Blood biomarker identified for episodic migraines

A biomarker in the blood has been identified that indicates episodic migraines.- JR

A team of researchers at the Johns Hopkins University School of Medicine in Baltimore claims to have identified a biomarker present in the blood for episodic migraine. According to the researchers, the study findings could potentially have significant implications in diagnosis and treatment of episodic migraine.

A person suffers from episodic migraine when he or she experiences less than 15 headaches in a month. The author of the study, published in the journal Neurology, B. Lee Peterlin, says that “while more research is required to confirm the initial findings, the possibility of discovering a new biomarker for migraine is exciting.”

During the study, the researchers analyzed the neurological exam, blood samples and body mass index of a group of 52 women with episodic migraine and 36 women with no history of migraine headaches. The first group of the women had an average of 5.6 headache days in a month.

In the blood samples, the researchers looked for a group of lipids called ceramides, which plays a role in homeostasis and also helps regulate brain inflammation. The researchers found that in women with episodic migraine, the level of ceramides decreased.

Women suffering from migraine had 6,000 nanograms per milliliter of ceramides in their blood as compared to the women with no headache, who had 10,500 nanograms per milliliter of ceramide. Therefore, the researchers associated the standard deviation increase in levels of ceramide with a 92 percent less risk of developing migraine.

In another small random study, the researchers studied the levels of ceramide in a group of 14 subjects. Based on the levels of the ceramide, the team was able to correctly identify whether the participant had episodic migraine or not.

"This study is a very important contribution to our understanding of the underpinnings of migraine and may have wide-ranging effects in diagnosing and treating migraine if the results are replicated in further studies," said Karl Ekbom of the Karolinska Institutet in Stockholm, Sweden.

Ekbom further said that some of the shortfalls of the study include non-inclusion of males and exclusion of chronic migraine.

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Concussions affect men and women differently

According to a study, concussions affect men and women differently.

New research suggests concussion may not significantly impair symptoms or cognitive skills for one gender over another, however, women may still experience greater symptoms and poorer cognitive performance at preseason testing. The study released today will be presented at the Sports Concussion Conference in Denver, July 24 to 26, hosted by the American Academy of Neurology, the world's leading authority on diagnosing and managing sports concussion. The conference will feature the latest scientific advances in diagnosing and treating sports concussion from leading experts in the field.

The study involved 148 college athletes from 11 sports at the University of Michigan in Ann Arbor. All had taken tests of learning and processing along with other measures of the brain's abilities, such as attention and working memory speed. Of the participants, 45 percent were female, 51 percent played a contact sport and 24 percent had experienced a concussion.

They had an average of 0.3 concussions, ranging from zero to four. Men and women were equally likely to have a history of concussion, even after researchers adjusted for the percentage who played contact sports.

Women who have had a history of at least one concussion do not score lower on computerized cognitive baseline testing. However, all women, regardless of concussion history, had greater symptoms, symptom severity and poorer cognitive performance than men at baseline. Women reported on average 1.5 more symptoms and scored three points higher on symptom severity than men. On a clinical reaction time task, women were 19 milliseconds slower to react than men. On cognitive tasks assessing processing speed, attention and working memory speed women scored on average seven percent below men with the greatest difference on processing speed (8.5 percent).

"More research is needed to confirm these results and to understand why women may have lower performance at preseason baseline. The difference in performance between genders should be of great interest to athletes, coaches, athletic trainers, and doctors who utilize baseline assessments to aide recovery protocols," said study author Kathryn L. O'Connor of the University of Michigan in Ann Arbor and a member of the American Academy of Neurology.

"This finding that cognitive skills were not significantly affected by having a concussion for either gender should be reassuring to athletes who have experienced a concussion and wonder about its later effects," O'Connor said.

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Differences in sleep issues between women and men

This article explains the differences in sleep issues faced by women and men.

As a nation we are severely sleep-deprived. According to data from the Centers for Disease Control and Prevention, as much as a third of all Americans do not get the recommended seven hours of sleep a night.

"One of the myths is that we can power through or sleep when we're dead," Dr. Charles Czeisler, chair of the National Sleep Foundation and director of sleep medicine at Harvard Medical School, told "CBS This Morning." "But of coursewe'll get there faster if we don't get enough sleep. "

Women and men run into different roadblocks when it comes to their quest for a good night's sleep.

Women are more likely to toss and turn frequently and fight bouts of insomnia, a result of differences in hormonal regulation. Estrogen tends to shorten the length of the sleep cycle, which is why women often report that they experience sleep troubles around the time of menstruation, pregnancy or menopause.

According to a poll taken by the National Sleep Foundation, 63 percent of women versus 54 percent of men experience insomnia at least few nights a week. Women are also more likely to experience daytime sleepiness.

"One of the things is the internal clock controls the timing of sleep," said Czeisler. "It runs faster in women than it does men. It's only about a tenth of an hour but it adds up so that women, in general, their internal clocks are set to about an hour or an hour and half earlier than men, and that means it wakes them up earlier in the morning and it's harder to stay awake in the evening."

