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If you suffer from the throbbing, intense pain set off by migraine headaches, you may well wonder which medicines are most likely to offer relief. A recent study suggests a class of drugs called triptans are the most helpful option, with one particular drug rising to the top.

The study drew on real-world data gleaned from more than three million entries on My Migraine Buddy, a free smartphone app. The app lets users track their migraine attacks and rate the helpfulness of any medications they take.

Dr. Elizabeth Loder, professor of neurology at Harvard Medical School and chief of the Division of Headache at Brigham and Women’s Hospital, helped break down what the researchers looked at and learned that could benefit anyone with migraines.

What did the migraine study look at?

Published in the journal Neurology, the study included self-reported data from about 278,000 people (mostly women) over a six-year period that ended in July 2020. Using the app, participants rated migraine treatments they used as “helpful,” “somewhat helpful,” or “unhelpful.”

The researchers looked at 25 medications from seven drug classes to see which were most helpful for easing migraines. After triptans, the next most helpful drug classes were ergots such as dihydroergotamine (Migranal, Trudhesa) and anti-emetics such as promethazine (Phenergan). The latter help ease nausea, another common migraine symptom.

“I’m always happy to see studies conducted in a real-world setting, and this one is very clever,” says Dr. Loder. The results validate current guideline recommendations for treating migraines, which rank triptans as a first-line choice. “If you had asked me to sit down and make a list of the most helpful migraine medications, it would be very similar to what this study found,” she says.

What else did the study show about migraine pain relievers?

Ibuprofen, an over-the-counter pain reliever sold as Advil and Motrin, was the most frequently used medication in the study. But participants rated it “helpful” only 42% of the time. Only acetaminophen (Tylenol) was less helpful, helping just 37% of the time. A common combination medication containing aspirin, acetaminophen, and caffeine (sold under the brand name Excedrin) worked only slightly better than ibuprofen, or about half the time.

When researchers compared helpfulness of other drugs to ibuprofen, they found:

• Triptans scored five to six times more helpful than ibuprofen. The highest ranked drug, eletriptan, helped 78% of the time. Other triptans, including zolmitriptan (Zomig) and sumatriptan (Imitrex), were helpful 74% and 72% of the time, respectively. In practice, notes Dr. Loder, eletriptan seems to be just a tad better than the other triptans.
• Ergots were rated as three times more helpful than ibuprofen.
• Anti-emetics were 2.5 times as helpful as ibuprofen.

Do people take more than one medicine to ease migraine symptoms?

In this study, two-thirds of migraine attacks were treated with just one drug. About a quarter of the study participants used two drugs, and a smaller number used three or more drugs.

However, researchers weren’t able to tease out the sequence of when people took the drugs. And with anti-nausea drugs, it’s not clear if people were rating their helpfulness on nausea rather than headache, Dr. Loder points out. But it’s a good reminder that for many people who have migraines, nausea and vomiting are a big problem. When that’s the case, different drug formulations can help.

Are pills the only option for migraine relief?

No. For the headache, people can use a nasal spray or injectable version of a triptan rather than pills. Pre-filled syringes, which are injected into the thigh, stomach, or upper arm, are underused among people who have very rapid-onset migraines, says Dr. Loder. “For these people, injectable triptans are a game changer because pills don’t work as fast and might not stay down,” she says.

For nausea, the anti-emetic ondansetron (Zofran) is very effective, but one of the side effects is headache. You’re better off using promethazine or prochlorperazine (Compazine), both of which treat nausea but also help ease headache pain, says Dr. Loder.

Additionally, many anti-nausea drugs are available as rectal suppositories. This is especially helpful for people who have “crash” migraines, which often cause people to wake up vomiting with a migraine, she adds.

What are the limitations of this migraine study?

The data didn’t include information about the timing, sequence, formulation, or dosage of the medications. It also omitted two classes of newer migraine medications — known as gepants and ditans — because there was only limited data on them at the time of the study. These options include

• atogepant (Qulipta) and rimegepant (Nurtec)
• lasmiditan (Reyvow).

“But based on my clinical experience, I don’t think that any of these drugs would do a lot better than the triptans,” says Dr. Loder.

Another shortcoming is the study population: a selected group of people who are able and motivated to use a migraine smartphone app. That suggests their headaches are probably worse than the average person, but that’s exactly the population for whom this information is needed, says Dr. Loder.

“Migraines are most common in young, healthy people who are trying to work and raise children,” she says. It’s good to know that people using this app rate triptans highly, because from a medical point of view, these drugs are well tolerated and have few side effects, she adds.

Are there other helpful takeaways?

Yes. In the study, nearly half the participants said their pain wasn’t adequately treated. A third reported using more than one medicine to manage their migraines.

