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Trigger factors differ from person to person as intensity and frequency of

occurrence of migraine attacks also differ from person to person.

Nevertheless, a few common triggers are:

¾ Tiredness and exhaustion

¾ Stress from physical and environmental factors

¾ Over-illumination or glare

¾ Missing meals or fasting

¾ Excessive or lack of Sleep

¾ Changes in atmospheric pressure

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¾ Changes in altitude

¾ Loud unusual noises and strong smells and scents

¾ Intense physical activity, including sexual activity

¾ Hormonal changes

¾ Birth control pills

¾ Menstrual cycles

¾ Alcoholic beverages

¾ Chocolate

¾ Excess of caffeine

¾ Specific medications or food items affecting diameter of the blood vessels

¾ Specific foods containing additives

¾ Allergic food items

Doctors and researchers assert that the effect of dietary factors is more often

subjective. Some dietary components precipitate a migraine attack while some

others play no role at all.

Some foods which may be linked to migraines are:

¾ Hot dogs and pizza as they contain processed meat, fish, and nitrates

¾ Aged cheese, bread and crackers containing cheese

¾ Sourdough bread

¾ Chicken livers

¾ Alcoholic beverages like red wine

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¾ Dark chocolate

¾ Citrus fruits

¾ Aspartame (artificial sweetener)

¾ Caffeine

¾ Monosodium glutamate - This is an additive with natural and artificial

forms, that is commonly present in canned foods, Chinese food,

seasonings (like soy sauce) and tenderizers.

¾ Pickled foods

¾ Brewer's yeast, including fresh yeast, coffee cake, doughnuts

¾ Certain dairy products like buttermilk and sour cream

¾ Excess of onions

¾ Certain fruits like papaya and passion-fruit

¾ Preserved or marinated foods like olives

¾ Some snack foods

¾ Peanuts

¾ Broad beans, peas, lentils

Doctors normally advise you to stay away from such trigger foods and factors for

a considerable time. You can then try to eat these foods after a gap of a month

or more to help you better understand the extent and effect of such trigger

factors. You cannot ascribe any single factor as the apparent reason for such a

trigger. It could be combination of several factors.

However, dietary restrictions do not in any way reduce or eliminate a migraine

attack. You can probably reduce the intensity. Nevertheless, the major triggers

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are missing meals, excessive caffeine and intake of alcohol. The best option to

lessen the impact and frequency of migraine attacks is to moderate your body

functions. Follow a regular pattern of exercise, have timely meals with adequate

rest and try to lead a stress free life.

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7. What is the Real Cause of Migraine Headaches?

There are no clear medical reports to pinpoint any particular cause for migraine

headaches. However, the majority opinion favors changes in blood flow to the

brain. Normally, migraine patients have very sensitive blood vessels.

How Does it Happen?

Any stressful event affects your brain. This occurs mainly due to the

concentration of innumerable nerves in the arteries at the base of the brain.

Stress causes seizure or contraction of most of these nerves. This, in turn,

affects the functioning of the arteries carrying blood to the brain. Therefore, your scalp and arteries of your neck suffer from reduced blood supply.

So, your brain also receives less blood. The brain immediately senses some

danger, and that leads to the formation of blood clotting platelets. Serotonin is a chemical substance released during this process. This substance further restricts

the supply of blood to arteries and brain.

Lower blood supply leads to a lesser supply of oxygen to the brain. Lack of

oxygen causes unclear vision and/or speech, headache and other symptoms,

similar to those of a nervous breakdown.

A cyclic reaction takes place among the other arteries of the body. They widen to

carry more blood to the brain. However, such widening releases prostaglandins

from different blood cells and tissues. These prostaglandins are pain-causing

substances and lead to swelling and inflammation. The widening and resultant

inflammation causes the throbbing sensation. This sensation is primarily felt as

migraine headaches.