On the other hand, anatomical differences in men mean they're more likely to have sleep apnea -- a result of more fat deposit around the neck. Approximately 17 percent of men and 9 percent of women are diagnosed with sleep apnea, a type of sleep disorder that is caused by infrequent or paused breathing.

"If you crowd out the airway then you're going to have trouble when you sleep," said Czeisler. "One out of 3 men and about 1 out of 6 women suffer from disturbed sleep disordered breathing. But unfortunately, because it tends to be viewed as a male dominated disease women are much less likely to be diagnosed. Only 1 out of 10 women compared with men get diagnosed for sleep apnea."

Regardless of these challenges, everyone can take a number of measures to avoid sleep deprivation. Czeisler says good sleep hygiene is essential, such as going to bed at the same time each night to regulate your circadian rhythm. Some people find it helpful to set an alarm for bedtime. Creating a bedroom that's conducive to sleeping is also essential: remove all electronics from the bedroom and keep your room cool and dark.

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Women, in addition to men, suffer from sleep apnea

This article explains that not only men are affected by sleep apnea.

Decades ago, heart disease was thought of as a "man's disease" before well-targeted public education campaigns increased cardiac illness recognition among women and its profound impact on their health. Similarly, one of the most common sleep disorders, obstructive sleep apnea (OSA), has received a masculine label.

Granted, OSA affects half as many women as men, but it is far from rare -- about 6 percent of women suffer from this condition [1]. The lack of awareness in the medical community about the impact of OSA on women is partly rooted in gender bias and partly due to sex differences of the symptoms.

OSA is characterized by repeated episodes of the throat closing or narrowing enough to restrict airflow, which results in fluctuations in the amount of oxygen in the blood. This leads to numerous brief disruptions of sleep as well as poor sleep quality.

Untreated OSA is a risk factor for high blood pressure, heart disease and stroke, and is associated with overall decreased quality of life and wellbeing. The "textbook" symptoms primarily include loud snoring, episodes of gasping for air often witnessed by bed partners, excessive daytime sleepiness, and waking up unrefreshed.

Between 1979 and 1988, many reports on the overwhelming predominance of men among OSA sufferers were published in prestigious journals [2, 3, 4]. This led to health care providers primarily screening male patients for OSA symptoms thereby under-recognizing and thus under-diagnosing OSA in women.

On standardized questionnaires, women with OSA tend to be as sleepy as men, but are more likely to complain of insomnia, depression and fatigue rather than the textbook symptoms of the disorder [5]. Women more often lack a bed partner's account of observed snoring and pauses in breathing and more of them come to the clinic without a spouse or a life partner who can serve as a witness [6].

Another difference among men and women is the change in the OSA risk throughout the lifespan. While a man's risk increases linearly as he ages, a woman's risk is relatively low until menopause and then sharply increases to reach that of similarly aged men [7].

Two exceptions are pregnant women, especially those who are obese before conception, and women with polycystic ovarian syndrome (PCOS). PCOS is a reproductive hormonal disorder characterized by higher than normal testosterone levels and problems with fertility [8]. Among pregnant women, untreated OSA increases the risk of gestational diabetes and pregnancy-induced hypertension [9].

It is essential to educate both health care providers and the population at large on both the prevalence of OSA in women and its unique clinical presentation in order to recognize and appropriately treat women with OSA. Early diagnosis and treatment can help prevent the complications mentioned above, improve overall wellbeing, and indirectly reduce the costs of managing multiple, preventable chronic illnesses.

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Why are brain tumors more common in men?

Research aims to explain why men get brain tumors that are more frequent and often more harmful than women.

New research at Washington University School of Medicine in St. Louis helps explain why brain tumors occur more often in males and frequently are more harmful than similar tumors in females. For example, glioblastomas, the most common malignant brain tumors, are diagnosed twice as often in males, who suffer greater cognitive impairments than females and do not survive as long.

The researchers found that retinoblastoma protein (RB), a protein known to reduce cancer risk, is significantly less active in male brain cells than in female brain cells.

The study appears Aug. 1 in The Journal of Clinical Investigation.

"This is the first time anyone ever has identified a sex-linked difference that affects tumor risk and is intrinsic to cells, and that's very exciting," said senior author Joshua Rubin, MD, PhD. "These results suggest we need to go back and look at multiple pathways linked to cancer, checking for sex differences. Sex-based distinctions at the level of the cell may not only influence cancer risk but also the effectiveness of treatments."

Rubin noted that RB is the target of drugs now being evaluated in clinical trials. Trial organizers hope the drugs trigger the protein's anti-tumor effects and help cancer patients survive longer.

"In clinical trials, we typically examine data from male and female patients together, and that could be masking positive or negative responses that are limited to one sex," said Rubin, who is an associate professor of pediatrics, neurology and anatomy and neurobiology. "At the very least, we should think about analyzing data for males and females separately in clinical trials."