If you experience these problems, consult a health care provider who can help you find a more effective therapy. “If you’re using over-the-counter drugs, consider trying a prescription triptan,” Dr. Loder says. If nausea and vomiting are a problem for you, be sure to have an anti-nausea drug on hand.

She also recommends using the Migraine Buddy app or the Canadian Migraine Tracker app (both are free), which many of her patients find helpful for tracking their headaches and triggers.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Approximately three million Americans have inflammatory bowel disease (IBD). IBD is an umbrella term for Crohn’s disease and ulcerative colitis, illnesses marked by chronic or repeated bouts of inflammation in the digestive tract. Both types of IBD represent a complex interplay of genes, environment, and immune factors.

Current therapies for IBD suppress the immune system to reduce inflammation. But emerging research on the human microbiome may help scientists better understand and manage IBD. And some preliminary studies on cells, animals, and humans have investigated whether probiotics — which are sometimes called “good” bacteria — are beneficial for people with IBD.

The healthy microbiome: Building a barrier

The human intestinal microbiome is the vast community of trillions of helpful and harmful bacteria, viruses, fungi, and other microorganisms that inhabit our gut. Ideally, the lining of the gut acts as a barrier that prevents harmful bacteria and toxins from entering the bloodstream.

A healthy microbiome helps this lining block out harmful bacteria while enabling it to absorb nutrients. Beneficial bacteria in the microbiome promote a healthy, hospitable gut environment that limits inflammation and helps crowd out harmful bacteria.

Recent studies on human cells and in mice suggest that a healthy microbiome produces substances that

• nourish cells lining the colon, so that they form a tight barrier difficult for harmful bacteria to penetrate
• interact with immune cells in the gut, reducing inflammation
• prompt the gut lining to make mucus that acts as an additional barrier to harmful bacteria.

In animal studies, a healthy microbiome is essential to help build and maintain an effective barrier. Animals raised in the laboratory without a microbiome, or whose microbiome has been depleted by antibiotics, have intestinal linings that are easily damaged.

An unbalanced microbiome: Inflammation and damage

What happens if the microbiome doesn’t have a good balance of helpful and harmful bacteria? The gut lining may become increasingly permeable. That may allow potentially harmful bacteria and their toxins to cross into the intestinal tissue and then into the bloodstream, triggering inflammation that can damage the gut.

An imbalanced microbiome is known as dysbiosis. And the inflammatory cascade linked to dysbiosis is a hallmark of IBD.

Probiotics: More promise than evidence

Probiotics — live microorganisms in supplements or in fermented foods like kombucha, kefir, yogurt, and sauerkraut — have been proposed as therapies for IBD. The idea is that by eating beneficial bacteria we can restore and maintain a balanced microbiome, reduce inflammation, and improve the gut barrier. But what does the evidence say?

Thus far, no probiotic therapy is routinely prescribed for IBD. Small randomized studies have compared specific probiotics with standard immunosuppressive therapies for IBD. The studies measured IBD symptoms, remission rates, or quality of life. Results were mixed at best:

• Ulcerative colitis. Some studies suggest that certain bacterial strains, such as Bifidobacteria and Lactobacilli, are somewhat effective for ulcerative colitis, reducing symptoms, promoting remission, and improving quality of life. But these effects are modest compared to standard therapies, and probiotics have not shown enough benefit to be accepted in medical practice.
• Pouchitis. Some people with IBD may need surgery to remove the colon (large intestine). This can lead to inflammation in the remaining small intestine, which gets formed into a J-shaped pouch and attached to the anus. However, 25% to 45% of people who have a J-pouch later experience inflammation known as pouchitis. Several studies show that combining standard medication with a probiotic mix called VSL#3 effectively quells the symptoms and inflammation of pouchitis. VSL#3 contains eight strains of bacteria. It is used to treat chronic pouchitis, which is the only accepted use of probiotics in common practice for IBD.
• Crohn’s disease. Probiotics have not been studied as rigorously in Crohn’s disease as in ulcerative colitis. Most of the limited set of studies found that probiotics are no better than placebo in reducing symptoms or promoting remission.

Diet, fiber, and prebiotics: A role in IBD?

The makeup and activity of our microbiomes can be altered by diet. That’s true even if the foods you consume aren’t well-known probiotic stars like kombucha, yogurt, kefir, and other fermented foods.

Gut bacteria that break down dietary fiber are a cornerstone of a healthy microbiome. A high-fiber diet can boost the number of these bacteria, as well as their beneficial and anti-inflammatory effects.

Food ingredients that are not absorbed by the gut but are instead consumed by the gut microbiome are called prebiotics. We have limited — though promising — evidence supporting prebiotics for people with IBD. Currently, no specific prebiotic food or supplement is recommended for general use.

