children are particularly vulnerable to middle ear infections as:

the Eustachian tube is smaller in children than in adults a child’s adenoids are relatively much larger than an adults

Certain conditions can also increase the risk of middle ear infections, including:

having a cleft palate – a type of birth defect where a child has a split in the roof of their mouth having Down’s syndrome – a genetic condition that typically causes some level of learning disability and a characteristic range of physical features

Diagnoses

A middle ear infection (otitis media) can usually be diagnosed using an instrument called an otoscope.

An otoscope is a small handheld device with a magnifying glass and a light source at the end. Using an otoscope, a doctor can examine the ear to look for signs of fluid in the middle ear, which may indicate an infection.

Signs of fluid in the middle ear can include the ear drum:

bulging being an unusual colour (usually red or yellow) having a cloudy appearance

In some cases, a hole may have developed in the eardrum (perforated ear drum) and there may be fluid in the ear canal (the tube between the outer ear and eardrum).

Some otoscopes can also be used to blow a small puff of air into the ear to check for any blockages in the middle ear, which could be a sign of an infection. If the Eustachian tube (the tube that connects the throat and middle ear) is clear, the eardrum will move slightly. If it’s blocked, the eardrum will remain still.


Further tests are normally only required if treatment isn’t working or complications develop. These tests will usually be carried out at your local ear, nose and throat (ENT) department.

Some of the tests that may be carried out are described below.

Tympanometry

Tympanometry is a test that measures how the ear drum reacts to changes in air pressure.

During a tympanometry test, a probe is placed into your child’s ear. The probe changes the air pressure at regular intervals while transmitting a sound into the ear. A measuring device is attached to the probe to record how the drum moves and how changes in air pressure affect this movement.

A healthy ear drum should move easily if there’s a change in air pressure. If your child’s ear drum moves slowly or not at all, it usually suggests there’s fluid behind it.

Audiometry

Audiometry is a hearing test that uses a machine called an audiometer to produce sounds of different volume and frequency. This can help determine if your child has any hearing loss as a result of their condition.

During the test, your child listens through headphones and is asked if they can hear the sounds.

Scans

On the very rare occasions where there’s a possibility the infection has spread out of the middle ear and into the surrounding area, a scan of the ear may be carried out. This may be either a:

computerised tomography (CT) scan magnetic resonance imaging (MRI) scan

A CT scan takes a series of X-rays and uses a computer to assemble the scans into a more detailed image, whereas an MRI scan uses strong magnetic fields and radio waves to produce images of the inside of the body.

Treatments

Most cases of otitis media pass within a few days, so there’s usually no need to see your GP.

However, see your GP if you or your child have:

symptoms showing no sign of improvement after two or three days a lot of pain a discharge of pus or fluid from the ear – some people develop a persistent and painless ear discharge that lasts for many months, known as chronic suppurative otitis media an underlying health condition, such as cystic fibrosis or congenital heart disease, which could make complications more likely

Read more about diagnosing middle ear infections


Most ear infections clear up within three to five days and don’t need any specific treatment. If necessary, paracetamol or ibuprofen should be used to relieve pain and a high temperature.

Make sure any painkillers you give to your child are appropriate for their age. Read more about giving your child painkillers.

Antibiotics aren’t routinely used to treat middle ear infections, although they may occasionally be prescribed if symptoms persist or are particularly severe.

Read more about treating middle ear infections


Most middle ear infections (otitis media) clear up within three to five days and don’t need any specific treatment.

You can relieve any pain and a high temperature using over the counter painkillers such as paracetamol and ibuprofen.

Make sure any painkillers you give to your child are appropriate for their age.

Placing a warm flannel or washcloth over the affected ear may also help relieve pain until the condition passes.

Preventions

It’s not possible to prevent middle ear infections, but there are some things you can do that may reduce your child’s risk of developing the condition. These include:

make sure your child is up-to-date with their routine vaccinations – particularly the pneumococcal vaccine and the DTaP/IPV/Hib/HepB (6-in-1) vaccine avoid exposing your child to smoky environments (passive smoking) don’t give your child a dummy once they’re older than six to 12 months old don’t feed your child while they’re lying flat on their back if possible, feed your baby with breast milk rather than formula milk

Avoiding contact with other children who are unwell may also help reduce your child’s chances of catching an infection that could lead to a middle ear infection.

Complications

Serious complications of middle ear infections (otitis media) are very rare but very young children are still at risk because their immune systems are still developing.

Some of the main complications associated with middle ear infections are detailed below.

Migraine
of brain nerves and spinal cord

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. Many people also have symptoms like nausea, vomiting and increased sensitivity to light or sound.

There are several types of migraine, including:

migraine with aura – where there are warning signs before the migraine begins, like seeing flashing lights migraine without aura – the most common type, where the migraine occurs without warning signs migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, without a headache

Some people have frequent migraines up to several times a week. Other people only have occasional migraines. It’s possible for years to pass between migraine attacks.


