Ask the Doctor: Hypomania; Headache Treatment; Cognitive Symptoms of Fibromyalgia

Q: I recently found out a friend was diagnosed with bipolar disorder? She said she has periods of hypomania, along with depressive episodes. What’s the difference between mania and hypomania?

A: Someone with bipolar disorder has abnormal shifts in mood, energy and activity levels. They are often described as episodes of mania and depression, but there can be a wide range in how long episodes last, their intensity, and how much they may interfere with one’s quality of life. Manic or “up” episodes are marked by feelings of elation and high energy. Depressive or “down” episodes are, as you might imagine, periods of low energy and sadness.

Simply stated, hypomania is like mania, but less intense. It’s usually a symptom of bipolar II disorder, which is one of four main types of bipolar disorder. Bipolar I disorder, for example, includes manic episodes of a week or more followed by depressive episodes of two weeks or more. Bipolar II disorder is similar, but the “up” episodes aren’t as disruptive of work, relationships or daily functioning. Many people with bipolar II disorder lead normal lives.

During these episodes you may notice your friend is unusually energetic, anxious to start projects, and especially upbeat. While these are usually considered positive traits, hypomania can sometimes interfere with a person’s ability to concentrate at work or do other things that require serious effort. Hypomania typically doesn’t require hospitalization. Serious mania episodes, however, can require hospitalization and medication.

With mania, a person may be more likely to engage in very risky behavior and have wild, complex thoughts and ideas. A person experiencing hypomania probably won’t do a lot of scary risk-taking. Hypomania can develop into mania, however. But if your friend is getting good, supervised care, this isn’t an inevitable development.

Q: I’m a heart attack survivor who takes a daily low-dose aspirin to prevent a second event. Can I take ibuprofen for a headache?

A: This is a common concern among people who don’t want to run the risk of a bleeding incident triggered by a combination of aspirin and a painkiller such as ibuprofen. These are both part of a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), which pose a risk of stomach irritation and internal bleeding. In general, you should avoid taking an aspirin (even a low-dose aspirin) with another NSAID. For a headache, try acetaminophen (Tylenol), which is not an NSAID. Another non-NSAID is capsaicin (Zostrix), which can be applied as a topical cream to help relieve back pain, arthritis and other aches. Ask your doctor about headache relief options, as well as what other medications may be risky to take along with your aspirin.

Q: Are there brain-related symptoms of fibromyalgia?

A: Fibromyalgia remains a medical mystery. It is characterized by musculoskeletal pain that can affect all parts of the body. It has no cure, and its causes are not known. There is also no blood test to diagnose it. Researchers believe that fibromyalgia symptoms are related to changes in the way the brain processes pain signals. As to your question, yes there are brain-related symptoms of fibromyalgia. These include mood changes (anxiety and depression), memory problems, sleep disturbances, and stress. Exercise and stress-reduction techniques help many people with fibromyalgia reduce their symptoms. Treatments for fibromyalgia include pain relievers, antidepressants, physical therapy, and counseling. If you believe you may have fibromyalgia, see a doctor and be prepared to discuss your symptoms in detail. Often a review of your medical history and a description of your symptoms can confirm a diagnosis.

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