Stress and migraines
Migraines aren’t what you’d consider an ordinary headache. They have a tendency to clobber you over the head with intense head pain and can cause other symptoms that range from disruptive to debilitating.
Sounds stressful, right? It sure it. But the relationship between migraines and stress is a two-way street.
Stress is one of the biggest triggers for migraine headaches.
What are migraines?
Far from “just a headache,” a migraine is believed to be a neurological disorder characterized by intense throbbing pain located at one or both sides of the head that can last anywhere from four to 72 hours, according to the National Institute of Neurological Disorders and Stroke.
The condition results from genetic, environmental, and lifestyle factors.
What also sets a migraine apart from a typical headache is that it comes with other symptoms, like nausea, vomiting, and a sensitivity to light, smell, and sound.
Many migraineurs also experience an aura, or neurological disturbances that precede head pain, such as seeing zigzag lines or flashes.
Certain auras can even be more concerning—say, if you have weakness on one side of your body, or other stroke-like symptoms.
What’s a stress migraine?
A stress migraine isn’t an official diagnosis. Rather, stress triggers the migraine process.
“For a long time, people would say that stress is causing the migraine, but we know that’s not the case. These people have migraine genetically independent of stress—though it is a contributor,” explains Chaouki K. Khoury, MD, a neurologist with Panda Neurology & Atlanta Headache Specialists.
Other migraine triggers include hormonal changes during menstruation, skipping a meal, getting less sleep than usual, certain foods and additives like aspartame, and various strong scents.
(Learn more about menstrual migraines.)
Here’s everything you need to know about the link between stress and migraines, including symptoms and prevention strategies.
Can stress cause migraines?
The hypothalamic-pituitary-adrenal (HPA) axis is made up of the hypothalamus (found in the brain), the pituitary gland (found at the base of the brain), and the adrenal glands (found on top of the kidneys).
Together, they play a role in how we react to stress.
When the stress hormone cortisol activates the HPA axis, it causes effects on serotonin, a neurotransmitter that plays a role in the development of migraines, says Mary O’Neal, MD, director of the women’s neurology program at Brigham and Women’s Hospital in Boston.
The unfairness of let down migraines
If stress can trigger a migraine, you’d think that recovering from a stressful week with a relaxing weekend would be just what the doctor ordered.
But there’s a phenomenon called a “let down migraine,” in which people get migraine attacks on the weekend. But the week’s stress is already over, so gives?
While experts aren’t quite sure why this happens, says Dr. O’Neal, it is something that doctors regularly see.
“We know that, as a generalization, migraineurs tend to be successful people. There must be some reason why they can continue to be successful despite having a debilitating disease,” she says.
One theory: perhaps the migraine is being suppressed until it doesn’t need to be. When the stress is over, your body doesn’t see a need to hold back anymore. Like that, you’re left lying in bed all day on a Saturday.
Another theory has to do with changes to sleep routines and eating schedules, which can trigger a migraine regardless of stress.
Signs of a stress migraine
You know you’re stressed. That much is obvious, but is your migraine really induced by stress? Here are the symptoms to watch for:
Your muscles are tense
One physical symptom of a migraine: muscle tension.
“Neck and shoulder tension is common in migraine, but this does not make it a tension headache,” says Dr. Khoury. In fact, migraines are often misdiagnosed as tension headaches.
(This is the difference between a migraine and a headache.)
The head pain is intense
It can be tough to tell the difference between a tension headache and migraine.
Both tension headache and migraine can feature mild or moderate pain. But if your pain is more on the severe end of the spectrum, it’s more indicative of a migraine.
Migraine pain will also pound, throb, or be debilitating. The pain of a tension headache may be more distracting and uncomfortable.
Your mood has changed
If your mood shifts after your headache, there’s a good chance it was a migraine.
Following the attack stage of a migraine (that’s when pain happens) is the postdrome phase, also known as a migraine hangover. It can last hours or a day or two, and can cause changes in mood.
You have migraine symptoms
If you have nausea, vomiting, dizziness or light-headedness, sensitivity to light or sound, muscle weakness, or vision changes, it’s most likely a migraine.
Head pain, another sign of a migraine, can go on for hours or even days if it’s not treated.
You’re really anxious
Stress and anxiety feed a migraine. But migraines also causes profound stress and anxiety, says Dr. Khoury.
“It becomes a forward-feeding loop. You can’t get out of the cycle and start spiraling,” he says.
Over time, this may lead to something called a chronic migraine, which is defined as having 15 or more headache days per month.
You’re a perfectionist
Overachievers are more likely to be migraineurs.
“Many are type A overachievers who were straight-A students,” Dr. Khoury says.
But the connection is complicated.
“In the past, we thought that because these patients are driven, that’s why they got migraines,” he says.
That is, maybe their overachieving ways led to more stress and, as a result, migraines.
“No,” says Dr. Khoury. “Genetically, they are more likely to be driven and have migraines.”
When to see a doctor
Get help sooner rather than later. The problem with stress as a trigger is that if you’re under constant stress, you’re more likely to get more migraines.
The more often you have to treat them with medications like over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), the more likely you are to deal with rebound headaches, which is pain that’s triggered by the medication itself.
“Migraine begets migraine,” says Dr. Khoury.
Intervene now before you reach the point of having chronic migraines, which can make treatment more challenging.
How to treat stress migraines
If you have migraines only
If you have migraines occasionally, a NSAID such as ibuprofen (Advil) or a prescription triptan may be recommended to stop them.
However, these shouldn’t be used more than nine days per month; taking them too often can cause rebound headaches, according to the American Migraine Foundation.
In that instance, your doctor may consider preventive medications.
If you have muscle tension or pain
A muscle relaxant may be an option for you. This can have an antimigraine effect, says Dr. Khoury.
“This type of medication works on the central nervous system to quiet down those nerves,” he says.
If you also have anxiety or depression
Ask about antianxiety medication, particularly a serotonin-norepinephrine reuptake inhibitor (SNRI), suggests Dr. O’Neal.
This type of medication targets serotonin pathways that can help decrease both anxiety and migraines, she says.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may also be used.
These work indirectly by addressing depression, which can have a beneficial effect on your mental health and stress levels, but they do not directly target migraines, explains Dr. O’Neal.
So how can you stop stress migraines from happening?
The answer is at once both simple and difficult. You should try to address your stress and bring that level down by taking both small (and maybe life-changing) steps, if you can.
What makes you relaxed? Is it a massage? Yoga at home? Sitting down for 10 minutes alone and breathing?
These little stress-management moves add up in a big way to make you more resilient and counter the effect stress has on you.
Since migraine has a genetic component, others in your family may also get attacks. Dr. Khoury suggests finding things you like to do as a family that bring calm. Take after-dinner walks together or go hiking on the weekends, for example.
If you feel prodrome symptoms (that is, signs of an impending attack), taking time to relax may help prevent the migraine from progressing.
(Get quick stress relief in five seconds.)
Exercise is one of the best ways to counter stress and improve your sleep, thereby addressing two triggers at once, says Dr. O’Neal.
According to a 2020 review in Current Pain and Headache Reports, aerobic exercise can significantly reduce migraine frequency, intensity, and duration.
It looks like higher-intensity exercise is best, but a low-impact activity like yoga is also likely beneficial, the researchers say.
Consider big life changes
Dr. Khoury has had patients who, after getting divorced or changing jobs, have seen their migraines drastically improve.
Some life changes—being able to change jobs, for example—aren’t doable for everyone. And rather than leave your current relationship if it’s a source of stress, you might consider couples counseling.
However, if you do feel like you have the ability to explore something else, be it a new company or career, take your migraine as the signal that you—for the sake of your health—need something new.
The bottom line: in order to address your stress migraines, you need to target the source of your stress.
Once you’ve identified the source, try some of these stress management tips to help you get started.
The rise (and rise again) of tofu
If tofu is new to you, know that it has a decades-long history in the United States and an even longer history worldwide. Not only is the soy product versatile but it also packs a health punch. Tofu nutrition is no joke.
Also known as bean curd, tofu has been around for thousands of years. The earliest records of its consumption date back more than 2,000 years to China, and it became a staple in Chinese cuisine in the 10th century.
Other Asian countries adopted it over the following centuries, but tofu did not appear in many U.S. grocery stores until the 1970s.
Since then, it has become a major protein source for countless people who follow vegetarian, vegan, or plant-based diets. It’s popular enough that you’ll find it in most grocery stores and restaurants.
Here’s what you should know about tofu nutrition, including its calories, carbs, and protein, as well as how to use it.
What is tofu?
Tofu is basically soybean curd, made by curdling soy milk, explains Jackie Newgent, RDN, a plant-focused chef, nutritionist, and author of The Clean & Simple Diabetes Cookbook.
The first step to making tofu is to make soy milk.
Dried soybeans are washed, soaked, and ground up. Water is added to the mix, then the solution simmers for 15 to 30 minutes. It’s drained through a piece of cloth in a sieve.
The soy milk that remains contains all of the soybeans’ beneficial nutrients.
The next step is coagulation, which involves heating the milk at a low temperature along with a coagulant, most commonly nigari, a sea water extract.
The final step involves pressing the coagulated soy milk into white edible blocks, Newgent says, which is how tofu is often packaged at the grocery store.
“In a packaged tofu, a standard ingredient list may include water, soybeans, nigari, and calcium sulfate,” she says.
What are the types of tofu?
There are different types of tofu, varying in consistency and firmness.
The softer the tofu, the higher the water content. This makes it more likely to fall apart but also means it is more taste absorbent.
As firmness increases, so do density, durability, fat, and protein content.
The most common forms of tofu, according to Newgent, are silken, soft, medium firm, extra firm, and super firm.
This form of tofu has the highest water content and is actually undrained and unpressed.
“Silken is ideal for smoothies,” Newgent says. It also works well in sauces, dips, desserts, and salad dressings.
Soft tofu is one step firmer than silken, with a higher water content than the firmer varieties. It is generally used similarly to silken.
With a little less water content than soft, medium tofu is still delicate enough that it would fall apart in a frying pan. This is the type of tofu found floating in miso soup.
Some people like to use it in stir fries, but it may fall apart more than some of the firmer options.
Newgent maintains that extra-firm is great in stir fries because it holds its shape well if you slice it.
You can also use it when making grilled and baked tofu.
Super firm is the densest tofu, and very high in protein.
Other types of tofu
Other types of tofu are becoming increasingly popular.
Precooked tofu is already flavored and baked, and can be found in the refrigerated section of grocery stores.
Also be on the lookout for black tofu, which is made from yellow and black soybeans, Newgent says.
And due to the growing popularity of plant-based foods, there are new faux tofus popping up in natural markets “as an alternative to traditional soybean-based tofu,” she explains.
Pumfu, for instance, is made with pumpkin seeds.
Because tofu is plant based, it is cholesterol free and has minimal saturated fat, explains Ellen Liskov, a registered dietitian nutritionist at Yale New Haven Hospital.
“The firmer the tofu, the higher the protein content and overall calories because there is less moisture,” she points out.
While the exact nutritional value varies with type of tofu as well as brand, the average three-ounce portion (a generous half cup) of firm tofu contains the following nutrients.
A three-ounce serving of firm tofu has about 80 calories.
A serving also contains less than half a gram of saturated fat.
That’s “about 3 percent daily value, or 3 percent of our day’s needs, based upon a 2,000-calorie-a-day diet, which is average for Americans,” Liskov explains. “For nutrients we want to limit, like saturated fat, less than 5 percent daily value is good. So this is considered low in saturated fat.”
There are eight grams of protein in a three-ounce serving of tofu, which is 15 percent of our daily need.
The sodium content is “very low” at five milligrams, or less than 1 percent of the daily value.
“Again, this is important because the typical American eats too much sodium,” Liskov says.
Of course, if you buy pre-flavored tofu, pay attention to the nutrition label to make sure a lot of salt wasn’t added.
Tofu is also low in carbohydrates, with two grams per serving. That accounts for 1 percent of your daily needs.
Fiber varies from between one and three grams, depending on the brand.
“Foods with at least three grams of fiber are a good source of dietary fiber,” Liskov points out.
Tofu is a good source of calcium, Liskov says. It offers 10 percent of the daily recommended value for calcium, based on the average need for 1,300 milligrams of calcium per day.
“Foods with 10 percent daily value or more for a nutrient is considered a good source of that nutrient,” she says.
If you don’t consume animal products (and therefore avoid cow’s milk), you may be able to get more calcium by eating tofu.
Tofu is also a great source of iron, offering 6 percent of the daily value, based on the average need of 18 milligrams a day.
There are many benefits of adding tofu to your diet.
It is a high-protein plant food
For anyone on a meat-free diet, tofu is a great alternative.
“Tofu is rich in plant protein and is an excellent swap for meat, nutritionally speaking,” Newgent says.
Liskov agrees. “This is a good substitute for meat, poultry, even fish,” she says.
It is good for the environment
Tofu is good not only for your body but also for the natural environments on which we all depend.
That’s because it’s a less carbon-intensive protein source than meat. So eating tofu contributes less to climate change.
“As a plant protein food, tofu is a much more environmentally friendly source of protein than meats like beef and lamb, which significantly contribute to greenhouse gas emissions,” Newgent explains.
It could help lower cholesterol
Newgent points to research that says tofu’s soy isoflavones (helpful antioxidants) may help reduce LDL cholesterol levels.
“That’s the ‘bad’ cholesterol,” she says. When LDL cholesterol gets too high, it can raise your risk for heart problems.
It can help improve heart health
Tofu may have cardiovascular benefits.
“Numerous studies cite the benefits of eating a plant-forward diet related to risk reduction for heart disease and also diabetes,” Liskov says.
It may reduce your risk of breast cancer
There is some research to suggest soy can effectively keep breast cancer at bay.
One highly cited 2020 study, published in Cancer Research, found that women who consumed soy products at least once weekly reduced their risk of developing breast cancer by 48 to 56 percent, likely due to the isoflavones in them.
It may help with menopause symptoms
Newgent explains that soybean foods, including tofu, contain phytoestrogens, which may play a role in curbing hot flashes and other symptoms of menopause.
A analysis of 19 studies, published in Menopause, found that supplements with soy isoflavone effectively reduced the severity of menopause-induced hot flashes by more than 26 percent.
Is there any risk of eating tofu?
While there is some confusion about the health effects of soy, the general consensus is that most people can safely consume it without any issues.
Some research has linked eating high amounts of soy to breast cancer, but this theory is not widely accepted. And recent studies, like one published in 2020 in PLOS One, have found the opposite.
In fact, studies have found that in geographical regions where soy is a primary source of food, breast cancer rates are lower.
Of course, if you’re allergic to soy, you’ll want to avoid tofu.
How cook tofu
Tofu is far more versatile than many people realize. “You can bake, scramble, panfry, air fry, simmer, sauté, stir-fry, grill, and blend it,” Newgent says.
Another great thing about tofu? It’s super versatile.
“It is somewhat chameleon-like, so it’ll take on the flavors of what you add to it,” she says. “So don’t be shy with seasonings.”