Scientists have identified many sex-linked diseases that either occur at different rates in males and females or cause different symptoms based on sex. These distinctions often are linked to sex hormones, which create and maintain many but not all of the biological differences between the sexes.

However, Rubin and his colleagues knew that sex hormones could not account for the differences in brain tumor risk.

"Male brain tumor risk remains higher throughout life despite major age-linked shifts in sex hormone production in males and females," he said. "If the sex hormones were causing this effect, we'd see major changes in the relative rates of brain tumors in males and females at puberty. But they don't happen then or later in life when menopause changes female sex hormone production."

Rubin used a cell model of glioblastoma to prove it is easier to make male brain cells become tumors. After a series of genetic alterations and exposure to a growth factor, male brain cells became cancerous faster and more often than female brain cells.

In experiments designed to identify the reasons for the differences in the male and female cells, the team evaluated three genes to see if they were naturally less active in male brain cells. The genes they studied -- neurofibromin, p53 and RB -- normally suppress cell division and cell survival. They are mutated and disabled in many cancers.

The scientists found RB was more likely to be inactivated in male brain cells than in female brain cells. When they disabled the RB protein in female brain cells, the cells were equally susceptible to becoming cancers.

"There are other types of tumors that occur at different rates based on sex, such as some liver cancers, which occur more often in males," Rubin said. "Knowing more about why cancer rates differ between males and females will help us understand basic mechanisms in cancer, seek more effective therapies and perform more informative clinical trials."

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Migraines worse for women during menopause

A study claims that women's migraines may get worse during menopause.

New research confirms what women with migraine headaches have told their doctors for years: migraine attacks seem to get worse in the years before and during menopause.

"In women who have migraine, headaches increase by 50 to 60 percent when they go through the perimenopause and menopausal time periods," said Dr. Vincent Martin, professor of medicine and co-director of the Headache and Facial Pain Program at the University of Cincinnati.

The new finding, Martin said, "basically confirms what women have been telling us physicians for decades. We finally have some evidence."

The perimenopausal period is the time when the body is transitioning to menopause -- when monthly periods end. Perimenopause can last several years, and is often marked by irregular periods, hot flashes and sleep problems. Perimenopause can begin in the 40s, and menopause occurs, on average, at age 51, according to the U.S. National Institute on Aging.

The study is due to be presented on Wednesday at the American Headache Society annual meeting in Los Angeles. Findings presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

Martin and his colleagues surveyed just over 3,600 women, aged 35 to 65, in a mailed questionnaire that asked about their menopausal status and whether they had migraines and, if they did, how often. The women were classified as having high frequency headaches if they had 10 or more headache days a month.

The women in the study were about evenly divided among the three groups: premenopausal, perimenopausal and postmenopausal.

While 8 percent of the premenopausal group had frequent headaches, 12.2 percent of the perimenopausal group did along with 12 percent of the menopausal women.

At first, the results might seem puzzling, since experts know that younger women often get migraines right before and at the beginning of the menstrual cycle, said study researcher Dr. Richard Lipton, director of the Montefiore Medical Center Headache Center and professor of neurology at the Albert Einstein College of Medicine, in New York City.

"Women with migraine are most likely to get them a couple days before bleeding through the first few days of the cycle, when estrogen and progesterone both fall. The idea that women who have fewer periods [during perimenopause] would get more migraines seems paradoxical," said Lipton.

However, he said, experts believe decreasing estrogen levels explain the headaches in both cases.

The study provides welcome information on the problem of migraines, according to Dr. Elizabeth Loder, chief of the division of headache and pain in the department of neurology at Brigham & Women's Hospital in Boston.

"I think this study is particularly valuable because they went to the trouble of carefully determining what phase the women were in," she said.

Loder agreed that the study validates what patients have been telling doctors for years. Its size also lends credibility.

However, she said, it's important to put the study in perspective. "Although the relative differences [in headache frequency] between groups look big, the absolute numbers are not," Loder said. She pointed out that 8 percent of premenopausal women and about 12 percent of older women had frequent headaches.

For relief, Martin suggested, women could ask their headache specialist about adjusting or switching their migraine medicine.

The women might also ask about taking hormone replacement therapy for a brief time, he added, reasoning that raising estrogen might help decrease headaches. However, women and their doctors should discuss the benefits and the risks -- such as an increased risk of stroke -- with hormone use.

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Too much and too little sleep indicate memory problems

This article claims that both too much and too little sleep can lead to memory problems in older women.

Seniors who slept too little or too much during midlife or after are at increased risk for memory problems, as are those whose sleep habits changed over time, a new study suggests.

Researchers looked at more than 15,000 women, 70 and older, who took part in a large study of health professionals. The women were depression- and stroke-free when they underwent their initial assessment.