This shows that migraine headaches are primarily a neurological disorder. The

first affliction is in the nerves, which triggers a series of reactions and

counteractions in other body systems. Hence, you experience certain changes

and imbalances before the onset of migraine pain in the head.

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Such factors could start up to twenty-four hours before the migraine. Another

factor supporting this theory is that the effects of migraine headaches persist

even after the headache ceases. You feel a tender and uncomfortable feeling in

your head and it takes some time for you to recoup your previous thinking


A drop in serotonin levels leads to the release of neuropeptides by the trigeminal nerve. These neuropeptides dilate blood vessels, causing inflammation. Inflamed

blood vessels seem to hit across your head; this is the throbbing pain you feel

during a migraine attack.

Other Factors

There are various other migraine headache triggers too, such as the hormonal

changes in women during their menstrual cycles. This sets off migraine

headaches before or after periods. They sometimes also occur during pregnancy

and menopause. Women on birth control pills get more migraines.

Certain food items, additives and vegetable or fruits could also cause sensory

changes in your body leading to migraines. Environmental changes, medications,

irregular sleep and eating patterns are other major contributors.

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8. Risk Factors

Estimates say that more than thirty million Americans suffer from migraines.

Approximately 1/3 are male and the rest are female.

Risk factors include anything that induces or increases the chances of affliction of any disease or particular medical condition.

Major Risk Factors.

Certain major risk factors for the incidence of a migraine are:

Hormonal fluctuations: Hormones are most active in women between twenty

and fifty. Constant fluctuations occur in progesterone and estrogen levels during

this period. These changes bring the risk of migraines and may decide their

severity too.

Similarly, the premenstrual and postmenstrual time is a risky period for a

migraine to occur. Pregnant women experience migraines in the initial stages.

Women on birth control pills or hormone replacement therapies have a higher

risk of incidence of a migraine, not only during the normal course, but also

during pregnancy and menstruation.

Lack of Sleep or Sleep Apnea: Irregular and insufficient sleep patterns,

insomnia or excessive sleep are all contributing factors.

Depression: Anxious thoughts, pessimism and mental disturbances hamper

normal functioning of your nervous system and brain. This triggers a chain of

reactions in other body systems leading to severe headaches. Such depression

also causes grinding and clenching of teeth.

Arthritis: Wrong posture can lead to arthritis in the neck muscles. This upsets the regular supply of blood and oxygen to the brain causing migraines.

Irregular Meals: Skipping meals, fasting and having food at odd times of the day disrupts body functioning. Your body is unable to receive the necessary

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energy for functioning. A lack of sufficient nutrition at proper intervals leads to migraines.

Specific Food Additives and Nitrates: Certain foods contain monosodium

glutamate (MSG) or nitrates. These may trigger migraine headaches.

Alcohol: Red wine is a major cause for a migraine.

Stress: Excessive physical stress, including increased sexual activity and mental exhaustion, can trigger migraines.

Medications: Certain medications causing dilation of blood vessels can bring the risk of a migraine. Daily use of headache remedies is another major risk factor.

Hereditary: Hereditary genes could cause migraines. If either or both parents have migraines, there is every possibility of the offspring developing a migraine

at some or other time in their lives. This could be due to certain genetic

problems in blood vessel regulation.

Perfumes and Strong Scents: These trigger certain involuntary reactions

within your body which may pre-dispose you to develop migraines.

Excessive lights and sound: Blaring noise and bright lights increase activity of your nerve cells triggering headaches.

Physical changes in environment: Higher altitude with marked changes in

weather or time zone could lead to upsets in your body systems, triggering

migraine headaches.

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9. Who Gets Migraine Headaches?

Migraine headaches show greater incidence among certain categories of people.

The occurrence of a migraine does not follow any specific pattern. Nevertheless,

a generalized pattern stems from the frequency of its occurrence. Migraine

headaches occur commonly in the following categories:

Age: A migraine occurs between the ages of ten and forty. Although the

incidence of a migraine decreases after forty, late life migraines may develop in a very few cases; about one percent of the population. Similarly, very young

children and infants also suffer from migraines, but the percentage is very low.