However, the Mediterranean diet, which encourages fiber-rich vegetables, whole grains, and legumes, may modestly reduce symptoms and markers of inflammation in IBD. While these effects are small and inconsistent, the Mediterranean diet improves overall health in people with or without IBD. Largely for this reason, the American Gastroenterology Association recommends it for people who have IBD.

The bottom line

Probiotics, and possibly even prebiotics, hold promise. But we don’t yet know how to harness their full potential for treating IBD. While current evidence suggests probiotics may one day be an effective way to help treat IBD, the complexity of the microbiome means that a one-size-fits-all approach is unlikely to work.

Many questions remain: Which strains of bacteria in the gut should we study? How do we determine the best cocktail of probiotics to reap maximum benefit? Given that everyone’s microbiome is different, is a personalized approach to probiotics the right strategy? How can we define ideal dosage and formulation of probiotics?

Delivery method (capsules, powders, foods), dosage, and duration of treatment all require more research. Until these questions are answered, probiotics and prebiotics remain complementary strategies in treating IBD alongside standard immunosuppressive therapies.

About the Authors

Jake Dockterman, MD, PhD, Contributor

Dr. Jake Dockterman is from Carlisle, MA and earned his bachelor’s degree in molecular and cellular biology from Harvard College. He completed his MD and PhD in immunology at Duke University, studying host-microbe interactions and mucosal … See Full Bio View all posts by Jake Dockterman, MD, PhD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD

Trouble staying focused and paying attention are two familiar symptoms of attention deficit hyperactivity disorder (ADHD), a common health issue among children and teens.

When ADHD persists through early adulthood and on into middle age, it presents many of the same challenges it does in childhood: it’s hard to stay organized, start projects, stay on task, and meet deadlines. But now life is busier, and often expectations from work and family are even higher. Fortunately, there are lots of strategies that can help you navigate this time in your life.

Staying organized

Organizational tools are a must for people with adult ADHD. They’ll help you prioritize and track activities for each day or the coming weeks.

• Pick the right tools. Tools can include a pen and paper to make lists, or computer or smartphone apps to set appointment reminders, highlight important days on the calendar, mark deadlines, and keep lists and other information handy.
• Schedule updates. Set aside time each day to update your lists and schedules. Don’t let the task become a chore in itself; think of it like a routine task such as brushing your teeth, and do it daily so it becomes an established habit.
• Set a timer. And a word of caution: smartphones and computers can also turn into a distraction. If you have adult ADHD, you may find yourself spending hours looking at less useful apps or sites. If that’s a frequent trap for you, set a timer for each use or keep the phone off or in another room when you are trying to work.

Staying focused

Just being organized doesn’t mean your work will get done. But a few simple approaches can at least make it easier to do the work.

• Declutter your home and office. Give yourself an appealing work environment and keep important items easily accessible.
• Reduce distractions. This could mean changing your workstation so it doesn’t face a window, moving to a quieter space, or just silencing your smartphone and email alerts.
• Jot down ideas as they come to you. You may have an “aha” moment for one task while you’re in the middle of another. That’s okay; just write down that thought and get back to it later, after your more pressing work is finished.

Meeting deadlines

Deadlines pose two big challenges when you have adult ADHD. First, it’s hard to start a project, often because you want it to be perfect, or you’re intimidated by it so you put it off. Second, when you do start a project, it’s very easy to become distracted and leave the task unfinished.

How can you avoid these traps?

• Put off procrastinating. Put procrastination on your to-do list — like a chore — and fool yourself into actually starting your work.
• Deal with emails, phone calls, or other matters as soon as you can. That way there will be fewer things hanging over your head and overwhelming you later on.
• Be a clock watcher. Get a watch and get in the habit of using it. The more aware you are of time, the more likely you’ll be able to avoid spending too long on a task.
• Take one thing at a time. Multitasking is overrated for everyone — and it’s a nightmare for people with adult ADHD. Focus on completing one task, then move on to the next.
• Be realistic about your time. This can mean having to say no to new projects or other commitments.

Get more help

The ideas listed here can help you start coping with adult ADHD, but they may not be enough to help you overcome adult ADHD’s challenges.

Consider hiring an ADHD coach who can provide more strategies and give you additional tools to cope with your condition. Look for an ADHD coach who is a licensed mental health professional who specializes in treating ADHD, and may also have a certification in ADHD coaching from the ADHD Coaches Organization.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s easy to say you simply don’t have time to be mindful. With so much going on in daily life, who has time to stop and be present? But everyone has at least 10 minutes to spare to practice mindfulness.

The point of these brief, daily reflections is to help you tap into calmness whenever life gets too hairy. Practicing everyday mindfulness can also improve your memory and concentration skills and help you feel less distracted and better able to manage stress . And mindfulness tools have been successfully incorporated into treatments for anxiety and depression.