Before cooking, spend some time pressing the excess water from the tofu. You can do this by putting the tofu between layers of paper towels, and putting a small weight—like a can of beans—on top. The paper towels will absorb the excess liquid in about 30 minutes.
“This will help it to brown upon cooking,” Newgent says.
Alternatively, if you use tofu often, you’ll likely want to get a tofu press. The device makes pressing tofu a cinch, and does it more quickly.
If you’re aiming for a bit of a crunch to your tofu, try lightly tossing cubes of it with cornstarch before cooking.
Recipes to try
Newgent suggests starting your tofu journey with two recipes out of her own cookbook:
Peanutty Sprouted Tofu “Stir-Fry” Sheet Pan Dinner
This healthier version of a stir-fry is a one-and-done meal, involving just a single sheet pan.
Ingredients include creamy peanut butter, tamari sauce, ginger, garlic, broccoli, red peppers, sesame oil, and super-firm tofu.
Vegan Hollandaise Sauce
If you like eggs Benedict but want to avoid animal products altogether, this vegan alternative—which uses silken tofu—will have you falling in love with the traditional breakfast dish all over again.
Grilled Tofu Steaks With Spicy Strawberry-Ginger Glaze
Swap out a steak for extra-firm tofu with this sweet-meets-savory dish, perfect for summer. This recipe will teach you how to grill tofu like a pro.
Next, learn the best vegan protein sources for plant-based eaters.
What is papular urticaria?
Nobody likes bug bites, but people with papular urticaria have an especially good reason to hate them.
Papular urticaria is a hypersensitivity to bug bites. The condition causes a bump or red welts on the skin in reaction to an insect bite or sting.
In people with papular urticaria, these bites cause long-lasting, red, raised, itchy bumps to develop on the skin. It can also cause small blisters (called vesicles) to form on the skin, sometimes in clusters.
This condition is common and mainly impacts children, though anyone can develop it at any age.
A 2017 study published in the World Allergy Organization Journal suggests these severe bug bite reactions may affect around 20 percent of children aged one to six. Because much of the research is conducted in children, the prevalence in adults is unclear.
Here’s what you need to know about papular urticaria, including how to identify and treat it.
Symptoms of papular urticaria
People with papular urticaria develop raised, red, hard bumps (called papules) after being bitten by a bug. Typically, each papule has a small tip or raised point.
Papular urticaria can also cause blisters that contain fluid, which might be clear, yellowish, or dark-colored.
Papules and blisters caused by papular urticaria also tend to:
- Appear in clusters
- Range from 0.2 to 2 centimeters in width
- Appear every couple of days during months that bugs are most active and people are outdoors the most (summer and autumn)
- Occur on places with exposed skin, such as the face, neck, forearms, legs, or just above socks or below shorts
- Redevelop when old sores start to heal
- Appear sometimes in tiny clusters or groups over the whole body
- Leave dark spots on the skin after healing
- May impact only one person in a household or family
- Have the potential to open and leak fluid
- Scab as they heal sometimes
In very young children, symptoms may develop very quickly after the child is bitten.
With age, the reaction often takes longer to develop, or becomes delayed. In these cases, it can be nearly impossible to tell where the initial bite occurred and when.
(These are the bug bite symptoms you shouldn’t ignore.)
What causes papular urticaria?
When an insect bites and breaks the skin, it introduces foreign protein into the skin, explains Walter M. Ryan III, DO, an osteopathic doctor and allergist with the Florida Center for Allergy & Asthma Care in Boca Raton and Coral Springs.
Our immune cells do not recognize these foreign proteins, which spark an inflammatory process known as an allergic reaction. The body’s goal: to destroy and remove the unknown proteins.
This inflammatory process is usually triggered by the release of a chemical called histamine from specialized immune cells known as mast cells.
“When histamine is released after insect bites, it makes our skin turn red, activates itch sensation, and often leaves elevated bumps called papules,” says Danilo Del Campo, MD, a dermatologist with the Chicago Skin Clinic.
Most people develop some minor, temporary itchiness, redness, and a bit of swelling from bug bites.
But in people with papular urticaria, regular bug bites cause an exaggerated immune response and symptoms that are more severe and long-lasting.
Researchers believe that papular urticaria is a hypersensitivity, or increased sensitivity, an allergic reaction to bug bites, says Dr. Del Campo.
(These are the bug bites that need medical attention now.)
How long does a reaction/symptoms last?
The bumps and blisters associated with papular urticaria tend to last for days to weeks. In some cases, they may even stick around for several months.
Someone may also continue to develop new clusters or crops of bumps and blisters for months—even years—after the reaction first started.
Thankfully, the reaction tends to lessen over time.
As children grow older, their immune systems gradually become less sensitive to bug bites. So over time, the average child with papular urticaria will react less severely to bug bites, and the reaction will take longer to develop.
While adults can develop papular urticaria, most people become less sensitive to bug bites by age seven.
How is this different from hives?
Hives, or urticaria, are round, red, raised, solid bumps that are very itchy. Press on hives, and they’ll blanch (turn white in the center).
Despite its name, papular urticaria does not cause real hives. “Papular urticaria is not actual urticaria,” says Dr. Ryan.
True hives cause welts or bumps that last for less than 24 hours. Papules and blisters associated with papular urticaria last a matter of days or weeks.
Can all bugs cause papular urticaria reactions?
All biting insects can cause a papular urticaria reaction, but flea and mite bites are the most common triggers.
Other bugs that are known to cause papular urticaria reactions include:
- Black flies
- Horseflies and deerflies
- Sandflies and fleas
- Bed bugs
- Bird mites
- Carpet beetles
How is papular urticaria diagnosed?
A doctor will diagnose someone with papular urticaria by examining their skin and areas with symptoms.
They will also ask questions about:
- Exposure to bug bites
- History of exposure to bugs or bug bites
- Living environment
- Time and locations spent outdoors
- History of other skin conditions or allergic reactions
A doctor may also take a biopsy—a small sample of affected skin—to examine under a microscope to confirm the diagnosis. Most bug bites create specific microscopic patterns.
Experts say that despite how common it is, papular urticaria can be difficult to diagnose and often goes overlooked.
That’s why it is important to seek care from a skin specialist like a board-certified dermatologist.
“Any MD can diagnose this condition, but board-certified dermatologists are most familiar in diagnosing and treating this condition,” says Dr. Del Campo.
He suggests that people use the American Academy of Dermatology’s Find a Dermatologist tool to location a board-certified doctor nearby.
Treating papular urticaria
Treatment options for papular urticaria tend to focus on reducing the size and itchiness of bumps to relieve symptoms and make someone less likely to scratch and worsen the reaction.
Products or medications may also help prevent infection or keep the skin from drying out and becoming itchier.
“In general, avoiding scratching at the bumps, getting relief from itching, and avoiding further insect bites are the key factors in management,” says Dr. Del Campo. “Dermatologists often prescribe a topical medication to assist in relieving symptoms since chronic itching can lead to skin infections, broken-down skin, and impaired sleep due to itching.”
The best treatment, or combination of treatments, depends largely on how severe someone’s symptoms are. But some common treatment options for papular urticaria include:
These creams or ointments contain compounds, such as hydrocortisone, that reduce inflammation. They may also make symptoms go away quicker.
Apply topical steroids to affected areas of skin as soon as symptoms develop. You can get them in over-the-counter strengths, or by prescription.
These medications prevent the release of histamine when taken daily. They’re often taken to reduce existing symptoms or as a preventative measure during times of the year symptoms tend to occur.
Most antihistamines are available over the counter, though stronger prescription versions exist.
These creams contain compounds that kill microorganisms such as bacteria and fungi that can cause infection.
Microorganisms can enter the skin through tears or cuts or when someone scratches their skin with their fingernails.
Antiseptic creams are readily available over the counter but can come in prescription strength.
Unscented, gentle moisturizers
Applying moisturizing creams, gels, or ointments to impacted areas of the skin a few times daily, especially after bathing, can help reduce dryness and itchiness.
Moisturizers are available over the counter or in prescription strength.
Topical anti-itch or pain-relieving creams
Certain creams, gels, ointments, or other formulas contain compounds that prevent itchiness by temporarily cooling or numbing the skin. One such soothing treatment is calamine lotion.
Dr. Ryan suggests using anti-itch products with menthol, camphor, or pramoxine.
Some pain-relieving products may also create a sensation such as warmth, cooling, or slight burning to distract someone from itchiness.
Most of these products are available over the counter. Do not apply anti-itch or pain-relieving creams to broken skin or open sores.
Bumps and blisters caused by papular urticaria can leave behind dark spots on the skin once they heal.
Keeping these areas covered with sunscreen whenever they are in the sun will help these dark spots heal and fade quicker.
Make sure to use unscented sunscreen; those with heavy scents can attract bugs.
(Here are more ways to treat common types of bug bites and stings.)
Experts claim there is really only one way to prevent papular urticaria: prevent bug bites.
This may be easier said than done, especially for those who love the outdoors. But there are plenty of ways to reduce the likelihood of getting a bug bite.
Before going outside
Remember to wear long-sleeved shirts, socks, and full-length pants in areas where bugs are very active. Tuck your pant legs into socks and closed-toed shoes or boots.
Avoid spending time outdoors during times of the day when bugs are especially active, such as dawn and dust. If you do go outside during peak times, wear protective equipment, such as a hat with mosquito netting.
Lastly, be sure to avoid areas with standing water, such as marshes, ponds, and other wetland environments.
While outside and afterward
Stay on cleared paths or trails when hiking or going for a walk. Avoid going around places bugs are most active or looking to attach to clothing or skin, such as around trees, flowers, shrubs, bushes, wood or leaf piles, or tall grass.
Be sure to avoid going in the deep woods in the warmer months of the year.
When outside, try not to brush up against plants.
If bugs come near or swarm around you, remain calm. Walk away from them to prevent scaring them and increasing the risk they will bite or sting.
Keep an eye out for—and avoid—bug nests, mounds, or hives.
Lastly, make sure you check clothes, footwear, and equipment for bugs before bringing them into the house.
Check the whole body for bug or bug bites after being outdoors. In particular, look in places like the backs of your knees, around your waist, in your hair, in your armpits, and between your legs.
Other tips for preventing bug bites
At home, regularly check bedding, carpets, and other fabric surfaces or wood furniture for bugs or signs of bugs, like biting or chewing marks, burrowing holes, or feces and dead skins/shells.
Treat household pets for fleas and mites using solutions applied to the animal’s skin, sprayed on its fur, or in the form of a collar. Treat household pets for ticks and other parasites if they go outdoors.
For pets with bug infestations, be sure to seek veterinary care.
If you’re treating minor bug infestations, use household insecticides. Be sure to get an exterminator service to handle more severe infestations.
When at home, use screens on windows and doors, and keep household doors and windows shut if they are not screened. Watch for signs of biting insects like bed bugs to catch potential infestations as soon as possible.
Also, try to avoid eating and drinking outside in areas where bugs are common. Food can attract bugs to you even more.
Following the above tips and tricks can help you lessen your chances of getting bug bites.
Next, learn about the “harmless” bugs you didn’t know could bite you.
What is dermatographic urticaria?
Scratch your skin hard enough, and you’ll notice red, raised, itchy, and swollen marks. That’s a normal reaction.
But if you have dermatographic urticaria, a condition referred to as skin writing, you won’t have to scratch so hard to get a reaction. Even moderate pressure or irritation can trigger an exaggerated response.
Allergy-like symptoms, such as minor, temporary skin flares or swelling can develop and last more than just a few minutes.
In some cases, people with the condition can break out in hives, round, raised, itchy, red, or skin-colored bumps that blanch, or become white in the middle when pressed.
In some cases, this response is no more than bothersome and uncomfortable. But in rare cases, it can be severe enough to interfere with daily life.
Here’s everything you need to know about dermatographic urticaria, including causes, symptoms, treatment options, and prevention tips.
Why is it called skin writing?
Dermatographic urticaria answers to a few different names: dermatographia, dermatographism, dermographism, and, of course, skin writing.
The term “dermatographism” literally means “to write on the skin.” The condition gets its nickname from the lines or patches of hives that develop on the skin when it is scratched, rubbed, stroked, or when pressure is put on it.
“Dermatographism means skin writing because you could actually take your fingernails and write on someone’s skin,” says Joseph Jorrizzo, MD, and professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
What causes skin writing?
Dermatographism is caused by an abnormal or excessive release of histamine, a chemical released by immune cells that triggers allergic reactions, including hives.
When specialized immune cells called mast cells detect allergens, they release histamine into the body. They may also release it if they detect a lot of pressure.
Histamine causes blood vessels to widen, or dilate, and causes small blood vessels to leak fluid into the skin, causing edema, or swelling.
Simple dermatographism is not itself considered to be an allergy, says Dr. Jorizzo. It’s just an exaggerated reaction. The mast cells release histamine when there are no allergens present.
Symptomatic dermatographism, on the other hand, leads to actual allergic responses, such as hives.
“Symptomatic dermatographism is a true, physical allergy mediated by an immune response,” he explains. “In cases of simple dermatographism, it seems mast cells are simply more sensitive to pressure than normal.”
How common is dermatographic urticaria?
About 25 to 50 percent of people develop a minor red streak or skin flare and swelling when the skin is strongly pressed, stroked, scratched, or rubbed, according to DermNet NZ, a dermatological site supported by the New Zealand Dermatological Society.
In these cases, symptoms typically go away pretty quickly, often within minutes.
When the response to skin pressure or irritation is exaggerated (and prolonged) enough, it’s considered dermatographism.
“In around 7 percent of people, if you apply a standard pressure to the skin of their back, [they] develop an exaggerated wheal (raised, itchy patch of skin) and flare reaction,” says Dr. Jorizzo.
An even smaller portion of people experience symptomatic dermatographism.
Dermatographic urticaria does not seem to have any association with race or ethnicity. Some research suggests that having a family history of the condition increases the risk of developing it. And it appears to be more common in women than men.
Symptoms of dermatographic urticaria
Most people with simple dermatographism develop a line of raised, itchy, red, or flesh-colored skin where the skin has been moderately to firmly rubbed, pressed, scratched, or stroked.
Symptoms tend to develop within one to seven minutes after skin contact, and they reduce or resolve within 30 minutes to an hour.
The symptoms usually correspond to the shape or direction of the skin contact that caused them. For example, scratching the skin may cause vertical lines or streaks, while direct pressure may create a broader, more widespread pattern of impacted skin.
Someone can develop skin writing at any age, though symptoms most commonly begin during young adulthood.
Typically, this condition impacts regions of the skin, though it can impact mucous membranes, such as those that line the mouth and genitals.
In most cases, symptoms of dermatographic urticaria are bothersome and unpleasant but not overly severe or long-lived.
Symptoms of symptomatic dermatographism
People with symptomatic dermatographism develop round hives or lines of round hives and swelling even from very minor, gentle, or light contact.
Symptoms tend to be more severe than with simple dermatographism. They can cause extreme itchiness and burning or prickling sensations. They also tend to last for a few hours or more.
These symptoms also seem to worsen with heat and flare up at night, potentially from the pressure of and contact with bedding.
They may also seem worse at night because the mind is less distracted, giving a person the opportunity to focus more on itchiness, says Anisha B. Patel, MD, associate professor of dermatology at the University of Texas’s McGovern Medical School in Houston.