Genetic: Repeat from an earlier reference. Genes play a major role in your migraine. If either or both parents have migraine problems, there is every

possibility for you to develop a pattern of migraines.

Ethnic Differences: According to a worldwide study, migraines are most

common in North America, with lesser incidences in South America, Europe, Asia,

and Africa. However, doctors think genetic causes are responsible, and place less

importance on environmental factors.

Gender: Women are at a higher risk to suffer from a migraine across the world.

The percentage remains the same among boys and girls during childhood but the

percentage of incidence is much greater in girls after puberty.

Hormone Fluctuations in Women: The hormonally-active years of women

between adolescence and menopause experience the maximum fluctuations in

the hormones; estrogen and progesterone. This triggers a migraine in many

women. Similarly, pregnant women, women on contraceptives (or hormone

replacement therapies) and menstruating women experience migraines.

Medical Conditions: Specific infections like peptic ulcers due to bacteria H.

pylori and allergies can cause a migraine. Asthmatic patients suffer migraines

and could pass it on to their children. Epileptic patients have a greater chance of a migraine as they already suffer from nerve disorders. Fibromyalgia patients

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suffer from intense muscular pain and resultant fatigue. Excessive muscular

fatigue could also trigger a migraine.

Personality Traits: Although a migraine afflicts women more than men,

apparently strong-willed and conscientious women do not suffer from the

onslaught of a migraine. Weak women with a submissive personality have a

higher risk of a migraine.

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10. Migraine Headaches in Children

Migraines affect children too. It could start from the age of seven or ten. It

affects boys and girls equally. However, boys outgrow a migraine in their

adolescence while girls experience them with greater frequency and intensity due

to hormonal changes.

Children are often unable to express any symptoms of a migraine. Therefore, if

headaches occur weekly or occur regularly, it is best to consult a doctor to

determine the specific causes. Very young children unable to express migraine

headache pain could just hold their heads in their hands and cry. Nevertheless,

there is no specific rule or guideline to predict occurrence and presence of a

migraine in your child.


A migraine in children is predominantly a hereditary feature. There are other

contributing factors too, like:

Excessive noise and light: Bright light and loud noises, like those of movies on television, could trigger a migraine. Environmental changes and strong odors

may also cause a migraine.

Emotional disturbances: School problems, peer pressure and parental

expectations cause high stress and anxiety levels in children. Depression sets in

and leads to sad and lonely feelings and thoughts, sometimes causing a


Viral Infections: Viral infection in any part of the body like nose, urinary tract, or lungs could cause fever and associated headaches. Sometimes, these

headaches assume the form of a migraine.

Brain Tumors and Meningitis: A brain tumor is a rare occurrence in children.

However, migraines occur with increased frequency as the tumor grows. The

location of the tumor also decides the severity of a migraine. Meningitis is an

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inflammatory condition affecting the nervous system. Pressure on the brain

increases and therefore, leads to severe headaches and migraines.

Common Infections: Common infections like eye infections, ear infections, and sinus among others trigger headaches. Such headaches could become a regular

feature and assume the form of a migraine.

Head trauma: Children often suffer accidental bumps on their head. Although such headaches do not persist, headaches can occasionally graduate into

frequent instances of a migraine. Such injuries also cause nausea, confusion,

vomiting or changes in consciousness or response time.

Specific foods and beverages: Specific foods like bologna, bacon and hot dogs contain monosodium glutamate or MSG. This causes headaches in some people.

Similarly, certain beverages like chocolate, caffeine, and soda also are believed

to sometimes trigger migraines.

Lack of Sleep: Insufficient sleep causes overtiredness and may lead to


Excessive exposure to sun: Playing for long hours in hot sun could trigger a migraine.


Migraines in children could be with or without an aura. Flashing lights, blind spots in vision, wavy lines with disrupted vision may appear before and signal the

arrival of a migraine within few hours. Some children experience these indicators

with stomach pain before an abdominal migraine.