There are several types of migraine, including:

migraine with aura – where there are warning signs before the migraine begins, like seeing flashing lights migraine without aura – the most common type, where the migraine occurs without warning signs migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, without a headache

Some people have frequent migraines up to several times a week. Other people only have occasional migraines. It’s possible for years to pass between migraine attacks.


migraine with aura – where there are warning signs before the migraine begins, like seeing flashing lights migraine without aura – the most common type, where the migraine occurs without warning signs migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, without a headache

Some people have frequent migraines up to several times a week. Other people only have occasional migraines. It’s possible for years to pass between migraine attacks.

Symptoms

The main symptom of a migraine is usually an intense headache on one side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck.

The pain is usually a moderate or severe throbbing sensation. The pain gets worse when you move and may prevent you from carrying out normal activities.

Other symptoms associated with a migraine include:

nausea vomiting increased sensitivity to light and sound – which is why many people with a migraine want to rest in a quiet, dark room

Some people experience other symptoms, including:

sweating poor concentration feeling very hot or very cold abdominal (tummy) pain diarrhoea dizziness (light headedness)

Not everyone with a migraine experiences these additional symptoms. Some people may experience them without having a headache.

The symptoms of a migraine usually last between 4 hours and 3 days. You may feel very tired for up to a week afterwards.

Symptoms of aura

About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine. These include:

visual problems – such as seeing flashing lights, zig-zag patterns or blind spots numbness or a tingling sensation like pins and needles – which usually starts in one hand and moves up your arm before affecting your face, lips and tongue difficulty speaking

Sometimes, you might also experience:

feeling dizzy or off balance loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. The aura might start before the headache or you might experience it at the same time as a headache. Some people may experience aura followed by only a mild headache or no headache at all.

Speak to your GP if: you have frequent or severe migraine symptoms

Phone 999 if you or someone you’re with experiences: paralysis or weakness in one or both arms and/or one side of the face slurred or garbled speech a sudden agonising headache resulting in a blinding pain unlike anything experienced before headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash These symptoms may be a sign of a more serious condition, like a stroke or meningitis. You should be assessed by a doctor as soon as possible.

Causes

The exact cause of migraines is unknown. They’re thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain.

Around half of all people who experience migraines have a close relative with the condition. This suggests that genes may play a role.

Migraine triggers

It may help to keep a diary to see if you can identify a consistent trigger. It can be difficult to tell if something is a trigger or if what you’re experiencing is an early symptom of a migraine attack.

There might not always be a trigger for your headache.

Possible migraine triggers include:

Hormonal changes Some women experience migraines around the time of their period. This might be because of changes in the levels of hormones like oestrogen around this time. These types of migraines usually occur between 2 days before the start of your period to 3 days after. Some women only experience migraines around this time. This is known as pure menstrual migraine. Most women experience them at other times too. This is called menstrual related migraine. Some women find their migraines become worse during perimenopause. However, they might improve or disappear a few years after your last period.

Emotional triggers stress anxiety tension shock depression excitement

Physical triggers tiredness poor quality sleep shift work poor posture neck or shoulder tension jet lag fasting or low blood sugar (hypoglycaemia) strenuous exercise, if you’re not used to it

Dietary triggers missed, delayed or irregular meals dehydration alcohol the food additive tyramine (found in some cheeses and cured meat) caffeine products, such as tea and coffee lack of caffeine (if you’re used to regular caffeine) specific foods such as chocolate, citrus fruit and cheese Some people crave chocolate before a migraine begins. This can be a sign that you’re about to have a migraine rather than the chocolate being the trigger for the migraine.

Environmental triggers bright lights flickering screens, such as a television or computer screen smoking (or smoky rooms) loud noises strong smells changes in weather (windy weather or stuffy atmosphere)

Medication some types of sleeping tablets the combined contraceptive pill hormone replacement therapy (HRT), sometimes used to relieve symptoms of the menopause There are other types of medications that can cause some people to experience migraines. Speak to your GP if you start to experience migraines after starting to take new medication.

Diagnoses

There’s no specific test to diagnose migraines. For an accurate diagnosis, your GP must identify a pattern of recurring headaches along with the associated symptoms.

Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Your GP might do a physical examination and check your vision, co-ordination, reflexes and sensations. These will help rule out some other possible underlying causes of your symptoms.

Your GP may ask if your headaches are:

on one side of the head a pulsating pain severe enough to prevent you carrying out daily activities made worse by physical activity or moving about accompanied by nausea and vomiting accompanied by sensitivity to light and noise

Migraine diary

To help with the diagnosis, it can be useful to keep a diary of your migraine attacks for a few weeks. Note down details like:

the date time what you were doing when the migraine began how long the attack lasted what symptoms you experienced what medication you took (if any)

Taking too many painkillers is a reason why migraines can become difficult to treat. This is called medication overuse headache. Keep a record of what painkillers you take and how often you take them. You shouldn’t take painkillers on more than 10 days every month in the long-term.

It can be helpful to make a note when your start your period, if you have one. This can help your GP identify potential triggers.

Read more about keeping a migraine diary on The Migraine Trust website.

Referral to a specialist

Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). They’ll do further assessments and offer treatment if:

a diagnosis is unclear you experience significant migraines not controlled by your current treatment

Treatments

There’s no cure for migraines. There are treatments available to help reduce the symptoms. During an attack, many people find that sleeping or lying in a darkened room can also help.