How serious is dermatographic urticaria?
In most cases, skin writing is not a serious condition. But people with symptomatic dermatographism may experience painful, stressful symptoms and a reduction in quality of life or the ability to do daily activities.
Typically, there are no complications associated with dermatographism.
However, if you’re taking sedating antihistamines or antianxiety or antidepressant medications, you need to practice caution and make sure you’re not drowsy before driving or operating dangerous machinery.
Open sores caused by dermatographism can also become infected by bacteria or fungus. Left untreated, skin infections can become severe and spread throughout the body.
In rare cases, an extreme, abnormal immune response called sepsis may develop in response to infection. Sepsis causes the immune system to destroy healthy bodily tissues, and it can be fatal.
How is dermatographic urticaria diagnosed?
A dermatologist, a doctor that specializes in the skin, will diagnose dermatographism by stroking the skin and waiting to see if symptoms develop.
“We often take a tool like a tongue depression and with some pressure run it down the skin in a line,” says Dr. Patel. “Within around five minutes or so, if they have dermatographic urticaria, that line where the tongue depressor was applied will become red and raised like a line of hives.”
Skin writing can also be assessed using a dermographometer, a mechanical device that applies varying types of pressure to the skin to see if it causes an excessive reaction.
If you’re being tested for dermatographic urticaria, you’ll want to ease off medications that reduce immune function such as antihistamines; they can lead to false-negative test results.
To get the most accurate diagnosis, avoid antihistamines and other allergy medications for a few days before your appointment.
Talk to a doctor about how to proceed if you’re taking prescription medications that impact the immune system.
How is dermatographic urticaria treated?
The most effective way to treat dermatographism is using antihistamine medications.
Dr. Patel says antihistamines are the main treatment for dermatographic urticaria because symptoms seem to occur due to the overactivity of histamine in the skin.
“Most antihistamines I recommend are over the counter now,” she says. “I often get people to combine different over-the-counter drugs with different mechanisms, such as Benadryl, Zrytec, or Claritin, and Allegra.”
Dr. Patel says someone may need to take high doses of these antihistamines to control their symptoms. But often after a month or so, many people can begin to gradually reduce their dosage.
“The most important thing is to balance side effects of drowsiness from medication with efficacy,” she says. Take a med that makes you sleepy and you could get hurt (or hurt others), depending on the activities you do.
For this reason, nondrowsy antihistamines are usually recommended over sedating antihistamines.
Dr. Jorizzo says he wouldn’t suggest using medications with “D” in the name (think Claritin-D). They typically contain medication that constricts dilated blood vessels in your nose, which isn’t necessary and causes sedation.
If someone does need to take sedating antihistamines, Dr. Patel says it’s best to take them before bedtime or in the evening.
Other treatment options for dermatographism that may help manage symptoms include:
- Anti-anxiety medications
- Antidepressant medications
- Psychological therapy
- Cromolyn, a medication that helps stabilize the skin’s cellular membrane and reduce the release of histamine
Other treatment options still being investigated
Research trials are underway to see test if the medication omalizumab may help treat dermatographic urticaria.
There is also some evidence that light therapy may help treat dermatographism, though most people seem to experience symptoms again two to three months after stopping treatment.
Getting 1,000 milligrams of vitamin C daily may also help reduce symptoms of skin writing by increasing the breakdown and removal of histamine from the body.
Lifestyle tips for living with dermatographic urticaria
By far the most effective way to manage skin writing is to avoid triggers that cause symptoms, especially those that tend to cause the release of histamine.
Not everyone experiences the same set of triggers. But some known causes of dermatographism and hives include:
- Very hot water or steam
- Vigorous or excessive towel rubbing
- Stressful life events or excessive stress or anxiety
- Very cold or warm environments
- Friction from sweating and exercising
- Clothing, undergarments, jewelry, sports equipment, or supportive devices that rub or cause friction
- Antibiotics, especially penicillin
Other lifestyle tips for living with dermatographic urticaria include:
- Wear loose-fitting, comfortable clothes throughout the day and night. Choose breathable fabrics like cotton.
- Wear moisture-wicking clothing.
- Avoid prolonged cold or warm showers, baths, etc.
- Wear fitted clothing while exercising or being physically active to avoid rubbing.
- Use loose, soft, breathable cotton, silk, or satin bedding, which is less likely to cause irritation.
- Reduce itching and dryness with moisturizer.
- Use over-the-counter creams or ointments that prevent itching or numb the skin for 30 to 45 minutes, and apply them as soon as itching develops to prevent scratching and worsening symptoms.
Living with dermatographic urticaria
Many people experience dermatographism flares of symptoms for months to years after they first develop.
On average, idiopathic (of an unknown cause) symptomatic dermatographism can last for six years. But in some cases, dermatographism symptoms may start to reduce within six months after they first developed.
When dermatographism is directly related to a specific trigger, such as a skin disease or specific allergen, symptoms may only last for a few days to weeks.
In many cases, dermatographic urticaria resolves on its own without treatment. But early, effective treatment may reduce the risk of experiencing severe, long-lasting symptoms and complications.
The rising popularity of avocado oil mayonnaise
Some people baked sourdough and turned browning bananas into banana bread during the Covid-19 pandemic. Others, it seems, broadened their home cooking with a little mayo.
Mayonnaise sales increased as more consumers made meals at home during the pandemic, according to a 2021 report from market research firm IBIS World.
If you’re a fan of this creamy concoction, you’re probably aware that mayo is traditionally made with oil, eggs, vinegar, and lemon.
Soybean oil is the usual choice, but now there’s a new kid on the block. Mayonnaise made with avocado oil is sprouting up at numerous markets and online grocers.
The driver: America’s avocado obsession.
Avocados are a hot commodity in the United States. The demand for the decadent but healthful “butter fruit” has climbed steadily, with a triple increase in per capita consumption since 2001, according to the U.S. Department of Agriculture.
One thing to keep in mind if you follow a vegan or plant-based diet—most avocado mayo contains eggs (more on that in a bit). If that’s important to you, check the label to look for products made without animal-based ingredients.
Here’s everything you need to know about avocado oil mayo, its health benefits, how to shop for it, and my favorite brands to buy.
Avocado oil mayo vs. regular mayo
If you’re wondering whether avocado oil mayo is healthier than regular mayo, it’s complicated.
Currently, there isn’t research that compares the health outcomes of replacing polyunsaturated fat (in regular mayo) with monounsaturated fat (in avocado oil mayo). However, there is a multitude of research on the benefits of adding avocado oil to your diet.
From a strictly nutritional standpoint, here’s how avocado oil and typical mayo stack up:
Avocado oil mayo nutrition facts
Below are the nutrients and percent of recommended daily value (DV) for one tablespoon (15 grams) of Primal Kitchen’s avocado oil vegan mayo, which doesn’t contain eggs.
Total fat: 11 g (14 percent DV)
Sodium: 125 milligrams (5 percent DV)
Carbohydrates: 0 g (0 percent DV)
Sugars: 0 g (0 percent DV)
Protein: 0 g (0 percent DV)
Regular mayo nutrition facts
Below are the nutrients and percentages of DV for one tablespoon (13.8 g) of regular mayo salad dressing.
Total fat: 10 g (13 percent DV)
Sodium: 88 mg (4 percent DV)
Carbohydrates: 0.1 g (0 percent DV)
Sugars: 0 g (0 percent DV)
Protein: 0 g (0 percent DV)
Benefits of avocado oil
Avocados are remarkably good for you, as is the oil derived from the fruit.
Nearly 70 percent of the fat extracted from avocado comes from monounsaturated fatty acids, or MUFAs, with a lower ratio from polyunsaturated and saturated fatty acids, according to a 2019 study in the journal Molecules.
Monounsaturated fat was first discovered as beneficial during the 1960s, when researchers found that residents in Mediterranean countries experienced a low rate of heart disease despite consuming a high-fat diet.
They learned that the main fat consumed in the region was monounsaturated fat, which led to the understanding that not all fats are created equal.
For heart protection, the majority of the fat you consume daily—20 percent of your total calories—should come from monounsaturated fat, per the National Institutes of Health’s National Cholesterol Education Program.
MUFAs have also been shown in research to support blood sugar regulation and healthy weight management, including reductions in waist circumference, according to studies published in Diabetes Care and Diabetology & Metabolic Syndrome, respectively.
But before you run out (or log on) to buy a jar of avocado oil mayo, there a few things to keep in mind.
How to shop for avocado oil mayo
While avocado oil mayo can be heart healthy, it’s important to note that not all products are made the same way.
Your first stop when evaluating any product should be the ingredient list.
One popular brand’s ingredients include avocado oil, followed by canola and soybean oils, even though only avocado is in the product’s name.
To best benefit from the healthful MUFAs avocados provide, look for products made solely with avocado oil.
And keep in mind that not all avocado mayo is all natural. Avocados are associated with wholesomeness, but some brands use artificial preservatives in their formulation.
The only way to scope this out is to be a label sleuth. Look for brands made with simple, recognizable ingredients.
Finally, as we mentioned, if you follow a vegan or plant-based diet, be aware that most avocado mayo contains eggs, as this ingredient is part of the standard of identity for mayo.
According to the Food and Drug Administration, “standard of identity” is an agreed-upon legal definition for what a food actually is.
That said, there are vegan options for avocado mayo (see below) that contain no eggs or other animal-derived additives.
Healthy ways to use avocado mayo
Mayo can be used in a variety of ways, including as a spread, dip, dressing, or ingredient in dishes like potato salad and slaw.
You can even bake avocado oil mayo into goodies like moist cakes, cookies, and brownies.
To best take advantage of the health benefits of avocado oil mayo, pair it with whole, plant-based foods.
Instead of a traditional BLT (bacon, lettuce, and tomato), make an updated version using whole grain bread, roasted eggplant slices in place of bacon, and avocado oil mayo.
Incorporate avocado oil mayo into chilled protein salads made with white beans or chickpeas as stand-ins for animal protein.
A nutritionist’s top picks
The variety of avocado oil mayo on the market is impressive. In addition to vegan options, you’ll also find flavored varieties.
Tasty choices include jalapeno lime, rosemary garlic, wasabi, and harissa.
Here are four brands I recommend based on their overall quality and top-notch ingredients, including no additional oils.
Primal Kitchen Vegan Mayo
This 100 percent plant-based mayo’s first ingredient is avocado oil, blended simply with water, organic vinegar, salt, potato protein, and mustard oil.
Of the 11 grams of fat per tablespoon, 7 grams come from monounsaturated fat, with zero carbs and just 125 milligrams of sodium, 5 percent of the maximum daily limit.
Primal Kitchen also makes a few flavored vegan mayo versions, in addition to four non-vegan varieties, all made with avocado oil.
Chosen Foods Classic Avocado Oil Mayo
Chosen Foods makes eight versions of avocado oil mayo (with flavors including roasted garlic), including a vegan and an organic option.
Each is made with simple ingredients that celebrate avocado oil as the star.
The brand’s website also includes a blog with recipes that incorporate the mayo and other avocado-based products.
Sir Kensington’s Avocado Oil Mayonnaise
Upscale condiment brand Sir Kesington’s, known for its delectable ketchup and mustard, has added mayo to its lineup.
The avocado oil version is made with organic, certified-humane, free-range eggs and simple seasonings, including a hint of lime.
Better Body Foods Avocado Oil Mayo
Another traditional-style mayo, this product is made with avocado oil, egg yolks, vinegar, and seasonings.
Like the others, it’s carb free, but Better Body Foods is particularly low in sodium, with just 80 milligrams per tablespoon.
Tips for making your own avocado oil mayo
As you can see, one disadvantage of commercial avocado oil mayo can be its price.
Compared with $4 for a 30-ounce jar of traditional mayo, an avocado oil variety can run about $8 per 12-ounce jar. But you can save money by whipping up a batch of your own.
One of my favorite recipes calls for a simple blend of whole avocado, aquafaba (the liquid from canned chickpeas), vinegar, and seasonings.
Other recipes combine avocado oil with plant milk, lemon juice, ground mustard, and seasonings.
If you DIY it, make small batches to use immediately, and experiment with a variety of herbs, spices, and other flavorful add-ins.
Whether store-bought or homemade, avocado mayo is a delicious way to add color, flavor, texture, and nutrition to a variety of meals, snacks, and treats.
Scalp psoriasis vs. dandruff
Your scalp itches, and it’s driving you to distraction, to say nothing of the flakes that seem to fall like snow whenever you give in to the urge to scratch.
“Knowing what is causing the itching and flaking absolutely matters when it comes to effectively treating your symptoms,” says Adam Friedman, MD, professor and chair of dermatology at George Washington School of Medicine and Health Sciences in Washington, D.C.
Here’s everything you need to know when it comes to scalp psoriasis vs, dandruff, including symptoms, treatment options, and prevention tips.
What is scalp psoriasis?
Scalp psoriasis occurs when your body’s immune system goes into overdrive and revs up the production of skin cells.
Instead of shedding, these cells build up on your skin, forming raised, reddened plaques that itch and burn. These plaques may be covered with silvery scales that can flake off.
Psoriasis can strike any part of your body, including your scalp. More than half of people who live with psoriasis have plaques on their scalp, according to the National Psoriasis Foundation.
Scalp psoriasis symptoms
With scalp psoriasis, you may notice thick, crusted plaques that cover your scalp. It may extend beyond the hairline and onto the forehead, the back of the neck, and around your ears. (You can even have psoriasis on an eyelid.)
Psoriasis flakes are thicker than dandruff. “The flakes are broader and more adherent to the scalp,” Dr. Friedman says. They also tend to be powdery with a silvery sheen.
Scalp psoriasis runs the gamut from mild to severe and may cause hair loss.
“Scalp psoriasis can be more disabling than full-body psoriasis due to the visibility of your scalp, hair loss, and visible flaking that may occur,” Dr. Friedman says. With those symptoms, it can take a toll on your self-confidence and mental health.
By contrast, dandruff has many causes, including overly dry skin that flakes, irritated and oily skin, not shampooing frequently enough, and infection with a fungus that tends to feed off oil on the scalp (Malassezia).
It may also occur if you develop contact, or allergic, dermatitis from hair care products. (Here’s how to patch test skin products to see if you’re allergic.)
Dandruff may cause your scalp to itch, according to Dr. Friedman. “It affects areas with lots of oil glands, and the flaking is very fine,” he says.
These flakes are made up of dead skin and often look yellowish and greasy.
Keep in mind that if your head is very itchy and you don’t have obvious flakes that could be scalp psoriasis or dandruff, you could be dealing with another problem, such as head lice. Sometimes the lice nits or eggs can be mistaken for dandruff, but unlike dandruff, the white specks are attached to the hair shaft and can’t easily be brushed away.
Is it scalp psoriasis or dandruff?
You’ve spotted flaking. You’re definitely itchy. And you’re ready to know what you’re dealing with.
But how can you tell if it’s scalp psoriasis vs. dandruff?
You may not be able to determine this on your own. To be fair, even the pros have a hard time telling the difference, Dr. Friedman says.