A migraine without aura is most common among children. Symptoms include

nausea, vomiting, giddiness, fatigue, mood changes, special cravings for foods

and sugary snacks, or a loss of appetite. Your child could develop a fever of 102

to 103 degrees and diarrhea too. Your child could also lose his/her sense of


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Preventive Measures

Assure adequate rest, with eight to ten hours of deep sleep and proper intake of

food at correct timings, for your child. Maintain a headache diary with details of their time, frequency, and place of occurrence. Avoid stressors and cultivate a

healthy balance in your child’s life.


Always consult your doctor and give the prescribed medicines in appropriate

dosages to your child. You could help them to develop certain behavioral

patterns and changes to lower stress levels and develop a balanced life pattern.

Professional and peer counseling could work fine for curing stress-related

migraine problems. Do not take migraine problems in your children lightly.

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11. Recent Research on Migraine Headaches

The length, severity and frequency of occurrence of a migraine depend on an

individual’s conditions. These features also differ from attack to attack. You need proper treatment, not only during a migraine attack but also after that, to

prevent further attacks or lower impact of future attacks.

Different professional and consumer medical organizations are conducting

regular and detailed research into the possible causes, and ways to lower the

intensity and occurrence, of a migraine. Healthcare professionals, from across

different strata and disciplines, are joining hands to conduct effective research

and providing better remedies.

Recent Research Findings

The National Headache Foundation conducted a ten-year study on the prevalence

of migraine headaches in the United States. The report was released at the 13th

Annual Conference of the Diamond Headache Clinic Research and Education

Foundation on February 22, and contained about 2000 submitted details of

studies between 1989 and 1999.

The report clearly indicates that migraine sufferers continue to suffer and bear

their severe headaches despite developments in medicine. The major problem,

often, is a misdiagnosis of migraine headaches as sinus headaches and

administration of relevant medication. Hence, migraine sufferers often do not

receive proper treatment and continue to suffer.

Implantable Neurotransmitter

Many migraine sufferers could well be in sight of a suitable remedy for their

migraine headaches. Recently, researchers developed an implantable

neurotransmitter. Although these devices are on their clinical trials at this

writing, such devices could be of immense help to patients who suffer severe

migraines who cannot bear the side-effects of prevalent medications and do not

have any favorable response to available therapies.

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Boston Scientific has now put up a Precision Implantable Stimulator for migraines

(PRISM) on a trial basis. Roger Cady, M.D., Director of Clinvest and the

Headache Care Center in Springfield, MO, is upbeat about the possible positive

impact of the device on the lives of migraine-affected people that find no respite from their migraine despite using various conventional therapies.

However, presently, a precision neuro stimulation system is in use for treatment

of intractable chronic pain of trunk and limbs. Hence, usage for a migraine is still in the early investigation stage.

Loma Linda University’s School of Public Health in California conducted a clinical study to find if a high-complex carbohydrate diet could provide relief from migraine attacks. The result of such a diet was astounding. More than 94% of

the patients reported a 40% decrease in their headaches. Fifty percent of the

patients reported total freedom from the debilitating pain. The perceived

improvements seemed mostly to be about the intensity, frequency, duration and

the need for medication to treat migraines which reduced up to 70%, according

to reports.

The Loma Linda University was the first to treat a migraine with changes in a

person’s lifestyle. Dietary changes reduced blood-fat levels considerably. This

helped to restore the necessary biochemical balance in the body. Further

research and tests could confirm whether or not this therapy might be confirmed

as a method of preventing migraine attacks.

Many television and radio stations, popular magazines like Women's Health

Today, Men’s Health, Glamour, Allure and others reported the findings of the

study. They also carried detailed reports about the specific diets that they

reported as providing relief to many migraine sufferers across the world.