Participants who slept five hours or less, or nine hours or more a day -- either in midlife or later life -- had worse memory than those who slept seven hours a day. The difference in memory was equivalent to nearly two extra years of age, the researchers said.

Women whose amount of sleep changed by more than two hours a night over time had poorer memory than those who had no sleep changes, according to the study published May 1 in the Journal of the American Geriatrics Society.

"Given the importance of preserving memory into later life, it is critical to identify modifiable factors, such as sleeping habits, that may help achieve this goal," study leader Elizabeth Devore, of Brigham and Women's Hospital in Boston, said in a hospital news release.

"Our findings suggest that getting an 'average' amount of sleep, seven hours per day, may help maintain memory in later life and that clinical interventions based on sleep therapy should be examined for the prevention of [mental] impairment," she added.

The study adds "to our knowledge about how sleep impacts memory. More research is needed to confirm these findings and explore possible mechanisms underlying these associations," Devore concluded.

While the study found an association between sleep time during midlife and older age and memory function in older women, it did not prove a cause-and-effect relationship.

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Girls naturally more protected from autism development

This article explains why boys are four times more likely to develop autism and explains why girls may be naturally more protected from developing autism.

It takes more mutations to trigger autism in women than in men, which may explain why men are four times more likely to have the disorder, according to a study published 26 February in the American Journal of Human Genetics.

The study found that women with autism or developmental delay tend to have more large disruptions in their genomes than do men with the disorder. Inherited mutations are also more likely to be passed down from unaffected mothers than from fathers.

Together, the results suggest that women are resistant to mutations that contribute to autism.

"This strongly argues that females are protected from autism and developmental delay and require more mutational load, or more mutational hits that are severe, in order to push them over the threshold," says lead researcher Evan Eichler, professor of genome sciences at the University of Washington in Seattle. "Males on the other hand are kind of the canary in the mineshaft, so to speak, and they are much less robust."

The findings bolster those from previous studies, but don't explain what confers protection against autism in women. The fact that autism is difficult to diagnose in girls may mean that studies enroll only those girls who are severely affected and who may therefore have the most mutations, researchers note.

"The authors are geneticists, and the genetics is terrific," says David Skuse, professor of behavioral and brain sciences at University College London, who was not involved in the study. "But the questions about ascertainment are not addressed adequately."

Genetic burden:

The new study draws from the Simons Simplex Collection (SSC), a database of families that have one child with autism and unaffected parents and siblings. (This project is funded by the Simons Foundation, SFARI.org's parent organization.) In a 2011 study, researchers found that girls with autism in the SSC tend to have more large duplications or deletions of regions of the genome, called copy number variants (CNVs), than do boys with the disorder, although this disparity does not reach statistical significance2.

For the new study, Eichler and his colleagues cataloged the number of CNVs in 109 girls and 653 boys with autism from the SSC. They found that females are twice as likely as males to carry CNVs that are at least 400 kilobases long. (The larger the CNV, the more likely it is to disrupt important genes.)

When the researchers analyzed only CNVs that encompass risk genes for neurodevelopmental disorders, they found that females with autism are three times as likely as males with the disorder to carry CNVs that encompass these genes.

Females with autism also carry slightly more rare mutations that change a single DNA nucleotide than the men do. These are the "nastiest of nasty mutations," says Eichler, because they interfere with the protein's function.

The researchers saw a similar but smaller effect for CNVs in a larger group of 9,206 males and 6,379 females referred for genetic testing: 75 percent of this group turned out to have developmental delay, intellectual disability or autism.

Women in this group are 1.28 times more likely than men to carry large CNVs that include risk factors for these disorders.

Many autism-linked mutations arise spontaneously, or de novo, and about 80 percent of these come from the father.

Eichler and his colleagues found that women are far more likely than men to transmit the inherited mutations that confer autism risk.

Of the 27 large CNVs the researchers identified in the SSC group, 70 percent, or 19, were inherited from the mother. Mothers had similarly passed down about 57 percent of the 3,561 CNVs detected in the neurodevelopmental group.

Eichler intends to extend this work in a bigger study to assess whether certain mutations are more likely than others to be inherited.

"I think it's really critical to identify these inherited components," he says. "We know they're there, but we need to really focus on identifying the specific genes so we can advise [parents] a little more about recurrence."

However, it's unclear whether this gender bias is the result of genetics or reflects differences in diagnosis or the way females manifest symptoms of the disorder. Girls with autism tend to actively compensate for their symptoms in ways that boys don't, which may account for the discrepancy, says Skuse.

As a result, the females enrolled in studies may tend to be severely affected and carry multiple mutations. "There is some suggestion that higher-functioning females are out there in the general population, but they're not being referred," he says.

The study also does not address why women with autism transmit more mutations, or how they are protected from autism.

"We need to ask what it is about brain development that makes it such that females are protected -- because ultimately that is what we want know," says Aravinda Chakravarti, director of the Center for Complex Disease Genomics at the Johns Hopkins University School of Medicine in Baltimore. "We need to re-create that developmental environment."