Your dermatologist may examine the rest of your body to see if there is evidence of psoriasis anywhere else to make the call, he explains.
“I will also look at fingernails to see if there is any pitting or separation of the plate from the nail bed,” he says.
How to treat scalp psoriasis
Scalp psoriasis is one scalp condition you should never ignore.
Compared to people with psoriasis who don’t have scalp symptoms, people who have scalp psoriasis tend to be at higher risk of psoriatic arthritis, which is marked by joint pain and inflammation.
So if you think you have scalp psoriasis, it’s a good idea to see a healthcare provider—psoriasis can affect many parts of the body.
“This is one of the reasons that it is so important to recognize scalp psoriasis and treat it aggressively,” says Dr. Friedman.
You can treat scalp psoriasis with some of the same shampoo ingredients used for dandruff.
Prescription and OTC shampoos
There is a host of prescription and over-the-counter (OTC) shampoos to treat scalp psoriasis.
Using a tar, zinc, or salicylic acid-based shampoo can help slow skin growth and reduce inflammation, itching, and scaling, Dr. Friedman says.
Treating the scalp with a topical steroid is not always easy since your hair can get in the way.
“Finding a vehicle, such as a solution or an ointment, that plays nicely on your scalp can be difficult,” Dr. Friedman says. “You want a topical for your scalp that is cosmetically appropriate and won’t cause more problems.”
He suggests telling your doctor what you would prefer, whether that’s a mousse, an alcohol-based solution, or an ointment.
Light therapy, which uses ultraviolet B (UVB) light to slow skin cell growth, may also help treat scalp psoriasis. You’ll generally use this under the supervision of a doctor to ensure safety.
When other treatments don’t work, you may need to try systemic medications.
“I may step it up and give systemic therapy because of how disabling the scalp psoriasis is and because it’s a sign that this patient is at higher risk for psoriatic arthritis and other comorbidities that travel with psoriasis,” Dr. Friedman says
Systemic drugs such as biologics block certain proteins involved in the inflammation process. Cosentyx, a biologic drug that blocks interleukin-17A inhibitor, is approved to treat scalp psoriasis.
“The hope is that by treating the underlying inflammation, we will reduce the chances of psoriatic arthritis and other diseases that may occur with psoriasis, including heart disease and diabetes,” he says.
How to treat dandruff
Treating dandruff typically involves using a special shampoo and/or scalp treatment.
Some dandruff shampoos are available over the counter, and they’re a good place to start. Use one for a few weeks to see if you notice an improvement.
If an OTC shampoo doesn’t do the trick, see your dermatologist about stepping up your therapy with a prescription shampoo or a steroid lotion, Dr. Friedman says.
There are a lot of dandruff shampoos to choose from. They mostly differ based on their active ingredients.
Pyrithione zinc shampoos
These contain the antibacterial and antifungal agent zinc pyrithione.
These dandruff shampoos contain coal tar, which slows skin cell growth and reduces inflammation, itching, and scaling.
Salicylic acid-based shampoos
These can help eliminate dead skin cells from your scalp.
Selenium sulfide shampoos
These shampoos contain antifungal agents.
These kill the dandruff-causing fungi that live on your scalp.
There are also natural treatments for dandruff, which may help. These include tea tree and lemongrass oils.
In a study published in 2015 in Complementary Medicine Research, researchers found that people who use a lemongrass oil hair tonic twice a day for a week saw an improvement in dandruff.
What’s more, their dandruff continued to improve as time went on.
Lifestyle tips to avoid scalp psoriasis and dandruff
Preventing scalp psoriasis
Taking steps to minimize or prevent psoriasis flares can help keep scalp psoriasis at bay. This involves avoiding triggers, such as stress or illness, when and where you can.
Don’t pick at the scales, cautions Gary Goldenberg, MD, an assistant clinical professor of dermatology at Icahn School of Medicine at Mount Sinai in New York City.
“For every one flake you pick, a hundred will come back,” he says.
Some foods, such as white flour, white sugar, and dairy. are pro-inflammatory and may exacerbate scalp psoriasis, says Dr. Goldenberg.
To lower your risk of scalp psoriasis flares, eat a healthy, anti-inflammatory diet that is rich in fruits, vegetables, and seeds.
If your scalp is oily, shampooing every day may help prevent dandruff. Always shampoo gently and make sure you’re washing your hair properly.
There are other causes of dandruff, such as stress and diet. Finding a healthy way to cope with stress—like meditation, yoga, or even just taking a walk—makes most things better, including dandruff symptoms.
Full-fat dairy foods, including cheese and cream, may lead to dandruff in some people. But foods rich in zinc, such as oysters, red meat, poultry, legumes, nuts, and seafood, may help control oil production and limit dandruff.
Next, learn about proven treatments for psoriasis.
Kyphosis vs. lordosis
A quick look at your back will tell you that your spine curves, at least a little bit.
Normally, your spine will curve inward in the neck (cervical) and low-back (lumbar) regions, a curvature called lordosis. The outward curvature of your spine, specifically in the upper and mid-back (thoracic region), is called kyphosis.
Both of those curves are totally normal.
“It is only when these curves are excessive that we have a problem,” says Joseph Davey, MD, chief of pediatric orthopedics at the University of Oklahoma in Oklahoma City.
Abnormal spinal curves may make you automatically think of scoliosis. And, indeed, that type of curvature does deviate from the norm. But unlike kyphosis and lordosis, scoliosis is an abnormal sideways curve of the spine.
Excessive lordosis, however, may make your back extra flat or cause your butt and belly to stick out, while excessive kyphosis can lead to rounded shoulders.
Here’s how to spot the curves of kyphosis and lordosis and what to do to treat the spinal conditions.
Can you have both lordosis and kyphosis?
Lordosis and kyphosis can occur together—and that’s a good thing.
“We should always have both,” says Dr. Davey.
A certain amount of curvature in the lumbar and thoracic spine is essential to preserve the balance between internal and external forces. It’s how we keep our head and trunk over our pelvis and maintain internal forces created by muscles.
Essentially, lordosis, kyphosis, and our pelvic tilt work together to keep us upright.
“If the spine was just straight [looking from the side], it would be leaning forward,” says Dr. Davey. “The most normal, balanced position is to have our center of gravity over our pelvis.”
When these two curves are out of balance, typically when you have excess upper spine kyphosis or reduced lower lordosis, you can experience pain.
What is lordosis?
Lordosis is an inward curve of the lower spine and normally nothing to worry about—it’s natural to have some degree of curvature specific to how our body is structured.
Normal lordosis helps our body absorb weight and impact as we go about our day, whether we’re walking, getting out of a chair, or pounding the pavement during a run.
A certain amount is essential so we can stand up straight and have good posture.
As we get older, the curves can worsen. Some people may develop bad posture or spinal deformity, have pain, or experience difficulty walking.
When the lower spine becomes too curved, it’s called hyperlordosis, or swayback. When the lower spine is too straight, it’s called hyperlordosis, or flatback.
What causes swayback?
Hyperlordosis can develop at any age, but it tends to happen in adolescence. It’s often linked with one of the following:
Poor posture: Weak abdominal muscles struggle to support the lumbar spine.
Being overweight: Extra belly fat puts strain on the lower back and pulls it forward.
Trauma: Accidents or sports injuries can cause stress fractures that, if left untreated, may lead to spondylolysis. With this condition, the vertebrae slip out of alignment with the rest of the spine.
Achondroplasia: A common type of dwarfism.
Neuromuscular conditions: Certain conditions weaken nerve and muscle function, such as muscular dystrophy and cerebral palsy.
Congenital problems: These can affect the vertebrae
Arthritis: This may result in flatback syndrome.
- Osteoporosis: The bone disease osteoporosis causes weak, thinning bones and may lead to lordosis.
Signs and symptoms of lordosis
Here’s some good news: “Lordosis rarely causes any problems,” says Dr. Davey.
It’s more common to have pain if the spine is out of balance from excess upper-spine kyphosis or reduced lower lordosis.
“People with a flat back due to arthritis or other causes tend to lean forward and have pain,” he adds.
In more severe and untreated curvatures, lordosis might cause the following symptoms:
Pain in the lower back
Difficulty moving about while doing daily activities
More prominent buttocks and tummy
A large gap between the floor and the lower back while lying on a hard surface
Back pain when standing in one place for prolonged periods
Fatigue and neck discomfort
How is swayback diagnosed?
There’s a relatively wide range of normal lordosis in the lower back. That makes diagnosing it a bit tricky—what’s normal for one person may not be normal for another.
Your doctor may do a physical examination to gauge the extent of your curvature. If your back isn’t very flexible or there is pain, you may need X-rays to determine the cause of your issues.
And if you feel tingling, numbness, muscle spasms, pain, or weakness in your arms or legs, or experience changes in your bladder or bowels, your physician may recommend a neurological assessment.
Does swayback need to be treated?
In most cases, swayback is more of a cosmetic concern than a functional alignment problem.
Provided your back is still flexible (that is, you can still bend forward without issue), you probably won’t need treatment.
Still, your doctor may elect to keep an eye on the curve at routine checkups.
If you have pain, limited flexibility, or other symptoms, you may require one of these treatments:
Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain
Physical therapy to improve range of motion and build strength and flexibility
Exercises to instill better posture and strengthen the core and back muscles
Weight loss in the belly area to improve posture and decrease the curvature
What is kyphosis?
Kyphosis is a forward bending of the spine, which leads to a round back (a hump, or hunchback).
The average spine will curve outward in the upper mid-back region, so how do you know whether your curvature is normal or not? It can be hard to tell.
The range of normal kyphosis is fairly broad, falling between 10 and 40 degrees.
“Mild excess kyphosis is not usually a big problem,” says Dr. Davey. “If it continues to worsen or leads to back pain, we are more concerned. If kyphosis reaches 80 degrees, surgery may be needed.”
Types of kyphosis
Kyphosis can occur as a deformity in the womb, but it is most often seen in growing children. That said, it can still occur in adults.
The four primary types of kyphosis are postural kyphosis, congenital kyphosis, Scheuermann’s kyphosis, and age-associated kyphosis.
The most common form of kyphosis has to do with posture.
Slouching, carrying a heavy backpack, or otherwise practicing poor posture can stretch the muscles and ligaments that hold the vertebrae in place. Out-of-whack vertebrae can create a rounded shape in the spine.
The curve in this kyphosis is flexible, which means it can be minimized with good posture and exercises.
Congenital kyphosis occurs in the first six to eight weeks of fetal development, resulting in a malformation in the shape of one or more vertebrae.
It can cause the spine to develop a sharp forward angulation as it grows. This curve is visible when looking at the back.
The curve may become larger and more noticeable within the first year of life and can worsen as a child grows. Frequent medical observation is necessary since surgery is sometimes a necessary solution.
Scheuermann’s kyphosis, also known as developmental kyphosis, emerges when the bones of the spine in the middle of the back curve outward more than they should.
The curve in this type is rigid, so changing position and adjusting your posture, doesn’t make the hump disappear.
It happens to about 3 percent of kids ages 10 to 15 and is much more common in boys.
This type of kyphosis usually doesn’t cause too much concern because most kids outgrow it when their bones are done growing.
Age-associated kyphosis is directly associated with the natural aging process.
Our spines age with us, so as we get older we may develop conditions that lead to kyphosis.
“The kyphosis in aging adults can be from either disc degeneration, arthritis, or even compression fractures from osteoporosis,” says Tenner Guillaume, MD, a pediatric spine surgeon and chief of staff at Gillette Children’s Specialty Healthcare in Saint Paul, Minnesota.
Over time, fractures and osteoporosis weaken the vertebrae, causing them to narrow and shrink.
“This is often why older folks get shorter and more hunched with age,” says Dr. Davey.
Age-associated kyphosis can prompt more aches and pains and make mobility difficult, raising the risk of falls and fractures.
Kyphosis causes and risk factors
While some types of kyphosis develop in the womb, others result from acquired conditions such as:
Aging spine (disc degeneration, arthritis)
Signs and symptoms of kyphosis
Depending on your degree of kyphosis, you might not have any aches, pains, or difficulty moving your back.
But excessive kyphosis puts added stress on the muscles and joints of the spine and often results in pain.
Depending on your type of kyphosis or the conditions associated with your kyphosis, you may have additional symptoms beyond pain.
Here are the most common signs and symptoms of kyphosis:
One shoulder blade higher than or protruding more than the other
Head noticeably bent forward from the rest of the body
When bending forward, the upper back appears higher than normal
Hip problems (tight hip flexors)
Mild pain or stiffness in the back and shoulder blades.
When the kyphosis is due to an accident or injury, severe pain in the back and shoulder blades, with additional symptoms related to the injury
Difficulty walking, pain in the legs, and difficulty controlling the bladder (with congenital kyphosis)
How is kyphosis diagnosed?
When it comes to children, it’s always best to get an early diagnosis. There are more nonoperative treatment options available while the bones are still growing.
Sometimes a parent will notice a roundness of the upper back, pointing it out to their child’s doctor. Other times, a doctor might spot the hump during a checkup.
The standard protocol for diagnosing kyphosis in adults and children begins with a medical history, physical examination of the spine, and an X-ray of the spine.
If the curvature is severe, a doctor may order an MRI to see if the curves affect the lungs or spinal cord.
Older adults may need additional tests to see if the kyphosis is related to other existing conditions, such as degenerative disc disease or osteoporosis.
How is kyphosis treated?
If treatment is necessary, your doctor will consider your age, medical history, type of kyphosis, and the size of the curve before creating a plan to care for your kyphosis.
In children, the goal is to stabilize or stop the curve from getting worse. If the curvature needs treatment, the options include:
Often, you might not need treatment right now. In that case, your doctor will continue to observe the curvature via regular checkups. Children may get X-rays of the spine to monitor the curve’s progress during the growing phase.
Nonsurgical methods are highly successful in treating kyphosis. Physical therapy is the go-to method of treatment.
Exercises can help improve posture and strengthen the core and back muscles. Specific exercises can stretch tight hamstring muscles and soothe aches and pains.
(By the way, physical therapy is the mainstay treatment for scoliosis too)
If you experience pain related to your kyphosis, you may need to take NSAIDs as needed. These OTC meds are effective for relieving minor back pain.
Your doctor might suggest wearing a brace, but this type of therapy isn’t customary.
The exception is for children who have Scheuermann’s kyphosis.
“If [curvature is] over 55 degrees or painful, bracing may be an option and has been shown to be effective at altering natural history—but only in children with growth remaining,” says Walter Truong, MD, a pediatric orthopedic surgeon at Gillette Children’s Specialty Healthcare in Saint Paul, Minnesota, and assistant professor in the Department of Orthopaedic Surgery at the University of Minnesota.
Bracing isn’t effective, however, once a child is done growing.
Adults may get some pain relief from intermittent bracing and physical therapy, but the brace won’t correct the curvature in a person who has reached skeletal maturity.
The majority of kyphosis conditions are managed with nonoperative options such as physical therapy.
Surgery is reserved for people with severe back pain, spinal deformity, or decompression of nerve roots. In congenital kyphosis, surgery is performed before the curvature gets too large with a goal of effectively halting the growth of the curve.