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Part-III: Diagnosis of Migraine Headaches

12. How to Diagnosis Migraine Headaches

Migraine headaches occur due to a variety of causes. Doctors and physicians

follow a set pattern for diagnosis of a migraine. The very first step is to look for hereditary factors. Doctors often advise chronic headache patients to maintain a

diary to record the time and specific features of their headache.

You have to give details of:

¾ Time of occurrence of headache; both the dates and time of day too

¾ Type of pain; whether it is throbbing, splitting, mild or unbearable

¾ Location of the pain; on one side of the head or all over the head

¾ Accompanying symptoms; nausea, vomiting, giddiness, pain in the


¾ Duration of the headache; an hour, few hours, or few days

¾ Frequency of occurrence; fortnightly, monthly, intermittently, or during specific periods like menstrual cycle

¾ Place of occurrence; indoors or outdoors

¾ Proximity to any strong odors or scents

¾ Any specific medications that seemed to provide relief

¾ Any stress related cause; physical exertion, intense sexual activity or emotional outburst

¾ Lack of proper meals or hydration

¾ Environmental factors; weather or altitude

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¾ Any physical injuries

¾ Any inherent medical disorders

After collecting all available relevant information, doctors conduct urinalysis and blood chemistry tests. These can expose any underlying medical conditions like

infections and thyroid; these conditions often precipitate and trigger a headache.

If migraines run in your family, doctors advise various tests and brain scans to

understand the extent of a migraine. Otherwise, if you suffer from sudden and

severe headaches, you need specific vision checks with CT scan and MRI.

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Scans and Tests

CT scans

A CT scan is a computerized tomography scan of your head. Doctors conduct this scan through X-rays and try to locate any untoward growth, swelling, or

inflammation that could be the cause of your headache. This test can divulge

details of sinus problems, strokes, and tumors.

MRI scans

An MRI scan is a scan through Magnetic Resonance Imaging. This is a diagnostic

procedure to form images of your inner body parts and organs through a

combination of radio waves, computer technology, and a strong magnetic field.

You lie on a table while the detectors take measurements of your head from

various angles. Different computer processes form three-dimensional pictures of

your brain and head.

An MRI is a costlier procedure but delivers detailed revelations. MRI scans are

without iodine or contrast dye. You get to know of any sinus problems, malignant

diseases, skull fractures, concussions or other serious medical problems.

Lumbar Puncture or Spinal Tap

Sometimes doctors take some fluid from your lumbar region for testing about

your headaches. This test detects any brain diseases like subarachnoid

hemorrhage or meningitis. Tests of a sample of the cerebrospinal fluid (CSF) can

detect any such disease. You could develop a headache after this test as drawing

of fluid upsets your CSF pressure. This test carries the risk of infection too. The test lasts for around half an hour.

Sinus X-Ray

This can detect and provide a clearer picture if you have any sinus-related

problems where your headache could be an aftermath of such infection.

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Neurological and Ophthalmology Tests

Different neurological diseases, including epilepsy, could be the cause of your

headache, and eye and vision problems could also trigger a severe headache.

Therefore, your doctor conducts tests to determine existence of any of these

diseases and resultant headaches.

Skeletal Tests

Normally, all headaches are due to imbalances of skeletal and neuromuscular

muscles. A headache might be dependent on placement and positioning of your

jaw, skull and neck bones. Any dislocation or wrong shape and positioning could

cause severe headaches.

There are more than 300 muscles attaching your jaws, neck, and skull. 298 of

these muscles do the work of closing your lower jaw to fit in well within the skull.

A normal human uses the lower jaw more than 5,000 times each day. Therefore,

any abnormal compression, malalignment or dysfunction in the muscles around

these organs can cause headaches.

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Other Factors

Orthodontic Care

Orthodontic care is essential for proper functioning of your teeth and lower jaw.

Premolar extractions and other teeth problems sometimes shrink the jaw joints.

This leads to migraine headaches. Hence, you may not have any migraine

headaches in your genes but improper care during dentistry could lead to the

occurrence of a migraine.