It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. If you can’t manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

Always make sure you read the medication instructions and follow the dosage recommendations. Children under 16 shouldn’t take aspirin unless it’s under the guidance of a healthcare professional. Aspirin and ibuprofen are not recommended for adults who have a history of stomach problems, like stomach ulcers, liver problems or kidney problems. 

Painkillers Many people find that over-the-counter painkillers, like paracetamol, aspirin or ibuprofen, can help to reduce their symptoms. They tend to be most effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms. You shouldn’t wait until the headache worsens before taking painkillers as it’s often too late for the medication to work. Soluble painkillers (tablets you dissolve in a glass of water) are a good option because they’re absorbed quickly by your body. Taking too many painkillers can lead to medication overuse headache. You should not take them more than 15 days per month. If you can’t swallow painkillers because of nausea or vomiting, you should speak to your GP about anti sickness medication or suppository options. Suppositories are capsules that you insert into the anus (back passage). Opiates like codeine should not be prescribed as a treatment for migraines. They’re not any more effective than triptans and painkillers and can cause nausea and medication overuse headache.

Triptans If over the counter medication is not helping your symptoms, your GP might recommend a triptan and/or anti sickness medication. Triptan medicines are a specific painkiller for migraine headaches. They’re thought to work by reversing the changes in the brain that may cause migraine headaches. Triptans are available as tablets, injections and nasal sprays. Common side effects of triptans include: warm-sensations tightness tingling flushing and light headedness feelings of heaviness in the face, throat, limbs or chest Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own. Taking too many triptans can lead to medication overuse headache. You should not take them more than 10 days per month. Your GP will usually recommend having a follow-up appointment once you’ve finished your first course of treatment. This is so you can discuss their effectiveness and whether you had any side effects. If treatment is not effective or causes unpleasant side effects, your GP may try prescribing a different type of triptan. Everyone reacts differently to each type of triptan. Triptans can be taken at the same as painkillers and/or anti-sickness tablets to improve their effectiveness. Your GP will discuss this with you.

Anti-sickness medicines Anti-sickness medicines, known as anti-emetics, can treat migraine in some people. They can be effective even if you don’t experience nausea or vomiting. They can be taken alongside painkillers and triptans. Anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet. Side effects of anti-emetics include drowsiness and diarrhoea. Some anti-sickness medication can cause involuntary movements, normally in the face. Speak to your GP if you experience involuntary movements.

Combination medicines You can buy some combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you’re not sure which one is best for you, ask your pharmacist. It can also be very effective to combine a triptan with another painkiller, like ibuprofen. Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to control the doses of each. Opiates like codeine should not be prescribed as a treatment for migraines. They’re not any more effective than triptans and painkillers and can cause nausea and medication overuse headache.

Treatment during pregnancy and breastfeeding

In general, migraine treatment with medicines should be limited as much as possible when you’re pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is recommended.

If medication is essential, paracetamol and sumatriptan are safe to take during pregnancy and when breastfeeding.

If you’re pregnant or breastfeeding, speak to your GP or midwife:

if you’re getting regular migraines before taking medication

High doses of aspirin should not be taken to treat headaches during pregnancy.

Preventions

It’s important to maintain a generally healthy lifestyle, including:

regular exercise, sleep and meals ensuring you stay well hydrated limiting your intake of caffeine limiting your intake of alcohol

One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. 

Preventative medication

Medication is available to help prevent migraines. These medicines are usually used if your migraines remain frequent (more than 1 migraine per week) following a period of avoiding possible triggers.

The following medications can be prescribed by your GP. If they’re not effective, you’ll be referred to a neurologist. The neurologist will consider what advanced therapies might be best to try next.

Medications used to prevent migraines are taken every day to reduce the severity and frequency of headaches. It takes a few weeks to reach the right dose and you might need to take it for several weeks (usually 8 weeks once the right dose is reached) to find out if it works.

Propranolol Propranolol is a medication used to treat angina and high blood pressure. It’s also effective in preventing migraines. It is taken every day in tablet form, regardless of whether you have a headache or not. Propranolol is not suitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes. Side effects of propranolol can include: cold hands and feet pins and needles problems sleeping tiredness light headedness

Tricyclic antidepressants You might be prescribed tricyclic antidepressants like amitriptyline or nortriptyline. This is a type of medication used for depression but at lower doses can also help prevent migraines. The side effects can include: drowsiness a dry mouth weight gain difficulty passing urine

Topiramate Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy. It’s now much more commonly used in migraine. It’s been shown to help prevent migraines. It is taken every day in tablet form regardless of whether you have a headache or not. Topiramate should be used with caution in people with kidney stones, liver problems or glaucoma. You should not take topiramate during pregnancy as it can harm your unborn baby. You must be on an effective form of contraception when taking topiramate. Topiramate can reduce the effectiveness of hormonal contraceptives. Your GP should discuss alternative methods of contraception if you’re prescribed topiramate. Side effects of topiramate can include: decreased appetite and weight loss nausea and vomiting constipation or diarrhoea tingling sensation memory problems and difficulty finding words problems sleeping

Candesartan You might be prescribed Candesartan. Candesartan is a medication used for high blood pressure. Candesartan can cause lightheadedness due to low blood pressure, tiredness and cough. It should not be used if you’re pregnant or trying for a baby.