Posterior spinal fusion surgery is the gold standard for flexible deformities. Fixed deformities often require more complex surgery.
Next, learn about the symptoms of scoliosis in kids and adults.
The case for a daily stretching routine
Whether you sit at a desk all day or stand and move around from nine to five, a daily stretching routine can help you feel good.
Maintaining a regular stretching routine can increase your range of motion, warm you up for more intense exercise, and even stave off aches and pains, says Chelsea Long, an exercise physiologist at the Hospital for Special Surgery in New York City.
Even if you’re perpetually crunched for time, you can squeeze in a few stretches that will benefit your entire body in just a few minutes.
Check out why you should stretch every day and which moves will help you get loose and feel calm.
What are the benefits of daily stretching?
A stretch a day keeps the doctor away. That might not be the exact adage, but it’s a good rule to live by.
Stretching can benefit both your physical and mental health.
Increases range of motion
This type of stretching, which involves holding a stretch for 30 seconds or more, can relieve tightness and help you move around better.
“Static stretching, when done consistently, increases flexibility and range of motion,” says Long. “Lots of bodily aches are due to a tightness of some variety that creates an issue somewhere else.”
Adefemi A. Betiku, a physical therapist, certified strength and conditioning specialist, and certified Pilates teacher, says static stretching is particularly good for relieving tense, tight areas. But he suggests doing a mix of both static and dynamic stretching for your daily routine to gain the most advantages from activity and holds.
Tightness and lack of range of motion in your joints can force you to compensate for that limited mobility, leading to stress and overuse of a different muscle or side of the body, Long explains.
This can lead to either an acute or chronic injury. But a regular stretch session can help you sidestep those issues, as it supports better movement patterns.
Dynamic stretching, in which you move in and out of a stretch, only pausing for a few seconds, can also help increase body temperature, enhance blood flow, and get the body revved for more movement, Long says.
“When the body is stiff and immobile in our beds or chairs and we ask it to start running or lifting under a load, it’s not prepared,” she says. “And that puts it at risk of injury, like muscle strains, cramps, or spasms.”
That’s why you want to do dynamic stretching before a workout. You can also do dynamic stretching throughout the day simply to squeeze in more movement and help the body become healthier overall.
Calms the body and mind
Besides those physical payoffs, stretching can also be meditative. “It’s a time to decompress and relax the body,” Long says.
How to stretch safely
The goal of stretching is to start slowly, easing into each stretch without forcing any position.
“Keep in mind when stretching that you are gradually lengthening your muscles,” Long says. “Reaching full range of motion in any movement does not happen without preparing it, or you can injure and strain the muscle.”
Taking deep breaths will help you ease into poses. Long suggests thinking about it as preparing for the stretch on the inhale and going a little deeper on each exhale.
“Many of us forget that breathing has a voluntary component, and you can control it,” she says. “It’s helpful when exercising to control heart rate and pace, but it’s also helpful when stretching through tough movements and tight spots. It can make your stretching feel more productive, decrease your blood pressure, and give you a sense of calm.”
She warns that you may be sore after a dedicated stretching session because you’re forcing your muscles into an eccentric lengthening phase. You shouldn’t feel pain, but the typical soreness you might get from another type of workout is normal.
Finally, to see results, you need to keep your stretching consistent, Long says. That’s why it’s smart to get in a habit of doing daily stretches.
7 stretches to do every day
For a full routine you can do right out of bed in the morning—or anytime throughout the day—Betiku recommends seven simple stretches.
Repeat the list for about three rounds. If you finish this list and want more, Long suggests adding moves like shoulder rolls and knee hugs to the lineup.
Start by lying on your back with your knees bent and together. Keep your feet flat on the floor and together.
Drop both knees to one side, keeping your torso steady and shoulders flat on the floor.
Bring your knees through the center of your body to the other side.
Repeat for 10 to 20 reps on each side. Hold on one side for 30 seconds, then hold on the other side for 30 seconds.
Lie on your left side on the floor. Keep your knees and hips stacked and bent 90 degrees. Extend your arms straight out in front of you, keeping them stacked.
Open your top (right) arm, bringing it to the other side of the body and as close to the floor as you can without the left shoulder lifting or your hips rotating. Your knees and hips should remain stacked.
Bring your right arm back to the original position. Repeat for 20 reps. On the last rep, hold the stretch for 30 seconds.
Repeat on the other side.
Stand in the middle of a doorway and lift both arms to shoulder height. Move your arms out to your sides, so your upper arms and body form a T. Place your forearms on the door frame or wall.
Step forward with one foot. If the stretch feels too intense, bring the arms a little lower than a T position.
Hold the stretch here for 30 seconds.
Shoulders towel stretch
Grab a towel and hold it in one hand overhead so the towel drapes down your back.
Tuck your other arm behind your lower back to grab the other end of the towel.
Pull the top arm upward to increase the stretch in the lower arm. Hold for 30 seconds.
Pull the bottom arm downward to increase the stretch in the upper arm. Hold for 30 seconds.
Switch sides and repeat.
Standing or seated in a chair while maintaining a tall posture, shoulders squared, slide your head back as if giving yourself a double chin. Keep your forehead steady (don’t tilt it up or down).
Release to neutral. Repeat for 10 to 20 reps.
Lateral neck stretch
Standing or seated in a chair while maintaining a tall posture, shoulders squared, lower your left ear toward your left shoulder. Use your left arm on the right side of your head to gently press your ear closer to your shoulder. Be careful not to tug too hard on your head.
Hold for 30 seconds, then switch sides.
Diagonal neck stretch
Standing or seated in a chair while maintaining a tall posture, shoulders squared, look halfway between the center of your body and left shoulder.
Turn your head down as if you’re moving to smell your armpit. Use your left hand to gently pull your head down.
Hold for 30 seconds, then switch sides.
One in every 13 Americans has asthma, a respiratory condition that causes swelling in the airways. Asthma symptoms include wheezing, coughing, chest tightness, and shortness of breath. It can range from mild to severe and, in some cases, can be life threatening There is no cure for asthma, but treatments can help prevent and deal with asthma attacks when they do happen. There are six main types of asthma, including adult-onset asthma. It’s often thought of as a childhood disease, and it is more common in children, but about 20 million U.S. adults ages 18 and over have asthma, according to the Asthma and Allergy Foundation. One of these is Amy Horton, 41, a photographer and mother of three living in Dallas. Here, she shares the experience that led to her diagnosis of adult-onset and allergic asthma and what living with asthma is like for her.
Anaphylactic shock from a protein shake
A protein shake. That one small thing started the allergic reaction that led to a near-death experience and, eventually, an asthma diagnosis that has changed the course of my entire life. Talk about a ripple effect.
Seven years ago, I was getting my regular post-workout protein smoothie at the gym when I made a split-second decision to go out of my comfort zone and asked them to add bee pollen.
I’d heard it was good for energy and some chronic health conditions. I figured I’d give it a whirl.
Turns out I’m allergic to bees—deathly allergic.
Up until then, I wasn’t aware I was allergic to anything, so it was a terrifying surprise when my throat started to close up while I was driving home.
I went into anaphylactic shock, a condition where your airways swell shut and can be fatal if not treated immediately.
Fortunately, I was able to get prompt medical care, but I was told to see an allergist immediately to figure out what was happening.
An allergy-induced asthma diagnosis
The doctor tested me for a variety of asthma triggers and told me I was in “the allergy big leagues.”
Unfortunately, there is no trophy for this win, unless you count the EpiPen I now have to carry with me at all times.
Since then, I have developed moderate, uncontrolled allergy-induced asthma. This means that not only do I have to worry about having an allergic reaction to something, I also have to be prepared for the allergies to trigger asthma attacks.
While I do have some identifiable triggers—in addition to bees, dust and pollen are big ones—sometimes the attacks seemingly come out of nowhere, which makes this condition even more frightening and frustrating.
What an asthma attack feels like
Asthma attacks are one of the most frightening things I’ve ever experienced. They have mostly happened to me while I’ve been running outside.
My nose will suddenly start to run, and then I start sneezing. That’s when I know something bad is coming.
It often progresses into a full asthma attack. I start wheezing audibly, and I feel like I can’t get a breath in because my chest feels like it’s full of fluid.
Then the panic sets in; I know I have only a short amount of time to get somewhere to get help.
If I pass out alone, I could die. This fear is very real.
Even when I do have a good day and try to exercise, I end up worrying the whole time, second-guessing myself, and scanning my body for signs of an impending attack.
Before the fateful protein shake, I was an avid runner, completing many races, including three half-marathons.
Now, I struggle to run even for short distances. And I never push myself outdoors anymore. I miss running so much!
When trying to breathe all day becomes exhausting
It’s not just running that’s become incredibly difficult. Asthma has affected my ability to work, to parent, and to do everyday activities.
Over the past two years, I have spent at least two days every week in bed, unable to live a normal life.
I work as a photographer and I love my job, but a terrifying incident has made me cut back on the type and number of jobs I take.
A couple of years ago, I was shooting a wedding, running around during the reception while everyone was dancing, when I suddenly felt an asthma attack coming on.
I’ve gotten great at hiding my condition, but I was terrified at that moment. Thankfully, it ended up being a relatively mild attack, and I was able to take care of it myself.
I ran to the bathroom, popped a Benadryl, used my rescue inhaler, and then rested until it passed.
I did finish out the night, but it really scared me, and I’ve had to be much more cautious about my work.
It’s also affected my family. My kids have had to learn that some days I’m not going to be able to be engaged and interact with them because I’m so worn out and mentally drained.
People don’t understand that when you have asthma, simply trying to breathe all day is exhausting.
My current treatment plan
Once a day, I take montelukast (Singulair). Twice a day, I use an antihistamine/steroid nasal spray. And every night before bed, I take an antihistamine.
I’m in the process of trying to figure out what steroid will work the best for me.
Steroids are the front-line treatment for asthma because they quickly decrease the inflammation, allowing your airways to open back up.
I’ve tried six different steroids so far and haven’t found one that I really like, but I’m working with my doctor on which one to try next, and I am hopeful.
I’ve also tried immunotherapy shots, injections that are supposed to train your immune system not to overreact to allergy triggers.
I did them every week for almost a year, but when the Covid-19 pandemic happened, the office shut down. The shots are only effective if you are consistent, so all my progress was lost.
I’m considering whether it’s worth it to start the program again because I only saw a slight improvement.
The will to keep fighting asthma
As an adult with asthma, my experience is different from people who were diagnosed as children because I can see exactly what asthma has taken from me.
It has not only stolen my ability to enjoy the things and activities I once cherished, but also it has robbed me of my confidence and my feeling of safety.
I am afraid every single day that I’m going to wake up and not be able to function.
It steals time I could be spending with my family. Instead, I’m stuck in my room, feeling like I’m living half a life.
Dealing with asthma is as much mental as it is physical. I’ve learned that every day I have to wake up and make a conscious decision to keep trying to enjoy life and to look for those moments of happiness.
Thanks to my medications, my asthma is better than it was. But it’s still not completely under control. I have to find a way to live with both joy and fear at the same time.
It’s a daily struggle, and some days are better than others. There are days where I don’t know if I have the will to keep fighting, but I refuse to give up. I refuse to let asthma take that from me too.
—As told to Charlotte Hilton Andersen
Making time to stretch
Even if you struggle to slow down, relax, and really stretch out, you know you always feel better when you do. There’s just something about a nice, long stretching session that eases tension and clears your head.
We hear you: life is busy. But mobility training (which comes in many shapes and sizes) is incredibly important for long-term health and wellness.
Reasons to stretch
Stop asking yourself whether you should stretch. The answer is a big, fat yes.
The better question: why does stretching matter so much? Well, it has to do with both your body and mind.
Maintain joint mobility
“It’s important to incorporate stretching into a healthy-living routine to keep your joints healthy,” says Daniel DeLucchi, a Seattle-based chiropractor.
Sit behind a desk all day, every day, and your range of motion becomes limited. When we move beyond this limited range of motion, we can injure ourselves.
“Countering these lifestyle-created limitations through regular stretching widens your body’s ability to perform and maintain your regular movement patterns and healthy habits,” DeLucchi says.
But maintaining your joints’ range of motion and enjoying proper mobility aren’t the only reasons to stretch.
Better mental health
“Stretching can be a great way to incorporate breathing and mindfulness into your daily routine, inhibiting the sympathetic nervous system and allowing you to relax,” says Jake Harcoff, MS, a certified strength and conditioning specialist and the head coach and owner of AIM Athletic in British Columbia, Canada.
Done correctly, stretching is an excellent way to prepare your body for the rigors of a workout. And it can help you prevent injury.
“Dynamic stretches warm up the muscle groups that you’re going to be using for the activity you plan on doing, while static stretching is used post exercise to increase flexibility,” says Ashley Hunt, a certified corrective and orthopedic exercise specialist and the founder of Pancea, an integrative health app for chronic pain.
Both forms of stretching are important. With proper use, they can help you make the most of all of the physical activity you’re engaging in, whether it’s lifting weights, running, or playing sports.
How to add a full-body stretch routine
When you’re considering adding a stretching routine to your daily life, you need to think about when you plan to do it, whether it’ll be part of a longer workout, and how you’re going to complete each stretch.
Once you know those details, you can determine whether static vs. dynamic stretching is better for your routine.
These stretches are your “traditional” stretches. Doing a static stretch, you’ll move to the end of your personal range of motion, then hold the position.
These are best performed at the end of a workout, when your body is nice and warm. Alternately, they can be performed as tension-relieving “comfort” stretches when you’re feeling tight or stressed.
Generally speaking, you should hold each stretch for 20 to 30 seconds, repeating the stretch two to three times for a total of a minute.
Choosing eight to 10 stretches that hit all of your major muscle groups can make an excellent static stretching routine.
Dynamic stretches are typically performed before a workout as part of a warm-up. They’re designed to prepare your body for the type of work you’ll do during your workout.
When done correctly—moving to the end of your natural range of motion and back out of it again in a steady, controlled manner—they can help reduce the likelihood of injuries during your workout routine.
For any given stretch or movement pattern, the goal is to perform the movement roughly 10 times in succession.
You can string these movements together, choosing between five and 10 different movements, to create a full-body stretch routine.
Cycling through the entire routine two times makes for an excellent dynamic stretch.
Most static stretches can be performed dynamically by simply moving to the end of your range of motion, pausing, then moving out of the stretch.
You can also consider ways to modify stretches to make them more static or dynamic.
“An example of a static stretch would be holding your arms out to the side as wide as you can, then holding the position to stretch your chest,” says Delucchi.
Now modify it to be a dynamic stretch: “Bring your arms out to the sides and create big circles with movement. This targets more muscle groups and is good as a warm-up,” he says.
If you’re performing a stretch routine on a recovery day when you don’t plan on performing another workout, you can combine static and dynamic stretches into a single routine.
Simply perform your stretches dynamically for one or two sets, helping warm up your joints and muscles, then for your final one or two sets, perform each stretch statically, holding the stretches in place.
(These are the types of stretching fitness experts recommend.)
A 10-minute full-body stretch routine
This full-body routine consists of stretches suggested by DeLucchi, Harcoff, and Hunt. It’s the perfect option for hitting every major muscle group.