There is more than one way to practice mindfulness. Still, any mindfulness technique aims to achieve a state of alert, focused, relaxed consciousness by deliberately paying attention to thoughts and sensations without passing judgment on them. This allows the mind to focus on the present moment with an attitude of acceptance.

Three easy mindfulness exercises to try

Here are three simple exercises you can try whenever you need a mental break, emotional lift, or just want to pause and appreciate everything around you. Devote 10 minutes a day to them and see how the experience changes your outlook. It’s time well spent.

Simple meditation

A quick and easy meditation is an excellent place to begin practicing mindfulness.

• Sit on a straight-backed chair or cross-legged on the floor.
• Focus on an aspect of your breathing, such as the sensations of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.
• Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas. Embrace and consider each without judgment.
• If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
• Take as much time as you like: one minute, or five, or 10 — whatever you’re comfortable with. Experts in mindfulness meditation note that the practice is most helpful if you commit to a regular meditation schedule.

Open awareness

Another approach to mindfulness is “open awareness,” which helps you stay in the present and truly participate in specific moments in life. You can choose any task or moment to practice open awareness, such as eating, taking a walk, showering, cooking a meal, or working in the garden. When you are engaged in these and other similar routine activities, follow these steps.

• Bring your attention to the sensations in your body, both physical and emotional.
• Breathe in through your nose, allowing the air to fill your lungs. Let your abdomen expand fully. Then breathe out slowly through your mouth.
• Carry on with the task at hand, slowly and with deliberation.
• Engage each of your senses, paying close attention to what you can see, hear, feel, smell, and taste.
• Try “single-tasking,” bringing your attention as fully as possible to what you’re doing.
• Allow any thoughts or emotions that arise to come and go, like clouds passing through the sky.
• If your mind wanders away from your current task, gently refocus your attention back to the sensation of the moment.

Body awareness

Another way to practice mindfulness is to focus your attention on other thoughts, objects, and sensations. While sitting quietly with your eyes closed, channel your awareness toward each of the following:

• Sensations: Notice subtle feelings such as an itch or tingling without judgment, and let them pass. Notice each part of your body in succession from head to toe.
• Sights and sounds: Notice sights, sounds, smells, tastes, and touches. Name them “sight,” “sound,” “smell,” “taste,” or “touch” without judgment and let them go.
• Emotions: Allow emotions to be present without judging them. Practice a steady and relaxed naming of emotions: “joy,” “anger,” “frustration.”
• Urges: When you feel a craving or an urge (for instance, to eat excess food or practice an unwanted behavior), acknowledge the desire and understand that it will pass. Notice how your body feels as the craving enters. Replace the wish for the craving to go away with the specific knowledge that it will subside.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Recently, a friend asked me about tonsil stones. He has sore throats several times a year, which are instantly relieved by gargling to remove them. When I told him I thought tonsil stones were pretty rare, he asked: “Are you sure about that? My ear, nose, and throat doctor says they’re common as rocks.” (Get it? stones? rocks?)

It turns out, my friend and his doctor are on to something. Tonsil stones are surprisingly common and often quite annoying. Here’s what to know and do.

What are tonsil stones?

Tonsil stones (medical term: tonsilloliths) are small white or yellow deposits on the tonsils. They develop when bacteria, saliva, food particles, and debris from cells lining the mouth get trapped in tiny indentations called crypts.

They vary considerably between people, including:

• Size. They may be so small that you can’t see them with the naked eye. Or they may grow to the size of gravel or, rarely, much larger.
• Consistency. They’re often soft but may calcify, becoming hard as a rock. Hence, the name.
• How long they last. Tonsil stones can last days to weeks, or may persist far longer before they break up and fall out.
• How often they occur. New tonsilloliths may appear several times each month or just once or twice a year.

While they’re more likely to form if you have poor oral hygiene, good oral hygiene doesn’t provide complete protection. Even those who brush, floss, and see their dentists regularly can develop tonsil stones.

How common are tonsil stones?

You’ve heard of kidney stones and gallstones, right? Clearly, those conditions are better known than tonsil stones. Yet tonsil stones are far more common: studies suggest that up to 40% of the population have them. Fortunately, unlike kidney stones and gallstones, tonsil stones are usually harmless.

What are the symptoms of tonsil stones?

Often people have no symptoms. In fact, if tonsil stones are small enough, you may not even know you have them. When tonsil stones do cause symptoms, the most common ones are:

• sore throat, or an irritation that feels as though something is stuck in the throat
• bad breath
• cough
• discomfort with swallowing
• throat infections.

Who gets tonsil stones?

Anyone who has tonsils can get them. However, some people are more likely than others to form tonsil stones, including those who

• have tonsils with lots of indentations and irregular surfaces rather than a smooth surface
• smoke
• drink lots of sugary beverages
• have poor oral hygiene
• have a family history of tonsil stones.