Other oral preventive medications Other less common options of oral preventative medications for migraine include: pizotifen flunarizine

Complementary therapies and supplements There are some complementary therapies and supplements which might help to prevent your migraine symptoms. These include: magnesium vitamin B2 (rivoflavin) coenzyme Q10 acupuncture You should discuss any complementary therapies you’d like to try with your GP.

Medical devices There are some devices that have been developed that might help treat migraines. These include: transcranial magnetic stimulation external trigeminal nerve stimulator non-invasive vagus nerve stimulation Read more about medical devices

Advanced therapies for migraine

The following medicines are advanced therapies for migraine that can only be prescribed by a neurologist.

Botulinum toxin type A Botulinum toxin type A is used to prevent headaches in some adults with chronic migraines. Chronic migraines mean you have headaches more than 15 days per month and at least half of them are migraines, over a period of 3 months. Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. It’s not exactly clear why this treatment can be effective for migraine. SIGN recommend this treatment as an option for people who have chronic migraine that hasn’t responded to at least three previous preventative medical treatments. Botulinum toxin type A should be injected to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be given every 12 weeks.

Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies CGRP might be prescribed if other medication has not prevented your migraines. This medication has been created specifically for migraines. CGRP monoclonal antibodies are given by an injection into the skin on your thigh or abdomen (tummy) once per month. You’ll have to self administer this treatment meaning you’ll need to learn how to deliver the injection yourself. Read more about CGRP

Preventing menstrual-related migraines

Menstrual-related migraines usually occur between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments.

Non-hormonal treatments The non-hormonal treatments that are recommended are: non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller (usually naproxen) triptans – a type of medication used to treat a migraine attack (usually naratriptan or frovatriptan) These medications are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding.

Hormonal treatments Hormonal treatments that may be recommended include: combined hormonal contraceptives, like the combined contraceptive pill, patch or vaginal ring (usually taken continuously for at least 3 months) progesterone-only contraceptives, such as progesterone-only pills, implants or injections oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days Hormonal contraceptives like the combined contraceptive pill or vaginal ring are not used if you have migraines with aura symptoms. This is because this can increase your risk of having a stroke. 

Migraine clinic

If the treatments above aren’t controlling your migraines, you might be referred to a specialist migraine clinic for further investigation and treatment.

A specialist might recommend other treatments like transcranial magnetic stimulation devices or greater occipital nerve blocks.

Complications

Migraines are linked to a very small increased risk of mental health problems. Migraines with aura are associated with a small increased risk of ischaemic strokes.

Stroke An ischaemic stroke occurs when the blood supply to the brain is blocked by a blood clot or fatty material in the arteries. People who experience migraines with aura have about twice the risk of having an ischaemic stroke compared to people without migraines. However, this risk is still small. The risk increases significantly if you smoke and take the combined contraceptive pill. It’s unclear why ischaemic strokes are linked to migraine.

Contraceptive pill The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill. Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill. Women who have migraine without aura can usually take the combined contraceptive pill safely, unless they have other stroke risk factors like high blood pressure or a family history of cardiovascular disease. Talk to your GP about alternative forms of contraception if you experience aura symptoms and are taking the combined contraceptive pill.

Mental health problems Migraine is associated with a very small increased risk of mental health problems, including: depression bipolar disorder anxiety disorder panic disorder

Miscarriage
of pregnancy and childbirth

Most of the time there’s no clear reason why it happens, but it’s very unlikely to be caused by anything you did or didn’t do.

About 1 out of 5 pregnancies miscarry. Since many miscarriages aren’t recorded the figure might be higher.

Always get medical help if: you’re bleeding from your vagina you’ve got strong, cramping pain your waters break your baby’s movements have changed, or you haven’t felt them move for a while If you’re registered, contact your midwife or local maternity unit. If you’re not registered, contact your GP or the NHS 24 111 service.


About 1 out of 5 pregnancies miscarry. Since many miscarriages aren’t recorded the figure might be higher.

Always get medical help if: you’re bleeding from your vagina you’ve got strong, cramping pain your waters break your baby’s movements have changed, or you haven’t felt them move for a while If you’re registered, contact your midwife or local maternity unit. If you’re not registered, contact your GP or the NHS 24 111 service.


Always get medical help if: you’re bleeding from your vagina you’ve got strong, cramping pain your waters break your baby’s movements have changed, or you haven’t felt them move for a while If you’re registered, contact your midwife or local maternity unit. If you’re not registered, contact your GP or the NHS 24 111 service.

Symptoms

Some women may need medicine or a short operation to treat this.

If you’re worried about seeking treatment, maybe a friend can come with you. Having support’s really important at this difficult time.

Taking time off work

Many women will want to take time off work after having a miscarriage.

If you have a miscarriage before the end of the 24th week, you’re entitled to:

take sick leave any sick pay you’d normally qualify for

If you lose your baby after the end of the 24th week, you’re entitled to:

take maternity leave any maternity pay you qualify for

Speak to your employer about which choices may be right for you and your family.