The most obvious explanation for autism's gender bias is that because men have only one X chromosome, they are hypersensitive to mutations in this chromosome. In line with this theory, several autism-linked genes are located on the X chromosome. However, most of the mutations that show a gender bias in the new study are not on the X chromosome, suggesting that other factors must be involved.

This article has been modified from the original. An earlier version incorrectly stated that 80 percent of the genetic risk factors for autism arise spontaneously. The exact contribution of spontaneous genetic variants to autism is not known.

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Chronic fatigue syndrome in men and women

Chronic fatigue syndrome, once considered a men's disease, now is known to be present in both men and women.

Previously long-term fatigue was considered a male disorder caused by societal pressures. Today women comprise the majority of these patients, and they feel that their condition is their own fault. Not only has the fatigued patient changed gender. Previously doctors believed that long-term fatigue was a neurological, physical disorder, while today it is categorized primarily as psychological in nature. And while in the past, society was thought to be the cause of the disorder, today the individual is supposedly to blame.

Throughout history some people have suffered from a lack of energy and long-term, physical fatigue. Today these symptoms are classified as myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

It is commonly thought that chronic fatigue has mainly psychological causes and that it affects perfectionistic women who cannot live up to their own unreasonably high standards.

This has not always been the case. Just over 100 years ago it was primarily upper class men in intellectual professions who were affected. "Neurasthenia," as the condition was called at the time, was a physical diagnosis with high status.

No longer legitimate

"The medical understanding of long-term fatigue has changed. Previously the condition was viewed as a typically male disorder; now it is perceived as a typically female disorder. The diagnosis of neurasthenia, which has a male connotation, was changed to the ME diagnosis, which has a female connotation," explains Olaug S. Lian, a sociologist and professor at UiT The Arctic University of Norway.

Together with Hilde Bondevik of the University of Oslo, Lian has studied how the view of women and perceptions of the body, gender and femininity in two different historical periods have been manifested in the medical understanding of long-term chronic fatigue.

"Long-term fatigue was viewed as a legitimate disorder, a result of the heroic efforts of the upper class male. Today, it is a stigmatizing disorder, understood as an expression of women's lack of ability to cope with their lives, a kind of breach of character," says Lian.

Not only has the fatigued patient changed gender. Previously doctors believed that long-term fatigue was a neurological, physical disorder, while today it is categorized primarily as psychological in nature. And while in the past, society was thought to be the cause of the disorder, today the individual is supposedly to blame.

What happened to cause this change?

Upper class diagnosis

At the end of the 1800s neurasthenia was the most widespread diagnosis for long-term fatigue. Neurologists believed the condition was caused by a physical, neurological disease that affected the entire body, causing intense, long-term fatigue.

Although women were also diagnosed with the disorder, the typical patient was a man, and not just any kind of man. He was "civilized, refined, and educated, rather than of the barbarous and low-born and untrained," according to neurologist George Beard.

Society was to blame

Doctors at the time believed that the cause of the disorder could be found in a rapidly changing society -- urbanization, industrialization and women's entry into working life.

Quite simply, modern civilization ran roughshod over the nervous system of upper class men, who were overstimulated by too much pressure and activity and too little sleep and rest.

"It was regarded as both legitimate and understandable that even the 'great men' could fall apart as a result of long-term, difficult intellectual work. It was viewed as positive that the body sent signals when the burden was too great. The body was viewed as an electrical fuse box and the thinking was that it was better for one fuse to burn out rather than for the house to catch on fire," says Lian.

Different genders, different causes

The comments about the diagnosis also revealed past understandings of biological gender differences. Women could get neurasthenia from sexual frustration, while men could get it from excessive sexual activity, including masturbation.

Moreover, there was a connection between gender and class.

"To simplify a bit, we can say that it was mainly middle class men and working class women whose diagnosis of neurasthenia was explained by overwork. For working class men it was due to sexual escapades, and for middle class women the cause given was heredity or 'women's issues'," explains Lian.

The fall of neurasthenia

Neurasthenia lost its popularity as a diagnosis in the early 1900s. One reason for this was that psychiatry became a medical field in its own right.

"Psychiatry took neurasthenia with it and changed its definition from a physical to a psychological condition. Since women were regarded as psychologically weaker and therefore more disposed to mental illness, the disorder became a female problem," says Lian.

Fight over definitions

Today ME is the most common name for the disorder, defined as long-term, intense fatigue that cannot be directly linked to a well-defined illness and that does not disappear with rest. The condition is chronic, it cannot be cured with medical treatment and there is disagreement as to the cause.

"The lack of scientifically generated findings, medical explanations and effective treatment make ME a diagnosis with low status and low legitimacy within the medical community," says Lian.