How are tonsil stones treated?

That depends on whether you have symptoms and how severe the symptoms are.

• If you have no symptoms, tonsil stones may require no treatment.
• If you do have symptoms, gargling with salt water or removing tonsil stones with a cotton swab or a water flosser usually helps. Avoid trying to remove them with sharp, firm objects like a toothpick or a pen, as that can damage your throat or tonsils.
• If your tonsils are inflamed, swollen, or infected, your doctor may prescribe antibiotics or anti-inflammatory medications.

Is surgery ever necessary?

Occasionally, surgery may be warranted. It’s generally reserved for people with severe symptoms or frequent infections who don’t improve with the measures mentioned above.

Surgical options are:

• tonsillectomy, which is removing the tonsils
• cryptolysis, which uses laser, electrical current, or radio waves to smooth the deep indentations in tonsils that allow stones to form.

Can tonsil stones be prevented?

Yes, there are ways to reduce the risk that tonsil stones will recur. Experts recommend the following:

• Brush your teeth and tongue regularly (at least twice a day: in the morning and before sleep).
• Floss regularly.
• Gargle with salt water after eating.
• Eliminate foods and drinks that contain a lot of sugar, which feeds bacteria that can help stones form.
• Don’t smoke, because smoking irritates and inflames tonsils, which can encourage stone formation. The same may apply to vaping, though there is limited research to rely upon.

The bottom line

Considering how common tonsil stones are and how bothersome they can be, it seems strange that they aren’t more well known. Maybe that’s because they often get better on their own, or people figure out how to deal with them without needing medical attention.

I hope you aren’t one of the many millions of people bothered by tonsil stones. But if you are, it’s good to know that they’re generally harmless and can be readily treated and prevented.

Now that you know more about them, feel free to spread the word: tonsil stones should be a secret no more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

When you live in a coastal area, preparing early for potential hurricanes is a must. Storms can develop quickly, leaving little time to figure out where you’ll be safe or which items to pack if you have to evacuate. And health care necessities, such as medications or medical equipment, are often overlooked in the scramble.

“People might bring their diabetes medication but forget their blood sugar monitor, or bring their hearing aids but forget extra batteries for them,” says Dr. Scott Goldberg, medical director of emergency preparedness at Brigham and Women’s Hospital and a longtime member of a FEMA task force that responds to hurricane-damaged areas.

Here’s some insight on what to expect this hurricane season, and how to prioritize health care in your hurricane kit.

What will the 2024 hurricane season look like?

This year’s hurricane predictions underscore the urgency to start preparations now.

Forecasters with the National Oceanic and Atmospheric Administration's National Weather Service expect above-normal activity for the 2024 hurricane season (which lasts until November 30).

Meteorologists anticipate 17 to 25 storms with winds of 39 mph or higher, including eight to 13 hurricanes — four to seven of which could be major hurricanes with 111 mph winds or higher.

What kinds of plans should you make?

Preparing for the possibility of big storms is a major undertaking. Long before ferocious winds and torrential rains arrive, you must gather hurricane supplies, figure out how to secure your home, and determine where to go if you need to evacuate (especially if you live in a flood zone). Contact the emergency management department at your city or county for shelter information.

If you’ll need help evacuating due to a medical condition, or if you’ll need medical assistance at a shelter, find out if your county or city has a special needs registry like this one in Florida. Signing up will enable first responders to notify you about storms and transport you to a special shelter that has medical staff, hospital cots, and possibly oxygen tanks.

What should you pack?

While a shelter provides a safe place to ride out a storm, including bathrooms, water, and basic meals, it’s up to you to bring everything else. It’s essential to pack medical equipment and sufficient medications and health supplies.

“It’s natural to just grab the prescription medications in your medicine cabinet, but what if it’s only a two-day supply? It might be a while before you can get a refill. We recommend at least a 14-day or 30-day supply of every prescription,” Dr. Goldberg says. “Talk to your doctor about the possibility of getting an extra refill to keep on standby for your go bag.”

Other health-related items you’ll want to pack include:

• medical supplies you use regularly, such as a blood pressure monitor, heart monitor, CPAP machine, wheelchair, or walker
• over-the-counter medicines you use regularly, such as heartburn medicine or pain relievers
• foods for specific dietary needs, such as gluten-free food if you have celiac disease (if you have infants or children, you’ll need to bring foods they can eat)
• healthy, nonperishable snacks such as nuts, nut butters, trail mix, dried fruit, granola bars, protein bars, and whole-grain bread, crackers, or cereals
• hygiene products such as soap, hand sanitizer, toothbrushes and toothpaste, shampoo, deodorant, infant or adult diapers, lip balm, moist towelettes, and toilet paper — because shelters often run out of it.