Working Families has more about your rights at work after a miscarriage

Causes

Doctors think most miscarriages are caused when the building blocks controlling the development of a baby (the chromosomes) aren’t right. Babies with too many or not enough chromosomes won’t develop properly. This leads to a miscarriage.

Miscarriages can also be caused by:

issues with your placenta cervical weakness – when your cervix (neck of your womb) starts to open

Motor neurone disease (MND)
of brain nerves and spinal cord

Amyotrophic lateral sclerosis (ALS) is the most common form of MND.

MND happens when specialist nerve cells in the brain and spinal cord, called motor neurones, stop working properly and die prematurely. This is known as neurodegeneration.

Motor neurones control muscle activity like:

gripping walking speaking swallowing breathing

As MND progresses, it can become more difficult to do some or all of these activities.


MND happens when specialist nerve cells in the brain and spinal cord, called motor neurones, stop working properly and die prematurely. This is known as neurodegeneration.

Motor neurones control muscle activity like:

gripping walking speaking swallowing breathing

As MND progresses, it can become more difficult to do some or all of these activities.


Motor neurones control muscle activity like:

gripping walking speaking swallowing breathing

As MND progresses, it can become more difficult to do some or all of these activities.

Symptoms

The symptoms of MND start gradually over weeks and months. They tend to appear on one side of the body first and get progressively worse.

Speak to your GP if: you have early symptoms of MND Being referred to a specialist as early as possible can help you access the right support.

There are usually 3 stages of symptoms.

Early symptoms

Sometimes the early symptoms are mistaken for similar conditions that also affect the nervous system.

Limb-onset disease In about two-thirds of people with MND, the first symptoms are in the arm or leg. This is sometimes called limb-onset disease. The symptoms include: a weakened grip, which can cause problems picking up or holding objects weakness at the shoulder, making lifting your arm above your head difficult tripping up over your foot because of weakness at your ankle or hip These symptoms are usually painless. You might also experience widespread twitching of the muscles (fasciculations) or muscle cramps. You might also see wasting of the muscles with significant weight loss.

Bulbar-onset disease In 1 out of 4 cases, the first MND symptoms will affect the muscles used for speaking and swallowing. These problems might initially affect the muscles used for speech and swallowing. Increasingly slurred speech (dysarthria) is usually the first sign of this type of MND. It might be misdiagnosed as a stroke. As the condition progresses, it may become increasingly difficult to swallow (dysphagia). This might be misdiagnosed as a blockage in the throat.

Respiratory-onset disease In rare cases, MND starts by affecting the lungs, rather than affecting them at the end of the condition. This is called respiratory-onset disease. In some cases the initial symptoms like breathing difficulties and shortness of breath are more obvious. You might suffer from a lack of sleep and a headache in the morning. This might be because your body isn’t getting rid of the carbon dioxide you normally breathe out.

Advanced symptoms

As MND becomes more advanced, more parts and functions of the body are affected. This can make you more likely to experience infections, like chest infections, which can cause your condition to get worse quicker.

Muscular symptoms The limbs will become weaker. The muscles in the limbs may become thinner. As a result, the person will find it increasingly difficult to move the affected limbs. The limbs may also become stiff. This is known as spasticity. Both muscle wasting and stiffness can also cause joint aches and pains.

Speaking and swallowing difficulties Speaking and swallowing can become increasingly difficult as MND progresses. Choking episodes can be distressing but they aren’t usually the cause of death.

Saliva problems Reduced swallowing can cause excess saliva. This can cause drooling. Thicker saliva can sometimes be difficult to clear from the chest or throat. This is because the muscles that control coughing become weak.

Excessive yawning Some people with MND have episodes of uncontrollable excessive yawning. This can happen even when they’re not tired. It can sometimes cause jaw pain.

Emotional changes MND can cause changes in your ability to control your emotions. This is more likely when there’s weakness in the muscles that control speech and swallowing. One of the most common signs is when a person has episodes of sudden uncontrollable crying or, more rarely, laughter. This is sometimes called emotional lability or emotionality.

Changes to mental abilities Sometimes, people with MND have significant difficulties with: concentration planning communication behavioural changes. This is where the condition is causing a type of dementia (usually frontotemporal dementia). Up to 15% of people with MND develop more profound frontotemporal dementia. This usually happens soon after, or sometimes before, their first muscle-related symptoms. Someone with MND might not be aware that there are problems with their behaviour or personality.

Breathing difficulties Breathing might become less efficient as the nerves and muscles that help control the lungs become more damaged. This might mean you feel short of breath after doing every day tasks like walking up the stairs. Over time, you might become even more out of breath when you’re resting. Shortness of breath can become a problem at night. Some people find it difficult to breathe when they’re lying down. Others might wake in the night because they feel breathless. As breathlessness increases, breathing support can help reduce this symptom. This is usually given by non-invasive ventilatory (NIV) support. It can be useful at night to improve your sleep quality. This can help reduce drowsiness during the day.