Currently the main theory is that ME results from an inability to handle stress and that perfectionistic people -- the "good girls" -- are especially at risk. The debate about how ME should be understood and explained is highly polarized, between those who believe that it is an illness caused by infections or vaccination and those who believe that ME has mainly psychological causes.

"I would like to see some humility about what we actually know about the disorder and not present value judgments as facts. Doctors must also be honest and acknowledge that we have very little hard-and-fast knowledge about this condition," states Lian.

Blame and shame

The two historical periods have almost identical depictions of the phenomenon of long-term fatigue, although the names are different. But there is one important difference: the disorder is no longer regarded as a legitimate, anticipated outcome of overwork.

"Today the medical community is searching for explanations of ME at the individual level. The ME patient is depicted as a woman with five-star goals and four-star abilities -- with character traits that make it hard for them to cope with their own lives," says Lian.

"When the entire problem is seen as the patient's fault, the person experiences blame and shame because it is the patient, not society, who is the cause of the illness. It is therefore the individual who is responsible for coping with the illness, such as by changing her own thought patterns," says Lian.

Wrong kind of tired

She points out that the ability to cope with one's own life is an important value in Western culture. Mental disorders, however, are associated with weakness. The current understanding of long-term fatigue is also linked to how we think about tiredness, according to Lian.

"There are strong norms for when you are allowed to be tired and worn out and how you are supposed to show tiredness in daily life. If you have been awake all night with a sick infant, you have a good reason to be tired at work. Other reasons are less legitimate. Workplace reports of absence never state that someone is at the psychologist, while it is completely acceptable to say that someone is at the dentist."

"Being tired for the wrong reasons is seen as a sign of weakness, which must be overcome and hidden. It is in this context that we must understand the medical theories on a lack of coping ability and the objections of ME patients to these theories," says Lian.

She believes such norms often make ME patients feel that the psychological explanation is a burden, although doctors do not necessarily mean for it to have this affect.

"What is it about the ME debate that makes the opposing sides so obstinate?"

"The doctors and patients talk past each other. The doctors think that an ME diagnosis is value neutral, but the patient hears 'it's my fault that I am sick and it's my responsible to get better'. But although most people feel that mental disorders have lower value than somatic disorders, it is not a given that the doctors do," says Lian.

Gendered explanation disappeared?

Although about three of four people who are diagnosed with ME today are women, the explicit, biology-based gendered explanations have disappeared from the debate, according to Lian.

"This may simply be because today we put greater focus on gender equality -- which makes it less legitimate to claim that women are naturally inferior to men," says Lian.

However, she believes that the ME diagnosis embodies a view of women that has long historical roots.

"The profile of the upper class woman from the 1800s who cannot cope with pressure and stress both inside and outside the home is still with us today," says Lian.

Cultural bias

"How can your analysis contribute to the current debate about ME?"

"We show how the medical understanding of fatigue and lack of energy is impacted by the norms and values of society at large, for example, that medical knowledge reflects the view of women in our culture. Norms and values combine with biomedical knowledge in a way that makes it difficult to see what is what," says Lian.

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Why Women Need More Sleep Than Men

This article discusses the differences that occur between men and women who get inadequate sleep.

Ever noticed how after a late night out with your man, you have a harder time the next day than he does? It's not all in your head. Thanks to different hormonal makeups, we suffer more emotionally and physically when we're short on zzzs.

"Poor sleep certainly had a more profound effect on women than on men," says Edward Suarez, Ph.D., an associate professor at Duke University School of Medicine and lead researcher of a studythat looked at the relationship between poor sleep and poor health. He found that for women, reduced sleep was associated with a significant increase in risk of heart disease and diabetes, as well as more stress, depression, anxiety, and anger. However, these associations were weaker or nonexistent for men.

What gives? Testosterone. Levels of this hormone rise after poor sleep in men, and "because it decreases insulin and increases muscle mass, testosterone has an anti-inflammatory effect, which kept men's stress hormones lower," he explains.

Unfortunately for us, women's hormones, especially progesterone, do not have that same stress-dampening effect. Estrogen is known to have an anti-inflammatory effect, so the decline in the hormone as we get older could contribute both to worse sleep and to feeling even crappier after a night spent tossing and turning.

And while you may have seen recent headlines proclaiming that women need more sleep than men, the truth is a lot more complicated, says Aric Prather, Ph.D., an assistant psychiatry professor at the University of California, San Francisco and author of a larger 2013 study that confirmed Suarez's findings. "I don’t think there is any good evidence yet that women needmore sleep than men," Prather says. "The present data is more in support of the fact that women may be more susceptible to the negative effects of poor sleep quality."

In both studies, physiological stress was measured by looking at blood levels of C-reactive protein (CRP), which rises in response to inflammation and is considered a better marker of stress than looking at cortisol levels alone. The volunteers were also asked to rate their sleep quality. 