Remember the basics

In some ways, you can think of shelter living like camping. You’ll need lots of basic supplies to get through it, including:

• a sleeping bag or blanket and pillow for each person in your family
• clean towels and washcloths
• a few extra changes of clothes per person
• a first-aid kit
• flashlights and extra batteries
• chargers for your electronic gadgets
• rechargeable battery packs.

Bring important paperwork

In addition to supplies, bring important documents such as:

• a list of your medications, vitamins, and supplements (include the name, dose, and frequency of each one)
• a list of the names, addresses, and phone numbers of your primary care provider and any specialists who treat you
• a list of your emergency contacts and their phone numbers
• your pharmacy’s phone number and address
• copies of your birth certificate and driver’s license
• copies of home, car, or life insurance policies
• copies of your health insurance cards
• a copy of your advance directive — which includes your living will and health care proxy form.

“Store these documents on a flash drive. Also make photocopies of them, which are easiest for doctors to consult in an emergency setting. Place them in a plastic zip-top bag to keep them dry,” Dr. Goldberg advises.

Prepare right now

Start today. Gather as many go-bag supplies as you can, including the bags. A small suitcase, backpack, or duffel bag for each person in your family will work well.

And try not to put off these important preparations. “Hurricanes are major stressors. You might be worried, sleep deprived, fatigued, and emotional,” Dr. Goldberg says. “All of that will make it hard to think clearly. You’ll do yourself and your family a favor by having discussions now and getting started on your hurricane plan.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

If you’ve ever tried to lose excess weight, you’ve probably gotten this advice: drink more water. Or perhaps it was more specific: drink a full glass of water before each meal.

The second suggestion seems like a reasonable idea, right? If you fill your stomach with water before eating, you’ll feel fuller and stop eating sooner. But did that work for you? Would drinking more water throughout the day work? Why do people say drinking water can help with weight loss — and what does the evidence show?

Stretching nerves, burning calories, and thirst versus hunger

Three top theories are:

Feel full, eat less. As noted, filling up on water before meals has intuitive appeal. Your stomach has nerves that sense stretch and send signals to the brain that it’s time to stop eating. Presumably, drinking before a meal could send similar signals.

• The evidence: Some small, short-term studies support this idea. For example, older study subjects who drank a full glass of water before meals tended to eat less than those who didn’t. Another study found that people following a low-calorie diet who drank extra water before meals had less appetite and more weight loss over 12 weeks than those on a similar diet without the extra water. But neither study assessed the impact of drinking extra water on long-term weight loss.

Burning off calories. The water we drink must be heated up to body temperature, a process requiring the body to expend energy. The energy spent on this — called thermogenesis — could offset calories from meals.

• The evidence: Though older studies provided some support for this explanation, more recent studies found no evidence that drinking water burned off many calories. That calls the thermogenesis explanation for water-induced weight loss into question.

You’re not hungry, you’re thirsty. This explanation suggests that sometimes we head to the kitchen for something to eat when we’re actually thirsty rather than hungry. If that’s the case, drinking calorie-free water can save us from consuming unnecessary calories — and that could promote weight loss.

• The evidence: The regulation of thirst and hunger is complex and varies over a person’s lifespan. For example, thirst may be dulled in older adults. But I could find no convincing studies in humans supporting the notion that people who are thirsty misinterpret the sensation for hunger, or that this is why drinking water might help with weight loss.

Exercise booster, no-cal substitution, and burning fat demands water

Being well-hydrated improves exercise capacity and thus weight loss. Muscle fatigue, cramping, and heat exhaustion can all be brought on by dehydration. That’s why extra hydration before exercise may be recommended, especially for elite athletes exercising in warm environments.

• The evidence: For most people, hydrating before exercises seems unnecessary, and I could find no studies specifically examining the role of hydration to exercise-related weight loss.

Swapping out high calorie drinks with water. Yes, if you usually drink high-calorie beverages (such as sweetened sodas, fruit juice, or alcohol), consistently replacing them with water can aid weight loss over time.

• The evidence: A dramatic reduction in calorie intake by substituting water for higher-calorie beverages could certainly lead to long-term weight loss. While it’s hard to design a study to prove this, indirect evidence suggests a link between substituting water for high-cal beverages and weight loss. Even so, just as calorie-restricting diets are hard to stick with over the long term, following a water-only plan may be easier said than done.

Burning fat requires water. Dehydration impairs the body’s ability to break down fat for fuel. So, perhaps drinking more water will encourage fat breakdown and, eventually, weight loss.

• The evidence: Though some animal studies support the idea, I could find no compelling evidence from human studies that drinking extra water helps burn fat as a means to lose excess weight.

The bottom line

So, should you bump up hydration by drinking water before or during meals, or even at other times during the day?