Chronic Neck and Shoulder Pain

Neck, shoulder, and jawbones work with each other. Any of these bones that

suffer any damage can cause problems for the others. You need to have a proper

tests and treatment to deal with all such problems. Physical therapy can provide

temporary relief. Prolonged prevalence of the problem causes a migraine.

Perennial tiredness and exhaustion could be due to sleep disturbances and lack

of a deep and regular sleep pattern. Such deprivation could be due to certain

specific problems like snoring asthma, or sleep apnea. Treating these disorders

can provide relief from headaches.

Prolonged pain and physical disorders often cause anxiousness and depression

for you. Depression causes problems in your nervous system. The most

important nerve of your body is the trigeminal nerve. This nerve takes care of

fifty percent of processing and working of your brain. It controls blood flow and

regulation within your head. Any disturbance in the working of this nerve may

cause serious problems to your brain and its functioning. This leads to severe

pain in your head and a migraine.


These tests can help to throw light on any medical condition you have. Doctors

can then analyze the occurrence of your headache and whether it may be

because of the existence of such conditions.

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If none of your symptoms or tests reveal anything indicating any disease, you

suffer from migraine headaches.

A migraine exposes certain symptoms and signs, but these differ from person to

person and from situation to situation. Therefore, you cannot assert its existence is only due to the presence of specific factors. So, doctors must check for the

existence of any possible disease.

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Part-IV: Prevention of Migraine headaches

13. Ten Tips to Avoid Migraine Headaches

Medications can resolve your migraine attacks to a certain extent. Adopt certain

changes in your lifestyle to lower the severity and intensity of migraine attacks.

Ten tips to avoid migraine headaches:

1. Maintain a “migraine diary” . Record when and how your migraine

starts. Also, note down your diet, any stress problems, headache

medications, or any other intake and happening. You can thereby do away

with any migraine triggers. A trigger can have a relation to something

even forty-eight hours before a migraine attack. Such a diary helps your

physician to study your physiological behavior and more quickly arrive at

possible reasons for your migraine attack.

2. Provide good rest for your body. Aim to have a sound sleep for about

nine hours at night. At the same time, do not oversleep or indulge in long

sleeping hours during the daytime. Maintain a regular time schedule of

going to bed and waking up in the morning. Stick to the routine during

holidays and vacations too, as much as possible.

3. Develop a regular exercise routine. You could try simple aerobic

exercises like walking, swimming, cycling or other muscle relaxation

exercises. Make sure that you do not over-exert yourself and trigger a


4. Along with physical exercise, do simple mental exercises also.

Maintain your cool through relaxing techniques like meditation, yoga,

soothing music, reading a book, enjoying a hot bath or even gardening.

Set a specific time of each day for you to be alone. Think and focus on

yourself, your needs and your feelings. This recharges your energy and

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can help you to develop immense inner peace. A cool mind shoos away

many a migraine attack.

5. Hydrate your body sufficiently. Drink plenty of water and other fluids.

Take care to reduce caffeine and certain fruit juices as they could reduce

the water available to your brain and help to start a migraine.

6. Have regular healthy meals and snacks. Never skip meals or indulge

excessively in fast food. These actions can lead to a drop in blood sugar

levels and, thereby, a sharp drop in oxygen supply to brain. Plan balanced

meals at every mealtime and allocate some free time to have your meal in

peace despite hectic schedules.

7. Avoid specific scents, perfumes and strong aromas which may

affect you. If you are aware of any earlier triggers do away with them.

Smokers may have to quit the habit to get relief from migraines.

8. Reduce your intake of estrogen. CONSULT YOUR DOCTOR FIRST.

Migraines and high estrogen levels are a potent combination. Similarly,

reduce your intake of high blood pressure and stroke medications as they

contain high estrogen levels. Birth control pills and medications for

hormone replacement therapy may be factors in your migraines.

9. Form support groups among friends, colleagues and in chat rooms

and online forums. You will find out you are not alone. Share and