It should take about 10 minutes to perform and can be done as a dynamic or a static stretching routine.
Lying Hamstring Stretch
Lie on your back on a mat, your legs fully extended. A slight bend in your knee is OK if your hamstrings are particularly tight.
Lift your right leg as high as you can, bringing it toward your torso.
Use both hands to lightly grasp behind your right leg, right above or below your knee, depending on what feels comfortable. Pull your leg closer until you feel a light stretch in your right hamstring.
Hold the position for 20 to 30 seconds before releasing and repeating on the opposite side.
Bring your leg to the point where you feel a good stretch, then lower your leg again, fully controlling the movement.
Repeat 10 to 15 times with one leg before repeating on the opposite side.
(Add these hamstring exercises to your workout.)
Side-Lying Quad Stretch
Lie on your right side on a mat, using your right forearm to support your head and neck while keeping your spine in alignment.
Bend your left knee and draw your left heel toward your butt.
Use your left hand to grasp your ankle and draw your heel closer to your butt until you feel a stretch through the front of your left thigh.
Hold the position for 20 to 30 seconds then switch sides.
To make this a dynamic stretch, draw your ankle to your butt until you feel a stretch. Release your leg, keeping your ankle flexed, as though you were performing a “glute kick.”
Continue for 10 to 15 repetitions before switching sides.
(Loosen up your legs with these quad stretches.)
Lie on your belly on a mat, your legs extended, your palms flat on the ground under your shoulders.
Take a breath in and lift your chest and shoulders from the mat, drawing your shoulders back until you feel a stretch through your chest and shoulders and a nice extension through your upper back and neck.
Lightly support the stretch with your hands. If you can, continue lifting your torso from the mat as you extend your elbows and continue stretching through your abdominals.
Stop when you feel a good stretch and hold for 20 to 30 seconds.
To make the stretch more dynamic, lift your chest and torso until you feel a good stretch, hold for a beat, then release your torso back to the starting position.
Repeat 10 to 15 times.
(Learn more about doing a cobra stretch for back flexibility.)
Child’s Pose With Chest Opener
Kneel on the mat on all fours. Position your hands under your shoulders, your knees under your hips, and your heels together.
Sit your hips back on your heels and extend your arms forward and overhead, allowing your belly to sink between your knees.
You should feel a stretch through your spine, upper back, the back of your shoulders, and even your biceps.
Hold the position for 20 to 30 seconds.
From this position, extend your left arm out to the left of your body, as though forming half of a T.
Turn your head to the right and twist your shoulders and chest slightly to the right until you feel a good stretch through the front of your left shoulder.
Hold for 20 to 30 seconds before returning to child’s pose. Repeat the same stretch, this time turning to the opposite side.
To make the stretch more dynamic, move smoothly from child’s pose to the left-sided stretch and then the right sided stretch. Your movement will be fluid until you’ve performed the stretch on each side 10 to 15 times.
(Improve your posture with these chest stretches.)
Downward Dog With Walkout
Come to a high plank position on your mat. (It’s the same position you’d be in if you were at the top of a push-up.) Your palms should be under your shoulders, your legs fully extended, and your toes tucked.
Press your hips up toward the ceiling as you extend your arms up from your shoulders to form an inverted V.
Press your heels toward the ground. They don’t need to touch the ground, however.
You should feel a stretch through your calves, hamstrings, chest, shoulders, and glutes.
Hold the position for 20 seconds.
Bend your right knee, pressing your left heel closer to the ground to deepen the calf stretch. After 20 seconds, switch sides.
After coming to the downward dog position (the inverted V), “pedal” your legs out slowly, bending and extending one knee, then the other, until you’ve pedaled 10 to 15 times per leg.
(Limber up with yoga’s sun salutation sequence.)
World’s Greatest Stretch
Come to a high plank position on your mat. Position your palms under your shoulders, fully extend your legs, and keep your core tight and engaged.
Step your left foot forward, placing it to the outside of your left hand in a deep lunge. You should feel a stretch through your glutes, hips, and calves.
From here, reach your left arm up toward the ceiling, twisting your torso to your left side and looking up as you perform the reach. This will stretch your chest and shoulders.
Hold this position for 20 to 30 seconds before releasing.
Return to high plank, then repeat the stretch on the opposite side.
After reaching your left arm up toward the ceiling, hold for a beat. Return to high plank and repeat the lunge and reach on the opposite side.
Continue moving back and forth, alternating sides until you’ve completed 10 to 15 repetitions per side.
(Ease hip pain with these stretches.)
Wide-Legged Forward Fold
Stand tall on your mat with your feet hip-distance apart, your core engaged, and your posture strong.
Walk your feet out to the sides, using a heel-toe movement, until you feel a stretch through your inner thighs and groin.
From here, tip forward from your hips, keeping your core engaged to control the movement. Slowly release your chest and shoulders toward the mat until you feel a good stretch through your hamstrings.
If you can, allow your fingers to rest on the mat.
Hang loose, releasing tension through your upper back, shoulders, and neck, for 20 to 30 seconds.
Keep your back straight and flat as you lower your chest toward the floor, pressing your hips back as you go.
When you feel a light stretch in your hamstrings, reverse the movement and lift your chest back as you return to standing. This should be a very steady and controlled movement.
Perform the action 10 to 15 times.
(These groin stretches will improve flexibility in your adductor muscles.)
Triceps Stretch With Side Bend
Stand on your mat with your feet hip distance apart. Check your posture. Your ears should be stacked above your shoulders, hips, knees, and ankles.
Engage your core, then extend your right arm directly overhead before bending your right elbow and dropping your right hand straight down your back. Your palm will touch between your shoulder blades.
Extend your left arm overhead, bend your elbow, and grasp your right arm (just above the right elbow) with your left hand.
Use your left hand to pull lightly on your right arm, reaching your right hand further down your spine until you feel a stretch in your right triceps.
From here, keeping your hips steady, lean slightly to the left stretching out your right side as you stretch your triceps.
When you feel a good stretch, hold the position for 20 to 30 seconds. Then switch sides.
After feeling a good stretch through your right side, take a breath, return to standing, then repeat until you’ve completed 10 to 15 reps.
Repeat on the opposite side.
Next, give these other triceps stretches a try.
The importance of preventing pertussis
You may not hear about it often, but pertussis, or whooping cough, is far from absent in the modern world.
After reaching an all-time low of 1,248 cases in the United States in 1981, thanks largely to an effective vaccine, annual cases have risen again, reaching almost 50,000 in 2012.
The infection is most dangerous in small babies, who can end up in the intensive care unit and even die. And while it would be unusual for older children and adults to actually die from pertussis, it’s far from benign, says Marian Michaels, MD, an infectious diseases specialist at UPMC Children’s Hospital of Pittsburgh.
People have coughed so hard that they’ve cracked ribs and even developed hernias.
“There’s no reason why you can’t prevent pertussis,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital in New York City.
Here are the pertussis precautions you should take to help prevent the disease and slow the spread in infants, kids, teens, pregnant women, and adults.
(Learn about diseases you didn’t know still existed.)
What is pertussis?
Pertussis is a highly contagious infection caused by a bacterium called Bordetella pertussis.
It’s more commonly known as whooping cough, a name that comes from the peculiar “whooping” sound patients make when they’re trying to get their breath back after a coughing fit.
While violent coughing fits are the hallmark symptom, they don’t start right away. The initial symptoms, says Dr. Michaels, resemble a cold.
Once whooping cough takes hold, symptoms can last for months. And you can get it again.
How does pertussis spread?
Whooping cough is spread primarily from person to person through respiratory droplets and aerosolized particles from coughing and sneezing.
“Whooping cough is a very violent kind of cough, so when a person with whooping cough coughs, it’s expelled quite a distance,” says Dr. Horovitz.
Hence its high transmission rate.
“If you have someone with whooping cough in a household where some of the people are susceptible, you’re going to have over 90 percent become infected,” says Dr. Michaels.
Sick people are most contagious up to three weeks after the cough begins, but because initial symptoms can be mistaken for a cold, people can spread pertussis without knowing it.
The bacterium can survive on surfaces, but this isn’t the main way it’s transmitted.
Pertussis precautions to take
When it comes to preventing whooping cough, it’s quite simple: get vaccinated. The vaccines are really the best way to prevent transmission and slow the spread.
Aside from vaccination, there are other precautions you can take to prevent an outbreak in your family.
Here are a few preventative measures experts recommend you take to prevent the spread.
About the vaccines
There are two types of whooping cough vaccines, both of which prevent against not just pertussis but also diphtheria and tetanus. The DTaP vaccine is for kids two months to seven years, while Tdap is for everyone older than that.
(Learn more about the differences between the Tdap vs. DTaP vaccines.)
Babies usually get their first dose of DTaP at two months of age, followed by four more by the time they’re four to six years old.
Because immunity wanes with time, children 11 to 12 should get a Tdap booster. And adults should get a booster every 10 years.
Importantly, people who are pregnant should get a Tdap vaccine during their third trimester. This will protect their babies before they have a chance to be immunized. People who have contact with the baby should also be vaccinated.
It’s difficult to pinpoint the exact efficacy of the vaccines, but they’re at least 70 percent effective, says Dr. Michaels.
Ask about antibiotics
Because the vaccines aren’t perfect, other precautions are also important.
If someone in your household has been diagnosed with the condition, preventive antibiotics can help you and other people who’ve been in contact with the patient avoid getting ill.
It’s especially important that young children and people who are pregnant get antibiotics.
“If someone gets exposed to someone with whooping cough, we can give them azithromycin or erythromycin and prevent them from getting sick,” says Dr. Michaels.
People who are sick and get antibiotics stop being infectious after five days of taking the medications. During that five-day window, they should quarantine themselves, says Dr. Michaels.
(Here’s what to know about the side effects of antibiotics.)
Wash your hands
Lifestyle measures to prevent infectious diseases should be fresh in your minds during the Covid-19 pandemic. First among them is washing your hands often and well.
Ideally, you’ll wash your hands for 20 seconds with soap and water. The next best solution is using hand sanitizer with at least 60 percent alcohol.
Cover your cough
If you think you have any type of infectious illness, you should cover your mouth and nose with a tissue when you cough or sneeze. That tissue should then go in the wastebasket to reduce the chances that anyone will come in context with it.
If you don’t have a tissue handy, cough or sneeze into your elbow or upper sleeve. In other words, don’t cough into your hands.
“You should never cough out into the atmosphere,” says Dr. Horovitz.
Keep your distance
If you can manage it, don’t be around other people when you’re sick. This doesn’t just go for whooping cough; it’s a good rule to follow for any other infectious disease.
And remember that the early phases of whooping cough may actually look like a cold.
“People need to take some responsibility for not spreading the disease, so if they’re sick they should really take that seriously and not go out and spread that disease to others,” says Dr. Michaels.
People who aren’t sick may think about practicing social distancing, especially if you know a person has a transmittable disease.
“Pay attention to the illnesses in our friends and colleagues,” she adds.
We don’t know how far droplets and particles from a person with pertussis can travel, but the six-foot rule for Covid-19 may not be enough, says Dr. Horovitz. It also depends on whether you’re inside or outside and what the ventilation is like.
Wear a mask
Yes, you read that right. We know that the U.S. mask mandate, set in place to stop the spread of Covid-19, has been dropped for fully vaccinated folks. But that doesn’t mean you should throw out your masks.
Since people started wearing masks, “we’ve seen less common cold, less strep, less pertussis,” says Dr. Horovitz.
The most recent flu season was practically nonexistent, as was respiratory syncytial virus (RSV), a common infection in children, says Dr. Michaels.
“It’s not a new strategy. We have used this for transplant patients and other vulnerable populations for decades with good outcomes,” she says, adding that she still wears her mask in many indoor settings as well as crowded outdoor environments.
Yeah, you may be tired of wearing a face mask during the pandemic. But the fact remains that masking works.
“If you’re sick or somebody around you is sick, you put on a mask. It’s really the same principle,” says Dr. Horovitz.
Next, find out the reasons to wear a mask other than Covid-19.
The menstrual migraine double whammy
Nobody will tell you premenstrual syndrome is breeze. (And if they do, they’ve probably never experienced it.) As if PMS wasn’t unpleasant enough, you may also deal with migraines during your menstrual cycle.
“Migraines are often a hereditary disorder, and there’s a major hormonal influence on them,” says Mary O’Neal, MD, director of the women’s neurology program at Brigham and Women’s Hospital in Boston.
In essence, a migraine is a pain disorder related to abnormal connectivity in the brain. It all starts, experts think, via “an abnormal electrical discharge in the brain that triggers downstream effects to activate the trigeminal vasculature,” she says.
In other words, nerves from the brain stem activate blood vessels around the brain, which in turn cause blood vessel changes and trigger a type of inflammation not associated with infection. The end result: you feel a whole lot of pain.
Several different migraine triggers may start this process, including poor sleep habits, caffeine use, certain foods, and weather changes.
Hormonal fluctuations associated with menstruation is among those possible causes. And it’s a very common one.
In fact, 60 percent of women who get migraines have menstrual migraines, according to the National Headache Foundation.
What are period migraines exactly?
Migraines are three times more common in women than men, according to the Migraine Research Foundation. That’s due, in large part, to hormonal influences, Dr. O’Neal explains.
So it’s no surprise that many women have menstrual-related migraines, which simply means that menstruation is one of the triggers for their migraines. Another name for this condition: hormone headaches.
Some people who get periods also have menstrual-only migraines, meaning they only get migraines around their period.
What causes period migraines?
Changes in estrogen levels can trigger migraines.
For some, increases in estrogen around ovulation can tip off head pain, but usually, it’s the decrease in estrogen during menses that prompts a migraine, Dr. O’Neal says.
Migraines also may become more frequent during other times of hormonal change.
These include your first trimester of pregnancy, when estrogen quickly rises; during the postpartum period, when hormones are shifting back to prepregnancy status; and during menopause, when estrogen is decreasing.
Signs you’re having a period migraine
Migraines can happen predictably, especially if you’re prone to having them before, during, or after your period.
You may get a migraine a day or two before you start to bleed. You may also get a migraine during the duration of your period. Or you might get one right after or during ovulation.
Certain signs make it easier to tell whether your migraine is happening in connection with your cycle. Here’s what to look for:
A migraine that starts before your period is known as a PMS migraine. It usually occurs in conjunction with other PMS symptoms. Some common symptoms include:
- Joint pain
- Head pain
- Increase in appetite and cravings for salt, chocolate, and alcohol
Symptoms of a period migraine are similar to those of a regular migraine. These include:
- Throbbing or pulsating pain on one or both sides of the head
- Sensitivity to light, noise, or smell
- Aura (seeing flashing or zigzag lights or black spots prior to headache), but this isn’t too common
Check out these signs you’re having a silent migraine.
How to treat period migraines
First, consider the most important question: are you having migraines only around your period, or do they happen at other times of the month too? Your answer will determine the best treatment option for you.
Here, our experts share some tips to help alleviate period migraine symptoms.
Use over-the-counter (OTC) medication to treat symptoms if you have migraines no more than two times per month, says Dr. O’Neal.