Some evidence does suggest this might aid weight loss, at least for some people. But those studies are mostly small or short-term, or based on animal data. Even positive studies only found modest benefits.

That said, if you think it’s working for you, there’s little downside to drinking a bit more water, other than the challenge of trying to drink if you aren’t particularly thirsty. My take? Though plenty of people recommend this approach, it seems based on a theory that doesn’t hold water.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. “Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood,” says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don’t have these symptoms.

What’s more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don’t have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.

Myth # 1: Celiac disease is usually diagnosed at a young age

Not typically. While celiac disease can develop any time after a baby’s first exposure to gluten, it’s usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.

Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto’s thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).

“We don’t know why some people go from being susceptible to actually having celiac disease,” says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may “flip the switch” and cause the disease to appear, he says. “Increasing numbers of people are being diagnosed at midlife and older, often after they’re found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies,” says Dr. Kelly.

Myth #2: Celiac disease only affects the gut

When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.

While gastrointestinal problems can occur, they aren’t always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.

Myth # 3: Celiac disease versus gluten intolerance

If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.

• Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
• Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.

“Non-celiac gluten sensitivity appears to be a real phenomenon, but it’s not well defined,” says Dr. Kelly. It’s unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.

• One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
• Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.

Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease

The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn’t always help. This problem is known as nonresponsive celiac disease.

“About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet,” says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.

Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:

• Enzymes that break down gluten, which people could take alongside gluten-containing foods. “It’s a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products,” says Dr. Kelly.
• Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
• Reprogramming the immune response to prevent the body from reacting to gluten.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Concussion is one of the most common injuries to the brain, affecting about two million children and teens every year. It is a particular kind of injury that happens when a blow to the head or somewhere else on the body makes the brain move back and forth within the skull.

It’s possible to get a concussion after what might seem like a minor injury, like a forceful push from behind, or a collision between two players in a football or soccer game.

What are the signs and symptoms of concussion?

Because the injury may not seem that significant from the outside, it’s important to know the symptoms of a concussion. There are many different possible symptoms, including

• passing out (this could be a sign of a more serious brain injury)
• headache
• dizziness
• changes in vision
• feeling bothered by light or noise
• confusion or feeling disoriented
• memory problems (such as difficulty remembering details of the injury) or difficulty concentrating
• balance or coordination problems
• mood changes.

Some of these are visible to others and some are felt by the person with the concussion. That’s why it’s important to know the signs and to ask all the right questions of a child who has had an injury.

Sometimes the symptoms might not be apparent right away, but show up in the days following the injury. The CDC’s Heads Up website has lots of great information about how to recognize a concussion.

How can further harm to the brain be avoided?

The main reason it’s important to recognize a possible concussion early is that the worst thing you can do after getting a concussion is get another one. The brain is vulnerable after a concussion; if it is injured again, the symptoms can be longer lasting — or even permanent, as in cases of chronic traumatic encephalopathy (CTE), a condition that has been seen in football players and others who have repeated head injuries.

If there is a chance that a child has had a concussion during a sports competition, they must stop playing — and get medical attention. It’s important to get medical attention any time there is concern about a possible concussion, both to be sure there isn’t a more serious brain injury, and to do a good assessment of the symptoms, so that they can be monitored over time. There are some screening questionnaires that are used by doctors that can be used again in the days and weeks after the concussion to see how the child is improving.

What helps children recover after a concussion?

Experts have struggled with figuring out how to protect the brain after a concussion. For a long time, the recommendation was to rest and do very little at all. This meant not doing any exercise, not going to school, not even reading or watching television. As symptoms improved, the restrictions were lifted gradually.

Over time, though, research showed that not only was this much rest not necessary, it was counterproductive. It turns out that getting kids back into their daily lives, and back into being active, is safe and leads to quicker recovery. Experts still recommend rest and then moving gradually back into activities, but the guidelines are no longer as strict as they once were.

One important note: A medical professional should guide decisions to move from rest to light activity, and then gradually from there to moderate and then regular activities based on how the child is doing. This step-by-step process may extend for days, weeks, or longer, depending on what the child needs. Parents, coaches, and schools can help support a child or teen as they return to school and return to activities and sports.

Some children will be able to get back into regular activities quickly. But for others it can take weeks or even months. Schools and sports trainers should work with children to support them in their recovery. Some children develop post-concussive syndromes with headache, fatigue, and other symptoms. This is rare but can be very disabling.

How can parents help prevent concussions?

It's not always possible to prevent concussions, but there are things that parents can do:

• Be sure that children use seat belts and other appropriate restraints in the car.
• Have clear safety rules and supervise children when they are playing, especially if they are riding bikes or climbing in trees or on play structures.
• Since at least half of concussions happen during sports, it’s important that teams and coaches follow safety rules. Coaches should teach techniques and skills to avoid dangerous collisions and other injuries. Talk to your child’s coaches about what they are doing to keep players safe. While helmets can prevent many head injuries, they don’t prevent concussions.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Don’t worry. It’s good advice if you can take it. Of course that’s not always easy, especially for health concerns.