In addition to overall snooze time, Suarez's study looked at four different aspects of "disturbed" sleep: how long it took subjects to fall asleep, how many times they woke in the night, how long it took them to fall asleep again, and if they awoke too early in the morning. Surprisingly, it wasn't just the total number of hours in the sack that made the difference. According to Suarez, the No. 1 factor correlated with an increase in CRP for women was taking more than 30 minutes to fall asleep when they first hit the sheets. This is a double-whammy for women, he says, who not only are we 20 percent more likely to suffer from insomnia than men but also suffer more ill effects from it.

Large epidemiological studies have found that women tend to rate their quality of sleep as worse than men even when their sleep is shown through objective measures to be better. "This raises the question of whether women may be more sensitive to sleep problems, which may have biological consequences, including elevations in inflammation," Suarez says.

Kelly Glazer Baron, Ph.D., clinical psychologist and director of the Behavioral Sleep Program at Northwestern University Feinberg School of Medicine, adds that bad sleep can become a vicious cycle: Shoddy shut-eye boosts stress, which in turn causes insomnia for many people, leading to even more stress on top of what you experience every day.

But there are things women can do to mitigate these effects. "We can improve how we prevent disease over lifetime simply by making small improvements in our sleep," Suarez says. This is why it's important to promptly treat sleep problems, especially insomnia. Baron says that if your insomnia reaches the point where it is making it hard to function during the day, talk to your doctor about lifestyle modifications and other options. 

She also recommends establishing a regular fitness routine. "It’s been known for a long time that exercisers sleep better," she says, citing her recent studies showing that 16 weeks of aerobic exercise at moderate intensity four days a week helped women get at least seven hours of sleep a night and also improved their perception of the quality of their rest.

Finally, don't forget the recommendations from the National Sleep Foundation, Prather says (which you likely can recite in your sleep—or as you stare at the ceiling): Go to bed at the same time every day of the week, avoid heavy meals before bed, establish a relaxing bedtime routine, don't nap, and exercise daily.

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Research on women, pregnancy, and the effects of epilepsy

Research looks into women, pregnancy and folic acid supplementation, and how valproate, an antiepileptic drug, effects them.

New research pertaining to the latest findings on the effects of epilepsy on both the mother and child were presented at the American Epilepsy Society's 67th Annual Meeting in Washington DC. These studies explore folic acid use, the effect of surgery with intractable focal epilepsy, and antiepileptic drug exposure during breastfeeding.

Researchers from the Harvard Neuroendocrine Unit at Beth Israel Deaconess Medical Center in Boston, Massachusetts investigated the frequency of folic acidsupplement use by women with epilepsy in the community and factors that may predict its use (Platform B.04 / Abstract 1722353). Folic acid deficiency in early pregnancy is known to cause birth defects and increase the risk of miscarriages, which can occur most with enzyme-inducing antiepileptic drugs (AED). Neural tube malformations are most common with the use of Valproate, a folic acid antagonist.

Data for this study was collected through the Epilepsy Birth Control Registry (EBCR), a web-based survey and educational site used to gather key information from 626 women with epilepsy in the community. The study found that 44% of respondents took folic acid.

"Our findings show that only about half of the women surveyed are taking folic acid, despite their high risk of unintended pregnancies. Additionally, we found that many of the respondents who were not taking precaution of neural tube malformation were taking Valproate, a folic acid antagonist," said Andrew G. Herzog, MD, principal investigator of the study. "Overall the women at risk, regardless of antiepileptic drugs or contraceptive use, did not differ significantly from women not at risk and on no antiepileptic drugs."

In a related study, researchers from The Mayo Clinic-Rochester presented evidence to support the importance of early surgery in women with intractable focal epilepsylooking to get pregnant (Poster 3.250 / Abstract 1750307). One hundred and thirteen women were included in this study. An average of 0.93 pregnancies and 0.73 births were identified prior to surgery, compared to a significantly higher success rate of 1.27 pregnancies and 0.96 births post-surgery. A total of 17 women had a total of 35 pregnancies and 25 births after surgery. Those patients who received fewer medications prior to surgery were more likely to have additional children following surgery.

"While the significance of these findings is uncertain, we believe that they support a role for earlier surgical intervention in the management of intractable focal epilepsy and the relationship it has to conceiving and giving birth," said Rachel R. Fabris, MD, the lead author of this study.

A third study was presented as a follow up to previous research determining the effects of antiepileptic drug exposure via breast milk on IQ at age 3 years old. The new data collected was from a cohort of children at the age of 6, which the researchers deemed an age more predictive of school performance and adult abilities (Poster 2.213 / Abstract 1732174). While breastfeeding is known to have beneficial effects for both the child and the mother, there is concern regarding whether breastfeeding while taking antiepileptic drugs could be harmful to the cognitive development of the infant.

Results of the study were analyzed as a function of whether the children had been breastfed or not. Overall, 43% of the children were breastfed, but the results failed to show adverse effects of AED exposure: children who breastfed exhibited higher IQ and Verbal Index scores even though their mothers used AEDs.