For example, take a pill that combines aspirin, acetaminophen, and caffeine (like Excedrin) right away to stop a migraine when it starts.
If that doesn’t work, talk with your doctor about taking these medications ahead of time to prevent a period migraine.
This works best “if you have a regular menstrual period and can identify when you get a migraine,” says Dr. O’Neal.
Maybe, like clockwork, you get a migraine two days before the first day of your period. You can take your OTC medication before it starts to lessen the severity of your symptoms.
Like Excedrin, nonsteroidal anti-inflammatory drug (NSAID) like naproxen and ibuprofen can be taken two to three days before the time of month you usually get a migraine.
Of course, this trick won’t work if your period is unpredictable.
Your doctor may also talk to you about a class of migraine-stopping medications called triptans. They have longer-acting formulas, which can be used before menstruation.
“These prevent the vascular changes that occur with a migraine,” Dr. O’Neal explains.
Hormonal contraception—aka the birth control pill—is an option too.
“In our headache practice, we do a lot of contraceptive management for pain,” says Chaouki K. Khoury, MD, a neurologist with Panda Neurology and Atlanta Headache Specialists.
This can be done in a few ways, he says:
Low-dose estrogen pill
This will diminish the drop in estrogen.
Two prescriptions for oral hormonal birth control
If your doctor prescribed this route, you would take a combination pill that has a higher amount of estrogen for 21 days.
During the seven days of placebo pills, you’d discard the placebos and take a low-dose estrogen pill instead. This method decreases the fluctuation in estrogen throughout the month.
Insurance usually doesn’t cover two prescriptions, says Dr. Khoury. But considering the pain of migraines, his patients are often comfortable paying for the second prescription out of pocket—especially if it works for them.
A 21-day prescription of the low-dose estrogen pill will last three months with this method.
Continuous oral contraception
Levonorgestrel and ethinyl estradiol (Seasonique or Lybrel) allow you to get your a period once every three months—or not at all. Usually, there are no swings in estrogen and no menstrual migraines, says Dr. Khoury.
If your period is just one trigger for your migraines and you have regular attacks (such as more than one per week), consider a preventive medication.
The problem with using OTC pain relievers or triptans to repeatedly treat migraines is that you can develop medication overuse headaches. That happens when the medication is actually triggering your migraine.
The right preventive migraine medication for you depends on a variety of factors, like your health history and other medical conditions, treatments you’ve tried already, and tolerability of side effects.
Here are some options your doctor may suggest:
- Blood pressure medications, such as beta-blockers and calcium channel blockers
- Serotonin antagonists
The ultimate goal is either to decrease the number of headaches you have in a month or to decrease their intensity so they’re easier to live with.
Sometimes, says Dr. O’Neal, a preventive drug will work throughout the month but not when it comes to menstrual headaches.
If that’s the case, your neurologist might consider increasing it before your period to see if that can prevent the episode.
How to prevent menstrual migraines
Treatment and prevention go hand in hand when you’re talking about period migraines.
A headache diary can be helpful for tracking when you get a migraine and where it falls in relation to your cycle.
Armed with that information, you can act by either stepping in with a migraine-stopping medication (like an NSAID or triptan) in the days before your expected migraine, take a migraine preventive medication, or start hormonal birth control.
For example, if you know that changes to your sleeping habits set off an attack, make a plan to prioritize a regular sleep schedule—and stick to it.
If you know that missing a meal leads to a migraine (and an irritable mood), be sure to eat at the same time each day and keep healthy, nourishing snacks on hand.
How to find the right care
Migraines can be challenging to treat. For the best care, see a migraine or headache specialist. This person is often a neurologist.
You can find one in your area by using the American Migraine Foundations’ Find a Doctor tool.
Some practices are also continuing virtual care, so you may be able to visit with a doctor who’s further away from where you live.
In that case, your primary care physician may be able to work with the migraine specialist while remaining involved in your care.
Relationship PTSD is real
About half of all adults in the United States will experience at least one traumatic event in their lives, according to the U.S. National Institute of Mental Health, and as many as one in 11 will develop a condition known as post-traumatic stress disorder (PTSD).
Some people still associate PTSD with “shell shock,” a term coined after World War I for the potentially severe psychological effects seen in soldiers and others who experienced traumatic events.
PTSD can be caused by many kinds of trauma, however, including trauma stemming from a relationship, says Silvia M. Dutchevici, a psychotherapist specializing in PTSD as well as president and founder of the Critical Therapy Center in New York City.
“You expect war to be traumatic and sad, but when you get into a relationship, you expect to be loved and not experience a frightening rollercoaster, with the person who is supposed to love and protect you inflicting the most pain upon you,” Dutchevici says.
Alisha Ali, PhD, an associate professor of applied psychology at New York University, agrees: “PTSD is defined based on having had a traumatic experience, and that can certainly include a traumatic relationship,” she says.
Some experts have even begun referring to the condition as post-traumatic relationship syndrome—PTRS.
What are the symptoms of relationship PTSD?
Because PTRS is related to PTSD, it can produce similar symptoms:
- recurring dreams
- flashbacks of traumatic events
- extreme psychological distress
- intrusive thoughts
- angry outbursts
Words, objects, or situations that remind the person of the triggering event might push the body into a fight or flight mode. With PTSD, this can lead to avoidance of anything that might remind them of the trauma.
However, with PTRS, a person can end up dwelling on the events that led to trauma—and the trauma itself—potentially worsening the symptoms.
“We become hypervigilant or stuck in time, or have the compulsion to repeat the trauma so we can understand and control or change it,” Dutchevici says. “But in doing so, the result is always the same,” she adds.
Dissociation, the state of feeling like a guest in your own body, might also occur.
Are some people more prone to relationship PTSD?
“Relationship PTSD could happen to anyone,” Dutchevici says. If you grew up in an abusive home, however, you may be more likely to end up in abusive relationships as an adult, she adds, due to poor modeling of healthy relationships in childhood.
Dr. Ali agrees, noting that people who have been in abusive relationships in the past often find themselves seeming to repeat the pattern.
They may not have a tendency to seek out abuse, however, but simply lack the personal and social resources needed to escape traumatic situations.
“They have been made to feel worthless,” Dr. Ali says, “or they have legitimate feelings of fear or uncertainty about their safety.”
How can relationship PTSD affect future relationships?
“Even if you find a nice person who is not abusive, your ability to be present, to trust, to have faith that this person will take care of you and not hurt you is greatly diminished,” Dutchevici says.
Love alone may not cure you. Research also suggests people with relationship PTSD often become codependent, aloof, judgmental, or abusive themselves in a relationship, and have difficulty coping with the challenges inherent to interpersonal relationships.
When should you seek help, and what kind?
“As with any problem, a person should seek help or make a change when they are having difficulty coping, when their ability to do things they want to do is compromised, or if they have persistent feelings of sadness, low self-worth, difficulty concentrating, and sleeping,” Dr. Ali says.
The American Psychological Association recommends cognitive behavioral therapy as a means of combating PTSD.
Dutchevici believes individual therapy sessions make more sense than couples therapy, due to the risk of an abuser disliking something a partner says in therapy, then harming the person afterward.
“It is also essential that the person learns not to rely on their partner for help,” she says. Antidepressants or anti-anxiety medications have been found to help alleviate PTSD symptoms in some cases.
Apart from therapy, lifestyle changes such as meditation, exercise, joining a support group, or opening up to loved ones can reap their own rewards.
How can you reduce the risk of suffering relationship PTSD—or inflicting it?
Ideally, people learn the art of preventing bad relationships on the playground, more or less, Dutchevici says. “We have to teach children to respect boundaries early on, and that the basics of any kind of relationship are based on mutuality and respect,” she says.
But you might also need to decondition yourself from ingrained Hollywood ideals of relationships.
“Romance movies tell you that you found this person who completes you, and everything’s perfect, and they insist on winning your heart because they know you better than you,” Dutchevici says.
“A few years down the line, they might be the same controlling person that gives you PTSD because that person doesn’t respect your boundaries. Healthy relationships are based on two people who acknowledge and see and respect each other, and interact on the basis of mutuality.”
If you or a loved one needs help with an abusive relationship, you can seek help through these organizations:
The art of being a good listener
We all know that listening to others is crucial—it helps you become a better co-worker, friend, parent, and partner. And being a good listener sounds pretty simple.
“It’s setting aside your own agenda and tuning into the other person and making an effort to understand what they are trying to communicate,” says Michael P. Nichols, author of The Lost Art of Listening: How Learning to Listen Can Improve Relationships.
The problem? “Most of us think we’re pretty good listeners,” says Nichols.
Sadly, though, we all have bad habits that stem from all-too-human reflexes like jumping in too quickly with a response. And while sometimes that’s okay, during a particularly emotional conversation, it’s not—and that can get in the way of our relationships.
(See if your relationship is healthy or unhealthy.)
The good news—you can overcome these challenges and become the listener everyone turns to and transform your relationships.
To help you do it, our panel of experts identified common challenges when it comes to listening and fixes you can make.
You have something to say too
“We all have stories to tell and things to talk about. So it’s difficult for most of us to set that aside. Often we’re listening but we’re waiting our turn,” says Nichols.
Even if you’re not actually interrupting to tell your news, you may just be so eager to take your turn you’re not really paying attention.
Other reasons for interrupting: “Sometimes people are worried they’re not going to remember what they want to say, or they get excited about what they want to say, so they don’t wait for the speaker to finish,” Nixaly Leonardo, New York-based psychotherapist and the author of Active Listening Techniques: 30 Practical Tools to Hone Your Communication Skills.
Wait a beat, suggests Anna Sale, author of Let’s Talk About Hard Things, and host of the WNYC podcast Death, Sex & Money, a show that talks about tough topics we all deal with in daily life.
Sale, who compares this pause to a musical beat, says she learned the technique when she was a public radio reporter.
“It was more a technical practice that I then learned had a really powerful, emotional impact. I just wait and to see what happens next.”
Two things can happen during that pause. “The person I’m talking to usually adds another layer to what they were just saying and often it’s a really interesting layer,” she notes.
“And sometimes they won’t fill the space. And that’s also interesting because that suggests a certain clarity that they have said what they needed to say,” she adds.
It’s also more important to focus on the whole rather than the parts and comment on the entire story, says Leonardo.
“Take a moment after the speaker is done to reflect on the message and come up with an appropriate response.”
(Also learn about the art of being more patient.)
It’s tough to listen if someone’s upset
We have trouble listening to people who have a problem or are unhappy, says Nichols.
“We want to fix their problem rather than listening to them talk about it. So we often offer advice that may not be wanted,” he says.
“And if someone is upset, it’s painful to be in their presence. So, although we may try to listen, we end up trying to say things to make people not feel that way—’It’ll be all right’ or ‘You tried your best'” Nichols says.
We also have been socialized to be polite in the face of uncomfortable topics, says Sale.
When somebody is disclosing something painful or upsetting, we often have the impulse to try to sidestep the revelation and go back to the comfortable territory because we think that’s a way to show we care, she notes.
First, try to rid yourself of the habit of trying to fix someone’s problems unless they ask you for help. Otherwise, they’re not going to feel heard. Ditto when you try to say something soothing in the face of their sadness.
(Here’s how to tell the difference between sadness and depression.)
But you have to say something. “It’s important to acknowledge by saying something, so the person knows that you’re hearing them. An unacknowledged response is like an unanswered letter or text,” notes Nichols.
“Something I’ve learned to do in interviews and in life is to say first, ‘Oh, I’m so sorry,'” says Sale, which acknowledges whatever pain the person is expressing.
“Then you can say, ‘Is it okay if I ask you a few more questions about that’ or ‘Do you want to say more about that?’ That keeps the door open so that they can say more because otherwise what you’re doing is you’re shutting that door and then they have to keep carrying that pain by themselves,” she explains.
You get distracted easily
“The pitter-patter of conversation is just faster than what good listening requires,” says Sale. This is especially true when you’re trading info or plans about your day.
“We’re speaking in bold bullet points to one another,” she notes.
Technology also makes it hard to listen—our phones buzz or beep with texts so it’s tough to concentrate—and we’re usually trying to do more than one thing at a time, she adds.
(You might actually have nomophobia, or smartphone anxiety.)
Not every conversation demands active listening.
Active listening means you make an effort to show you’re engaged, Leonardo explains.
You do this by a series of techniques, like using nonverbal cues (like nodding your head or making eye contact), and labeling and validating the person’s emotions (“You seem really mad” or “It’s okay to feel frustrated about that”), she adds.
“In everyday light conversation, it’s not necessary to restrain yourself entirely. I mean, if you tell me a little story about your cat and it doesn’t seem earth-shattering, I might respond with a little story about my cat,” Nichols says.
“But it’s important to listen to people you care about and people who are talking about something they have strong feelings about,” Nichols notes, adding that those powerful emotions can include happy or exciting events (like getting engaged) as well as sad ones.
That’s when you want to suspend your agenda (and bad habits) and tune into the other person.
You shut down the conversation
Sometimes when someone’s speaking, our instinct is to say, “Okay, I got it,” or “I know, I’m sure that was tough.” And that ends the conversation, or at least that part of it, and tells your partner or friend that it’s time to move on.
“You don’t want your acknowledgment to close off the discussion,” says Nichols.
Don’t make comments that end with a period, says Nichols.
Instead, let people know by making an effort by asking them questions.
“With a question mark in your voice, you’re inviting the person to confirm that your understanding is correct or to elaborate or correct it,” Nichols explains.
Open-ended questions can also invite a speaker to say more. “I think of open-ended questions as the question version of what it feels like to have someone lean in towards you,” Sale explains.
“If someone describes something to me and it’s something I have never experienced, I will just say something like, ‘Oh my gosh, what was that like?’ because it’s conveying this curiosity to know more about what the person is talking about.”
That’s different than asking a question that has the answer embedded in it or gives someone a choice (“Was that scary or exciting for you?”).
An open-ended question like “What do you think or feel about that?” lets you create more room for there to be a broader spectrum of details, Sale notes.
Another way to invite people to say more is to repeat their words.
“If there’s a phrase that someone used to explain something that sticks out—if it’s particularly evocative or words that I wouldn’t have chosen myself—I will repeat them back to the person and say, ‘That’s interesting that you said this. Can you tell me more about that?'” she explains.
You’re reacting too defensively
Listening can be especially tough when the topic is complicated, has high stakes, or involves conflict in some way—say, a discussion about who’s shouldering more kid-care in your house or how you’re going to save for a decent down payment.
“You can quickly move into the mode of reacting and competing for who’s going to win the conversation,” Sale notes.
“So I’m not thinking, ‘Tell me more about that point’—I’m thinking, ‘Aha! Here’s the way I’m going to come back with my argument.'”
The result: It shuts down the interaction and leaves people feeling unheard. Just remember, these arguments can end a relationship.
Hold off saying you disagree—which only turns the discussion into a battle—and ask more questions instead.
When you do that, says Sale, you’re indicating that you truly want to figure out what that person is saying.
You can even remark, “This is interesting to me because it’s not how I would respond or what I think, so I’m going to ask more questions about that.” And then you can explain your point of view.