End-stage symptoms

As MND progresses to its final phase, you might experience:

increasing body paralysis, which means you’ll need help with most daily activities significant shortness of breath

Eventually, non-invasive breathing assistance won’t be enough to make up for the loss of normal lung function. At this stage, more medication can help to reduce symptoms of breathlessness and anxiety related to it. Most people with MND become increasingly drowsy before falling into a deep sleep, where they usually die peacefully.

Secondary symptoms

Some people with MND have other symptoms that aren’t directly caused by the condition, but are related to the stress of living with it. These might include depression, insomnia and anxiety.

Causes

MND occurs when specialist nerve cells (motor neurones) in the brain and spinal cord progressively fail. It’s not clear why this happens.

Genetic causes

One known cause of MND is an error in your genes with 20% of cases linked to genetic causes. Half of genetic cases will be in people who have a family history of MND. The other half of genetic cases will occur in those without a family history.

Having a family history of frontotemporal dementia can also increase the risk of inheriting MND.

The error in the gene affects the cells ability to perform normally and survive.

If you have a genetic form of MND, there’s a chance that you could pass the risk of developing MND on to your child. The risk of them developing the condition can be affected by many factors like age.

Not everyone who has the genetic mutation will develop MND in their lifetime. Typically, the longer you live, the more likely you are to develop the condition.

If you have a parent with MND with no other family history of the disease, you’re at a slight increased risk of MND of about 1.4%. The risk to the general population of MND is about 0.3%.

Other possible causes of motor neurone disease

It’s unclear why the motor neurones begin to lose function. Most experts believe that it’s a combination of factors that affect either the motor neurones or the cells that support them. There are some theories involving different cell processes including:

Aggregates and RNA processing Aggregates are abnormal clumps of protein that develop inside motor neurones. They’re found in nearly all cases of MND and may disrupt the normal working of the motor neurones. It can also be a marker that the cell is under stress. The protein TDP-43 is most commonly found in these aggregates. This is a protein involved in the processing of the genetic instructions for the cell through a molecule known as RNA. Mutations in the gene (TARDBP) coding for this protein can be a cause of genetic cases of MND.

Cell transport disruption All cells have transport systems that move nutrients and other chemicals into the cell and waste products out of the cell. Research suggests that the transport systems in motor neurones become disrupted. Over time, toxic waste can build up in cells as a natural by-product of normal cell activity and aging. The body gets rid of the toxic waste by waste disposal systems that can be affected by ageing and the environment.

Glial cells Glial cells surround and support motor neurones and provide them with nutrients. When they don’t work properly the motor neurones no longer receive the support and nutrition they need to function normally. Their involvement in MND is still being researched.

Glutamate Nerve cells use special “messenger chemicals” called neurotransmitters to pass information between cells. One of the neurotransmitters is called glutamate. It excites neurones and one theory is that too much activity through this causes damage to the neurones. Riluzole, a drug used to treat MND reduces the level of neuronal activity by blocking the action of Glutamate.

Mitochondria Mitochondria are the “batteries” of cells. They provide the energy that a cell needs to carry out its normal function. Mitochondria in the motor neurones of people with MND might not function properly.

Diagnoses

Speak to your GP if you experience the initial symptoms of MND.

After hearing about your symptoms and an initial exam, your GP might refer you to a neurologist (a doctor who specialises in conditions affecting the brain and nervous system).

Diagnosing MND can be difficult during the early stages. This is because many of the first symptoms can be caused by other more common health conditions like:

a trapped nerve – wear and tear of the bones in the spine can sometimes cause nerves to become trapped under the spine peripheral neuropathy – where part of the nervous system is damaged by another condition, like type 2 diabetes swallowing difficulties caused by narrowing or inflammation of the gullet speech difficulties due to problems with the voice box damage to the brain by stroke or other neurological conditions like multiple sclerosis (MS) in younger people

Initial testing

MND is usually diagnosed by a neurologist based on the symptoms and a physical examination.

There’s no single test for MND. Various tests might be used to rule out other possible causes of the your symptoms. Tests might include:

blood tests – these can be used for several reasons, like checking that organs are working, or to look for a marker of muscle damage (creatinine kinase) magnetic resonance imaging (MRI) scan – to give a detailed picture of your brain and spinal cord electromyography (EMG) – measures the electrical activity in your muscles, which shows how well your motor neurones are working and connecting to the muscles nerve conduction test – similar to an EMG but measures how quickly your nerves can conduct an electrical signal lumbar puncture – a sample of spinal fluid might be tested to exclude an inflammatory or nerve condition caused by an infection muscle biopsy – in rare cases, a small sample of muscle might be removed for testing to determine whether the problem lies in the muscles

Gene tests can be used to support the diagnosis in some individuals. They might provide an explanation of why they’ve developed the disorder. Your GP can give you more information about specialists who can help with genetic testing.

Confirming the diagnosis

There are many reasons why there may be delays in diagnosis. The initial symptoms might not appear to be serious. Or symptoms might not be recognised as being related to the nervous system so a neurologist isn’t consulted at first.

Sometimes, the diagnosis of MND is clear without the need for further tests. Confirming a diagnosis can sometimes be time-consuming even for an experienced neurologist. They might need a period of observation to be sure, particularly in cases where the condition progresses slowly. MND can only be diagnosed if the symptoms are clearly getting worse (progressive).