The truth is: it’s impossible (and ill-advised) to never worry about your health. But are you worrying about the right things? Let’s compare a sampling of common worries to the most common conditions that actually shorten lives. Then we can think about preventing the biggest health threats.

Dangerous but rare health threats

The comedian John Mulaney says the cartoons he watched as a child gave him the impression that quicksand, anvils falling from the sky, and lit sticks of dynamite represented major health risks. For him (as is true for most of us), none of these turned out to be worth worrying about.

While harm can befall us in many ways, some of our worries are not very likely to occur:

• Harm by lightning: In the US, lightning strikes kill about 25 people each year. Annually, the risk for the average person less than one in a million. There are also several hundred injuries due to nonfatal lightning strikes. Even though lightning strikes the earth millions of times each year, the chances you’ll be struck are quite low.
• Dying in a plane crash: The yearly risk of being killed in a plane crash for the average American is about one in 11 million. Of course, the risk is even lower if you never fly, and higher if you regularly fly on small planes in bad weather with inexperienced pilots. By comparison, the average yearly risk of dying in a car accident is approximately 1 in 5,000.
• Snakebite injuries and deaths: According to the Centers for Disease Control and Prevention, an estimated 7,000 to 8,000 people are bit by poisonous snakes each year in the US. Lasting injuries are uncommon, and deaths are quite rare (about five per year). In parts of the country where no poisonous snakes live, the risk is essentially zero.
• Shark attacks: As long as people aren’t initiating contact with sharks, attacks are fairly uncommon. Worldwide, about 70 unprovoked shark attacks occur in an average year, six of which are fatal. In 2022, 41 attacks occurred in the US, two of which were fatal.
• Public toilet seats: They may appear unclean (or even filthy), but they pose little or no health risk to the average person. While it’s reasonable to clean off the seat and line it with paper before touching down, health fears should not discourage you from using a public toilet.

I’m not suggesting that these pose no danger, especially if you’re in situations of increased risk. If you’re on a beach where sharks have been sighted and seals are nearby, it’s best not to swim there. When in doubt, it’s a good idea to apply common sense and err on the side of safety.

What do Google and TikTok tell us about health concerns?

Analyzing online search topics can tell us a lot about our health worries.

The top Google health searches in 2023 were:

• How long is strep throat contagious?
• How contagious is strep throat?
• How to lower cholesterol?
• What helps with bloating?
• What causes low blood pressure?

Really? Cancer, heart disease and stroke, or COVID didn’t reach the top five? High blood pressure didn’t make the list, but low blood pressure did?

Meanwhile, on TikTok the most common topics searched were exercise, diet, and sexual health, according to one study. Again, no top-of-the-list searches on the most common and deadly diseases.

How do our worries compare with the top causes of death?

In the US, these five conditions took the greatest number of lives in 2022:

• heart disease
• cancer
• unintentional injury (including motor vehicle accidents, drug overdoses, and falls)
• COVID-19
• stroke.

This list varies by age. For example, guns are the leading cause of death among children and teenagers (ages 1 to 19). For older teens (ages 15 to 19), the top three causes of death were accidents, homicide, and suicide.

Perhaps the lack of overlap between leading causes of death and most common online health-related searches isn’t surprising. Younger folks drive more searches and may not have heart disease, cancer, or stroke at top of mind. In addition, online searches might reflect day-to-day concerns (how soon can my child return to school after having strep throat?) rather than long-term conditions, such as heart disease or cancer. And death may not be the most immediate health outcome of interest.

But the disconnect suggests to me that we may be worrying about the wrong things — and focusing too little on the biggest health threats.

Transforming worry into action

Most of us can safely worry less about catching something from a toilet seat or shark attacks. Instead, take steps to reduce the risks you face from our biggest health threats. Chipping away at these five goals could help you live longer and better while easing unnecessary worry:

• Choose a heart-healthy diet.
• Get routinely recommended health care, including blood pressure checks and cancer screens, such as screening for colorectal cancer.
• Drive more safely. Obey the speed limit, drive defensively, always wear a seatbelt, and don’t drive if you’ve been drinking.
• Don’t smoke. If you need to quit, find help.
• Get regular exercise.

The bottom line

Try not to focus too much on health risks that are unlikely to affect you. Instead, think about common causes of poor health. Then take measures to reduce your risk. Moving more and adding healthy foods to your meals is a great start.

And in case you’re curious, the average number of annual deaths due to quicksand is zero in the US. Still a bit worried? Fine, here’s a video that shows you how to save yourself from quicksand even though you’ll almost certainly never need it.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD