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As the adage goes, the eyes are the windows to the soul. So what does it mean to wish yours were a different color?

Apparently enough people share this desire to create a bustling market for color-changing eye drops, which are making the rounds through social media and online retailers.

Personalizing eye color might sound tempting, especially for younger people and those who enjoy experimenting with elements of fashion or style. But are over-the-counter, color-changing eye drops safe? The answer is a hard no, according to the American Academy of Ophthalmology (AAO), which recently issued a warning against “eye color-changing solutions.”

Why shouldn’t you try color-changing eye drops?

Color-changing eye drops aren’t approved by the FDA, haven’t been tested for safety or effectiveness, and could potentially damage people’s eyes, the AAO warns.

“It might seem benign when you see a product like this online,” says Dr. Michael Boland, an associate professor of ophthalmology and glaucoma specialist at Harvard-affiliated Mass Eye and Ear. “People think, ‘Why not try it?’.” “But there’s no way to know what’s in these bottles and no oversight over how they’re being made.”

How do the eye drops work?

That’s not clear. Companies manufacturing the drops claim the products adjust levels of melanin in the iris, the colored portion of the eyeball. Purportedly, the effects begin to be visible within hours and can last for a week or longer. If a user wants enduring results, they’ll need to continue using the product.

But these claims skirt a complete lack of evidence that the drops have any effects on the iris, much less the desired effects, Dr. Boland says.

“I’ve found zero descriptions of how they work in terms of a plausible mechanism,” he says. The ingredients list includes things that might be found in other eye drops or drugs or even cosmetics, but nothing that would actually change your eye color.”

How might the drops hurt your eyes?

The AAO lists a variety of potential safety risks from using these products or any other unregulated eye drops, including:

• inflammation
• infection
• light sensitivity
• increased eye pressure or glaucoma
• permanent vision loss.

“All of those problems are possible, since we don’t have any real idea what’s in these bottles,” Dr. Boland says. “The biggest concern is damage to the cornea, the clear part of the front of the eye. If the cornea is damaged by the chemicals in those bottles, you might lose vision.”

Are there safe alternatives to change eye color?

Still hankering for a way to get, say, Taylor Swift’s electric blue eyes or Julia Roberts’ golden brown peepers? There is a trustworthy option, Dr. Boland says: colored contact lenses. But he recommends choosing that option with caution.

“Professionally prescribed and dispensed contact lenses are a safe way to change your eye color,” he says. “But don’t buy them online. Get them from a reputable source to make sure they’ve been regulated and evaluated as safe, because contacts can damage the eye if they’re not designed properly or kept clean.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

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 an unfortunate reality: all medicines can cause side effects. While there are a few tried-and-true ways to deal with drug side effects, here’s a less common option to consider: adding a second medication.

That’s the approach taken with valbenazine (Ingrezza), a drug approved for a condition called tardive dyskinesia that’s caused by certain medicines, most of which are for mental health. Let’s dive into what TD is, how this drug is advertised, and what else to consider if a medicine you take causes TD.

What is tardive dyskinesia?

Tardive dyskinesia (TD) is a condition marked by involuntary movements of the face or limbs, such as rapid eye blinking, grimacing, or pushing out the tongue. TD is caused by long-term use of certain drugs, many of which treat psychosis.

TD may be irreversible. Early recognition is key to improvement and preventing symptoms from getting worse. If you take antipsychotic medicines or other drugs that can cause TD, tell your prescribing health care provider right away about any worrisome symptoms.

A sidewalk sale, a cookout in the park, and a pitch

One ad for Ingrezza starts with a young man working with customers at a sidewalk sale. Though his mental health is much better, he says, now he’s suffering with TD, a condition “that can be caused by some mental health meds.” A spotlight shines on his hands as he fumbles and drops an instant camera he’s selling. He seems embarrassed and his customers look perplexed.

Next we see a young woman at a cookout in a park. The mysterious spotlight is trained on her face as she blinks and grimaces involuntarily. Her voiceover explains that she feels like her involuntary movements are “always in the spotlight.”