Receiving the diagnosis

Being told you have MND can be devastating and the news can be difficult to take in at first.

After you’re diagnosed you should be provided with contact details of an MND care specialist. These are healthcare professionals with specialist experience caring for people with MND. They’ll be able to give you (and your family) extra support after the diagnosis and during your time with the illness.

Talking to a counsellor or a trained clinical psychologist might help with feelings of depression and anxiety.

It’s not unusual to have thoughts of taking your own life, although very few people with MND go on to do this. You should discuss these thoughts with your doctor.

Taking antidepressants or medicines to reduce anxiety may help. Your care team will be able to tell you about this.

Treatments

Although there’s no cure for MND, there are treatments available to help relieve the symptoms.

A team of healthcare professionals will work together to help care for you. This multidisciplinary team typically includes:

a neurologist and an MND care specialist a specialist in breathing (respiratory specialist) physiotherapists to advise on mobility aids occupational therapists to assess the need for adaptations to living environments speech and language therapist to provide help with communication and swallowing dieticians to support nutrition

As the conditions advances, you might also need palliative care.

Riluzole

Riluzole is the only licensed medication in the UK that’s shown a survival benefit for people with MND. Riluzole is thought to slow down the damage to the motor neurone cells by reducing their sensitivity to the nerve transmitter glutamate.

In medical research, riluzole extended survival by 2 to 3 months on average.

Side effects of riluzole are usually mild and can include nausea, tiredness and, less commonly, a rapid heartbeat.

Very rarely, riluzole has been known to cause liver damage. If you’re prescribed riluzole you’ll need to have blood tests for the first few months to check your liver is working properly. If you’ve had significant liver disease, riluzole may not be suitable for you.

Treating symptoms

There are treatments available that can help relieve many of the symptoms of MND and improve your quality of life.

Muscle cramps Physiotherapy can help muscle cramps. In some cases, a medication called quinine can help treat muscle cramps too. They often improve later in the condition. Quinine can cause side effects like: hearing and vision problems tinnitus – the perception of noise in one ear, both ears or inside the head vertigo – a sensation that you, or the environment around you, is moving Quinine will usually only be used if the potential benefits are thought to outweigh the risks.

Muscle stiffness Muscle stiffness, also known as spasticity, can be treated using medication like baclofen. This helps to help relax the muscles. Side effects can include increased weakness or tiredness.

Drooling Medication is available to treat drooling of saliva. One option is a hyoscine hydrobromide skin patch. Alternative medicines used to control drooling include: amitriptyline atropine eye drops applied to the tongue glycopyrronium botulinum toxin injections into the glands that produce saliva

Communication difficulties Not everyone with MND will have significant speech problems. There are ways to help people who find it hard to communicate. A speech and language therapist can teach you techniques to make your voice as clear as possible. As the disease progresses, you may need assistive technology to help you communicate. A range of communication aids is available. Your therapist will be able to tell you about the most effective communication aids for you.

Swallowing difficulties Not everyone with MND will have significant swallowing problems (dysphagia). For those that do, it can prevent normal eating and drinking. This can lead to you feeling more tired. If food or fluid goes down the wrong way into the lungs it can cause chest infections (called aspiration). One common treatment for dysphagia is a feeding tube known as a gastrostomy tube. The tube is surgically implanted into your stomach through a small cut on the surface of the stomach. It shouldn’t restrict your daily activities. You can continue to bathe and swim if you wish. Ideally you should have the tube inserted before you become too frail. This is so you can get the best out of it and to give yourself the best chance of recovering from the procedure. If you have thick secretions (fluids) you can’t cough up yourself, medicine like carbocisteine and acetylcysteine might help.

Breathing difficulties As MND progresses, the muscles that help you breathe will become weaker. Your breathing will become increasingly shallow, with a weaker cough. Breathing difficulties usually develop gradually. They’re sometimes the first sign of MND, although this is rare. It’s important to discuss breathing problems with your GP before they occur. Your GP or neurologist should be able to refer you to a respiratory (breathing) specialist or a palliative care specialist, depending on your needs. You might benefit from non-invasive mechanical ventilation (NIV) to support your breathing. Room air (not oxygen) is sucked into a small box. It’s filtered and then gently pumped into the lungs through a face mask or nasal tube each time you take a breath. NIV may not be suitable for everyone with MND. Your healthcare team will be able to discuss the options available to you.

Advance decision making Many people with MND draw up an advance decision (sometimes called an advanced directive). This is where you decide your treatment preferences in advance in case you can’t communicate your decisions later because you’re too ill. Issues that can be covered by an advance decision include: whether you want to be treated at home, in a hospice or in a hospital once you reach the final stages of MND the type of medication you’d be willing to take in certain circumstances whether you’d be willing to consider a feeding tube if you were no longer able to swallow food and liquid if you have respiratory failure (loss of lung function), whether you wish to have artificial resuscitation, like having a permanent breathing tube inserted into your throat (known as a tracheostomy) whether you’d be willing to donate any of your organs after you die (the brain and spinal cord of people with MND are very important for ongoing research) Your care team will be able to provide you with more information and advice about making an advance decision. Read more about end of life care

Research and drug trials

You might be given the opportunity to take part in research, including drug trials. Your MND care specialist and neurology consultant can provide further information on this.