Or take a time out when you realize you’ve stopped hearing what the other person says, suggests Sale.
“I will say things like, ‘Oh, I’m really tired and I’m not going to be able to talk about this in a way that’s not going to cause more stress,” she says.
“It just allows me to narrate to the person and to myself when I’m not listening in the way that I want to and to take responsibility for that,” she adds.
All that takes discipline, but it’s worth it, says Sale.
“In every important relationship in our lives, there’s disappointment and differences of opinions. By putting in the extra time and choosing your words carefully for how you express that disagreement, you can make a little bit more room for the differences and disagreement inside your relationship.”
Then, check out these tips for waging a fairer, more productive argument.
The benefits of being a better listener
The art of being a good listener also comes with some benefits for you and your relationships.
Leads to deeper relationships
“Listening is loving,” says Sale.
“It’s saying, ‘I want to hear what you have to tell me even if things are getting heated or someone is telling me something painful.”
Another plus: You’re getting to know someone more deeply and discovering new things about them, even if you’ve known them for years.
“When people feel heard, they feel connected and cared for,” says Leonardo. “As a result, they’re more likely to want to be around you, reach out to you for support, and also want to give you the same attention you give them.”
Makes life more interesting
“Life is so much more interesting when I preserve the space to be challenged, to have my impulses and opinions challenged,” says Sale.
“And it’s just more interesting when you can make room for that variety instead of going into a conversation with the intent of confirming what you thought before the talking even started,” she says.
When you show an interest in others by listening to them without interrupting or brushing past what they say, it improves the way they see you, says Leonardo.
“We feel good about ourselves as a result of having more people in our lives who care about and respect us.”
(Check out these instant self-confidence boosters.)
Helps you set boundaries
When we’re good listeners, we show people that we care and have good intentions—and that can gain their trust so when we need to set a boundary (saying “no,” for instance) it’s easier to do so, says Leonardo.
Next, find out why trust is so important in a relationship.
What does it mean to be “sober curious”?
When you think of sobriety, you probably imagine someone who completely abstains from alcohol.
After all, the term is often linked with the road to recovery from alcohol abuse or dependence.
Being sober curious, on the other hand, involves reassessing your relationship with alcohol.
The growing sober-curious movement
In the summer of 2020, Kerry Benson, RD, and Diana Licalzi, RD, authors of Mocktail Party: 75 Plant-Based, Non-Alcoholic Mocktail Recipes for Every Occasion and self-described “sober-curious dietitians” based in Philadelphia and Boston, respectively, decided to go alcohol free.
This experiment spurred a passion for at-home mixology without the hangover. The resulting sober-curious journey sparked an alcohol-free online community and two recipe collections.
“Short-term challenges like Dry January give individuals an opportunity to question their relationship with alcohol in a way that is very approachable,” says Benson. “Data suggests that people who participate in these challenges may reduce their alcohol intake long term.”
And while some people found themselves reaching for the nearest bottle during the height of the Covid-19 pandemic, others used the time as a way to explore their sober curiosity.
“The pandemic has also spurred a lot of people to question their drinking habits—ourselves included. We definitely believe that the sober-curious movement is more than a fad or a trend—it is here to stay,” Licalzi says.
Reasons to reduce alcohol intake
There are reasons to cut alcohol from your life entirely—if you have an addiction, for instance. But there are also good motivations for temporarily avoiding booze:
Benson and Licalz list several other health-related arguments for drinking less alcohol:
- A 2018 study in The Lancet suggests that all levels of alcohol consumption come with a degree of health risk.
- Reducing alcohol consumption could lead to deeper sleep, clearer skin, improved digestion, and better hydration.
- Alcohol contains seven calories per gram. These “empty calories” can negatively impact your weight.
- The 2020-2025 U.S. Dietary Guidelines for Americans state that “drinking less [alcohol] is better for health” and recommend no more than two drinks per day for men and one for women.
Finding sophisticated options for sober-curious people
A quick internet search will reward you with dozens of Shirley Temple-like mocktails: syrupy sweet, colorful, and often fizzy.
Most sober-curious adults want something that feels more sophisticated.
So I asked some experts to divulge their favorite nonalcoholic beverages. I tapped Benson and Licalzi; Chris Marshall, founder of the original Sans Bar, an alcohol-free bar in Austin; and Annie O’Donoghue, head mixologist at Sans Bar STL in Saint Louis.
After a day of zero-proof cocktail creations and mixing mocktails for strangers, what do they still want to drink?
Here are the zero-proof products and mocktail recipes they reach for again and again.
What do sober and sober-curious bartenders drink?
Here’s a peek at the bottles and cans our bartenders and home mixologists keep stocked for themselves. (However, keep in mind that drinks that mimic the look, smell, or taste of alcohol-containing drinks may not be safe or appropriate for someone in recovery from an alcohol abuse disorder.)
Wilderton Earthen. Marshall calls this spicy, lapsang souchong tea-infused spirit “the most imaginative liquid I’ve ever encountered,” while O’Donoghue praises its distinct, one-of-a-kind flavor.
Seedlip Spice 94. “[This has] its own unique botanical flavor that was made for zero-proof cocktails. I mean, why should [alcoholic] cocktails have all the fun?” says O’Donoghue.
Amethyst Lemon Cucumber Serrano. Marshall puts Amethyst spirits in an elevated “third wave” category.
According to our sober-curious experts, these beers are tops when it comes to nonalcoholic brews.
For Bitter For Worse Eva’s Spritz. According to Marshall, this “citrusy and light” mocktail is “a must” for sober-curious drinkers and bartenders.
Next up? The experts’ seven go-to zero-proof cocktail recipes.
Makes 1 serving.
This recipe from O’Donoghue uses one of her go-to spirits: Wilderton Earthen.
1-inch piece of ginger, sliced and peeled
2 large ice cubes or spheres
1½ oz. Wilderton Earthen
- In a rocks glass (short, wide tumbler often used for an old fashioned), place the fresh ginger and lime peel.
- Add one large ice cube or sphere and stir with a bar spoon for 10 seconds to allow the ginger and lime essential oils to distribute.
- Empty the glass of ice and herbs, then add a fresh cube or sphere.
- Add Wilderton Earthen and Ginger Beer Mule Mix Syrup.
- Stir and top with Dry Botanicals Bitters & Soda.
- Garnish with a lime peel.
Resting Booch Face
Makes 2 servings.
O’Donoghue’s Resting Booch Face is the perfect poolside summer drink. For video instructions with slightly different citrus ingredients, watch her Instagram demonstration.
Salt (to taste)
Sugar (to taste)
Chili powder (to taste)
1 lime, sliced
1 orange, sliced
½ grapefruit, sliced
2 oz. orange juice
2 oz. lime juice
2 oz. ginger beer
- Mix the salt, sugar, and chili powder on a small plate.
- Wet the rim of each glass with a lime wedge, then dip the rim into the mixture on the plate.
- Fill each glass partially with crushed ice.
- Add slices of lime, orange, and grapefruit.
- Pour in the orange and lime juices. Add the kombucha, then stir.
- Top with ginger beer.
- Stir gently with a bar spoon.
Makes 4 servings.
Like the mocktail above, this Benson and Licalzi creation also includes probiotic-packed kombucha.
2⅔ cups ginger kombucha
¼ cup lime juice
2 cups plain seltzer water
Lime wedges (optional)
- Combine the first three ingredients in a pitcher and stir.
- Fill four copper mugs with ice.
- Divide the mixture among the mugs.
- Garnish with lime wedges.
Nonalcoholic Mint Julep
Makes 1 serving.
6 mint sprigs
½ oz. simple syrup
2½ oz. Spiritless Kentucky 74
Powdered sugar (to taste)
- Gently muddle three to four mint sprigs with simple syrup in a julep cup.
- After muddling, rub the mint around the cup walls, then remove.
- Fill the cup halfway with crushed ice.
- Add Spiritless Kentucky 74.
- Fill to the top with crushed ice.
- Garnish with extra mint sprigs and a sprinkle of powdered sugar.
Makes 1 serving.
Another O’Donoghue classic, this zero-proof martini includes a jolt of caffeine.
1 oz. Seedlip Spice 94
¾ oz. simple syrup
Coffee beans for garnish
- Add everything but the coffee beans to a mixing glass or cocktail shaker.
- Shake vigorously (the more you shake, the better the foam will be).
- Strain into a chilled martini glass.
- Top with two coffee beans.
Makes 2 servings.
One of Benson’s and Licalzi’s favorite zero-proof cocktails, this mojito offers antioxidants from matcha tea and electrolytes from coconut water.
20 mint leaves, plus extra for garnish
1 teaspoon agave nectar
1 cup coconut water
2 tablespoons lime juice
1 teaspoon matcha powder
1 cup seltzer
- Muddle the mint leaves with agave nectar in the bottom of a cocktail shaker.
- Add the coconut water, lime juice, matcha powder, and ice.
- Shake vigorously.
- Fill two highball glasses with ice.
- Strain the shaken mixture into the glasses.
- Top with seltzer (½ cup per serving) and stir.
- Garnish with mint sprigs.
Makes 4 servings.
This dietician-crafted mocktail gets its creamy texture from low-calorie cauliflower.
4 cups frozen pineapple
1 cup frozen cauliflower or cauliflower rice
2 cups unsweetened coconut milk (from a carton)
½ cup canned coconut milk
A couple of squeezes of fresh lime juice
Pineapple slices, orange slices, or maraschino cherries for garnish
- Combine all drink ingredients (but not garnish) in a blender.
- Blend on high until well combined.
- Divide the mixture among four margarita or hurricane glasses.
- Garnish with fresh fruit.
When life gives you overripe bananas, make banana bread. That’s how the saying goes, right?
While the baked good may seem like a way to turn an otherwise healthy fruit into a quasi dessert, it doesn’t have to be bad for you.
With a few twists on a classic, your overly ripe bananas can be fully transformed into a healthy treat. Not only is this banana bread recipe healthy, but it even includes chocolate chips.
Whether you got too busy to eat them, totally forgot about them, or simply bought too big of a bunch, there’s a good chance at least a few of your bananas ripened too fast. Realizing you don’t have to throw out food or money makes banana bread even sweeter.
I love being able to repurpose food that would otherwise get tossed.
Unripened bananas are green and have a high starch content. As they ripen, they turn from green to yellow to brown, and the starch gets converted to sugar. With a lower percentage of starch and higher percentage of sugar, the flesh of the fruit sweetens.
So while they may look less appealing than their bright yellow siblings, brown-spotted bananas are extra sweet and perfect for turning into warm bread.
Is banana bread healthy?
Generally speaking, banana bread isn’t the healthiest breakfast treat.
Standard recipes often use white flour, a lot of processed sugar, and saturated fat-laden butter. They’re not the healthiest of ingredients.
But banana bread doesn’t have to be so unhealthy. What makes the baked good so great is its versatility. It’s easy to alter the recipe so it qualifies as healthy banana bread.
It has four basic building blocks: flour, sugar, fat, and eggs. You can swap out different ingredients within those four categories to better fit your own health and taste preferences. The bread will still bake properly, but you’ll end up with a more-nutritious loaf.
Why you should try healthy banana bread
There are a lot of reasons to love this healthy banana bread recipe, not the least of which is the ease of baking.
These substitutions will give your bread some added nutritional value and lower the calorie count. You likely have many of these ingredients on hand already. If not, you can find them wherever you buy your groceries.
Another reason to love my healthy banana bread recipe: it calls for minimal equipment.
No electric mixer or kneading is necessary to whip up the batter. With just a little measuring and stirring, you can quickly go from, “Ugh, I have too many ripe bananas!” to, “Mmm, I have a fresh loaf of banana bread!”
The whole wheat flour provides many of the remaining B vitamins, including B1, B3, B5, riboflavin, and niacin. Compared with white flour, whole wheat flour is more nutrient dense and contains more iron, calcium, and protein.
This recipe uses olive oil, a monounsaturated fat that’s been linked to anti-inflammatory benefits and lower levels of “bad” LDL cholesterol, according to studies like one published in The American Journal of Clinical Nutrition.
The use of Greek yogurt in this recipe also gives an extra boost of protein.
I include chocolate chunks in my banana bread recipe as an added treat. But I make sure they are at least 70 percent cacao—that’s what gives the chocolate its health benefits, like antioxidants and minerals, according to The Journal of Nutrition.
The substitutions in this healthy chocolate chip banana bread recipe result in a slice that contains about 175 calories.
Healthy chocolate chip banana bread
Makes 12 servings
2.5 ripe bananas
1/4 cup olive oil
1/4 cup 2 percent plain Greek yogurt
1/4 cup maple syrup
1 tsp vanilla extract
1.5 cups whole wheat flour
2.5 Tbsp brown sugar
1 tsp baking soda
1 tsp cinnamon
Pinch of salt (about 1/2 tsp)
1/3 cup dark chocolate chips/chunks (at least 70 percent cacao)
- Preheat the oven to 350° F.
- In a large bowl, mash the bananas. Stir in the eggs. Add in the olive oil, Greek yogurt, maple syrup, and vanilla extract.
- In a separate bowl, combine the whole wheat flour, brown sugar, baking soda, cinnamon, and salt.
- Add half of the dry ingredients to the wet ingredients and stir until blended, careful to not overmix. Add the remaining dry ingredients and stir until combined. Stir in the chocolate chips.
- Grease an 8.5-inch-by-4.5-inch loaf pan. Pour in your batter. Sprinkle cinnamon and brown sugar on top. Swirl if desired.
- Bake for 60 to 70 minutes, or until fully cooked through (you can check this with a toothpick).
- Remove from the oven and let sit for 10 minutes before removing from the pan and slicing.
How to make your banana bread recipe healthier
Not into whole wheat flour? Try substituting gluten-free flour, almond flour, or whatever else floats your boat. If you don’t want 100 percent whole wheat bread, you can use 1 cup whole wheat and 1/2 cup white flour.
And if you do not want to use any brown sugar, you may use 1/3 cup of maple syrup instead of 1/4 cup.
How to eat banana bread
Try a grilled slice, warming it on the grill or in a pan or skillet on the stove. You can serve with a little bit of butter.
Banana bread alternatives
We know that old bananas lead to banana bread, but what happens when your banana bread starts to get old? Don’t trash it!
In yet another way to repurpose this food, you can use some of the ingredients from my banana bread recipe to transform it into cake pops.
Banana bread cake pops
Ingredients (as needed):
Leftover banana bread
- Crumble your leftover banana bread into a bowl. Add in a little Greek yogurt until you are able to scoop and form a tight ball.
- Scoop and roll the mixture into tight cake pop balls. Place them on a plate or baking sheet. Sticks are not necessary, but if you want the full cake pop effect, place a toothpick or cake pop stick into each ball. Place the balls in the freezer for about 15 to 20 minutes.
- While they cake pops are in the freezer, melt some leftover dark chocolate chunks in the microwave. Dip and coat the cake balls into the melted chocolate, sprinkle with sea salt, and let cool until the chocolate has hardened.
No matter how you choose to eat your banana bread, take a moment to enjoy it and relax. You saved food from the fate of the trash can, and you did it in a healthy way.
Next, check out what doctors eat for breakfast.