"Our results are encouraging in that women with epilepsy can be less fearful of breastfeeding their baby," said the leader of this study, Kimford Meador, MD. "Nevertheless, this is a limited study and additional research is needed."

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Middle aged women commonly have sleep disorders

A survey shows that about a quarter of middle-aged women have sleep issues and disorders.

Almost a quarter of middle-aged women report their quality of sleep is less than good, according to a new study.

Sleep problems were tied to poor quality of life, chronic illness and medication use, researchers found.

The new study adds to earlier research by looking at common sleep problems among women before they hit menopause, according to Dr. Päivi Polo. She led the study at the University of Turku in Finland.

"Typically we think that these are problems of menopause and thus menopause is the reason for everything," Polo told Reuters Health.

"Then we try to treat all menopausal insomnia symptoms with hormone replacement therapy ... but because in some women the sleep problems are already evident before the menopause, the HRT may not alleviate all sleep problems and we physicians are wondering what to do next."

After menopause, hot flashes and night sweats increase sleep problems, she said.

Polo and her colleagues surveyed 850 mothers about their sleep when they were 42 years old, on average. One third had a chronic illness, like diabetes or heart disease, and 28 percent were on regular medication.

Women most often reported waking up frequently at night. Sixty percent of them had that problem at least once a week.

Sixteen percent of women reported having difficulty falling asleep and 20 percent said they woke up too early in the morning on a weekly basis.

Morning sleepiness was reported by 42 percent and daytime sleepiness by 32 percent.

Sleep troubles are not new for people of any age, but they do seem to be a bit more common among women. Hormonal changes related to menstrual cycles or menopause may be partly to blame, the authors write in Maturitas.

Occasional alcohol drinking was tied to better sleep quality and less falling asleep at work, they found.

But women's weight and physical activity levels were not linked to sleep problems. That might be because most women in the study were in the normal range for body size, Polo said. Other studies have tied obesity to sleep problems like sleep apnea.

"There is likely a bidirectional association such that obesity may induce poor sleep, and short sleep may induce weight gain and subsequent obesity," Dr. Helen Driver, who researches sleep at Queen's University in Kingston, Ontario, Canada, said.

"The study was not designed to assess much detail about the relationship between physical activity and sleep, which is a complex interaction depending on factors such as physical fitness, aerobic capacity, exercise type (aerobic, non-aerobic, stretching) and timing," Driver told Reuters Health in an email.

All sleep problems can affect daytime tiredness, work performance and quality of life, Driver said.

Women tend to get about seven hours of sleep each night during the week, but sleep needs are unique to individuals, she said.

"Sleep is so crucial, since we sleep one third of our life and it affects so much of our health," Polo said. Sleep problems can be a symptom of a disease or mental state, which doctors should keep in mind, she said.

Women having sleep problems should talk to their doctor and be sure to note any potential sleep-related side effects of medications, researchers said.

"A good start is to keep a sleep diary and note any patterns or symptoms such as snoring, restlessness, morning headache," Driver said. "If there is concern ask your family physician for a referral to a sleep center for an assessment by a qualified sleep specialist."

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Link between skin temperature and migraines

A new study shows that women with colder skin temperatures are more likely to have migraines.

Migraine sufferers have colder noses and hands than people without migraines, possibly due to underlying blood vessel abnormalities, says a study published online in Autonomic Neuroscience. Migraine headaches are considered a risk factor for cardiovascular diseases and stroke, but few studies have examined skin-temperature changes as a marker of vascular health, researchers said.

The study compared skin temperature in the face and hands of 41 Finnish women, 12 with migraines and 29 without headaches. A family history of migraine headaches was reported by 85% of migraine subjects and 31% of controls.

Half of the migraine subjects had headaches only on the right side and five had migraines accompanied by visual disturbances called aura. A digital infrared camera was used to measure skin temperature on the nose, cheeks, forehead, hands and fingertips in migraine subjects during a headache-free period, and in controls. The results were compared.

The average temperature of the nose and hands was about 3.6-degrees Fahrenheit lower in migraine subjects than controls. Of the migraine patients, 58% had skin temperatures below 86 degrees Fahrenheit, which is considered a normal skin temperature, in both the nose and fingers.

By comparison, the nose and finger temperatures were below 86 Fahrenheit in 31% and 40% of controls respectively.

Subjects with right-sided migraines had significantly higher blood pressure and lower hand and finger temperatures than healthy controls. The difference in fingertip temperatures was almost 9 degrees Fahrenheit, researchers said.

Of the controls with cold hands, half had a family history of migraine. Skin-temperature changes were unrelated to headache aura.

Colder extremities in migraine patients were likely due to constricted peripheral arteries or impaired function of the autonomic nervous system, which controls the heart and internal organs, the study suggests.

Caveat: The study and didn't include men. Subjects' vascular health wasn't measured. Healthy individuals may have cold extremities, researchers said.

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