Mouth cancer
of cancer, cancer types in adults

Mouth cancer, also known as oral cancer, is where a tumour develops on the surface of the tongue, mouth, lips or gums.

Tumours can also occur in the salivary glands, tonsils and the pharynx (the part of the throat from your mouth to your windpipe) but these are less common.

Symptoms of mouth cancer include:

red or white patches on the lining of your mouth or tongue ulcers a lump

Speak to your GP if these symptoms do not heal within 3 weeks, especially if you’re a heavy drinker or smoker.

Symptoms

Mouth cancer can develop on most parts of the mouth, including the lips, gums and occasionally, the throat.

The most common symptoms of mouth cancer include:

red or white patches in the mouth or throat a lump ulcers

Other symptoms may include:

persistent pain in the mouth pain or difficulty when swallowing (dysphagia) changes in your voice, or speech problems swollen lymph nodes (glands) in your neck unexplained weight loss bleeding or numbness in the mouth a tooth, or teeth, that becomes loose for no obvious reason difficulty moving your jaw

Causes

Mouth cancer occurs when something goes wrong with the normal cell lifecycle, causing them to grow and reproduce uncontrollably.

Risk factors for developing mouth cancer include:

smoking or using products that contain tobacco drinking alcohol – smokers who are also heavy drinkers have a much higher risk compared to the population at large infection with the human papilloma virus (HPV), the virus that causes genital warts

Read more about the causes of mouth cancer


The 2 leading causes of mouth cancer in the UK are drinking too much alcohol and smoking.

Both alcohol and tobacco are carcinogenic, which means they contain chemicals that can damage the DNA in cells and lead to cancer.

The risk of mouth cancer increases significantly in somebody who is both a heavy smoker and heavy drinker.

Exactly what triggers the changes in DNA that lead to mouth cancer and why only a small number of people develop mouth cancer is still uncertain.

Diagnoses

If you have symptoms of mouth cancer, your GP will carry out a physical examination and ask about your symptoms.

If mouth cancer is suspected, you will be referred to hospital for further tests or to speak to a specialist head and neck surgeon.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of mouth cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected mouth cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.


If the biopsy confirms cancer you will need further tests to check what stage it has reached.

If the cancer is diagnosed late it can have spread from your mouth into the lymphatic system – a series of glands throughout your body which produce many of the specialised cells needed by your immune system.

Once the cancer reaches the lymphatic system, it is capable of spreading to any other part of your body, including your bones, blood and organs.

However, it’s uncommon for mouth cancer to spread further than the lymph nodes near your mouth, although in some cases it may also spread to surrounding bones, such as the jaw bone, and in some cases your lungs.

Therefore, the tests will examine your lymph nodes, bones and the tissue near the site of your initial tumour to check for the presence of other tumours.

These tests may include:

an X-ray a magnetic resonance imaging (MRI) scan a computerised tomography (CT) scan a positron emission tomography (PET) scan

Further biopsies on nearby lymph nodes may also be carried out.

Treatments

There are 3 main treatment options for mouth cancer. They are:

surgery – where the cancerous cells are surgically removed and, in some cases, some of the surrounding tissue chemotherapy – where powerful medications are used to kill cancerous cells radiotherapy – where high energy X-rays are used to kill cancerous cells

These treatments are often used in combination. For example, a course of radiotherapy and chemotherapy may be given after surgery to help prevent the cancer returning.

Read more about treating mouth cancer


Many of these symptoms can be caused by less serious conditions, such as minor infections.

But it’s strongly recommended that you visit your GP if any of these symptoms have lasted for more than 3 weeks. It’s especially important to seek medical advice if you’re a heavy drinker or smoker.


Your treatment will depend on the type and size of the cancer, the grade and how far it’s spread – as well as your general health.


If the cancer hasn’t spread beyond the mouth or the oropharynx (the bit of your throat at the back of your mouth), a complete cure may be possible using a combination of surgery, radiotherapy and chemotherapy.

If the cancer has spread to other parts of the body, then a cure is unlikely but it will be possible to slow the progress of the cancer and help relieve symptoms by using surgery, radiotherapy and chemotherapy.

Deciding what treatment is best for you can be difficult. Your care team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, what are the advantages and disadvantages of particular treatments.


Radiotherapy makes the teeth more sensitive and vulnerable to infection so before treatment begins, you’ll be given a full dental examination and any necessary work will be carried out.

If you smoke or drink, stopping will increase the chances of your treatment being successful.

Your specialist nurse and your GP can provide help and support if you are finding it difficult to quit smoking and drinking.

Read more about quitting smoking and cutting down on alcohol

Complications

Both surgery and radiotherapy can make speaking and swallowing difficult (dysphagia).

Dysphagia can be a potentially serious problem. If small pieces of food enter your airways and become lodged in your lungs, it could trigger a chest infection, known as aspiration pneumonia.

Read more about the complications of mouth cancer


Complications of treatment for mouth cancer can include dysphagia (difficulty swallowing), speech problems and emotional disruption.