Later these two happily interact with others, their movement problems much improved. A voiceover tells us Ingrezza is the #1 treatment for adults with TD. The dose — “always one pill, once a day” — can improve unwanted movements in seven out of 10 people. And people taking Ingrezza can stay on most mental health meds.

That’s the pitch. The downsides come next.

What are the side effects of this drug to control a side effect?

As required by the FDA, the ad lists common and serious side effects of Ingrezza, including

• sleepiness (the most common side effect)
• depression, suicidal thoughts, or actions
• heart rhythm problems
• allergic reactions, which can be life-threatening
• fevers, stiff muscles, or problems thinking, which may be life threatening
• abnormal movements.

That’s right, one possible side effect is abnormal movements — a symptom this drug is supposed to treat!

What the ad gets right

The ad

• appropriately highlights TD as a troubling yet treatable condition that can cause stress and embarrassment and affect a person’s ability to function
• emphasizes once-daily dosing, presumably because the recommended frequency of a competitor’s drug for TD is twice daily
• shares clinical studies that support effectiveness claims
• covers many of the most common and serious side effects.

What else should you know?

Unfortunately, the ad skims over — or entirely skips — some important details. Below are a few examples.

Which medicines cause TD?

We never learn which medicines can cause TD (especially when used long-term), which seems vital to know. Many, but not all, are used to help treat certain mental health disorders, such as schizophrenia or bipolar disorder. Here are some of the most common.

Mental health medicines:

• haloperidol (Haldol)
• fluphenazine (Prolixin)
• risperidone (Risperdal)
• olanzapine (Zyprexa).

Other types of medicines:

• metoclopramide (Reglan), which may be prescribed for nausea, hiccups, and a stomach problem called gastroparesis
• prochlorperazine (Compazine, Compro), most often prescribed for severe nausea, migraine headaches, or vertigo.

Also, the ad never explains that TD may be irreversible regardless of treatment. Because improvement is most likely if caught early, it’s important for people taking these medicines to check in with their health provider if they notice TD symptoms described above — especially if symptoms are growing worse.

What about effectiveness and cost?

Seven in 10 people reported that their symptoms improved, according to the ad. How much improvement? That wasn’t shared. But here’s what I found in a key study:

• Among 202 study participants with TD, only 24% reported having minimal or no symptoms of TD after six weeks of treatment with Ingrezza.
• Up to 67% of study subjects reported smaller improvements in symptoms.

What happens after six weeks? A few small follow-up studies suggest that some people who continue taking Ingrezza may improve further over time.

And the cost? That’s also never mentioned in the ad. It’s about $8,700 a month. No details on the financial assistance program, or who qualifies for free treatment, are provided.

Are there other ways to manage TD?

Well, yes. But the ad doesn’t mention those either. Three approaches to discuss with your healthcare provider are:

• Avoid drugs known to cause TD when other options are available.
• If you need to take these medicines, it’s safest to use the lowest effective dose for the shortest time possible. For example, limiting metoclopramide to less than three months lowers risk for TD.
• If you notice TD symptoms, ask about lowering the dose or stopping the offending drug right away. This may successfully reverse, or reduce, the symptoms.

If you have TD, you and your health care provider can consider several options:

• whether other drug treatments for TD not mentioned in the ad, such as deutetrabenazine (Austedo) or tetrabenazine (Xenazine), might cost less or minimize bothersome side effects
• botulinum toxin injections (Botox), which can relax the muscle contractions causing involuntary movements
• deep brain stimulation, which involves electrical stimulation to certain areas of the brain to interrupt nerve signals to abnormally contracting muscles.

The bottom line

The idea of treating a drug’s side effect with another drug may not be appealing. Certainly, it makes sense to try other options first.

But sometimes there are no better options. It’s always worth asking whether a treatment is worse than the disease. But TD is one situation in which all options — including a drug treatment for another drug’s side effects — are well worth considering.

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

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

Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

I never think about my gambling.

Sometimes I think about gambling less.

I have decided to gamble less.

I am already trying to cut back on my gambling.

I changed my gambling: I now do not gamble, or gamble less than before.

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD

The daily bath or shower is a routine for many of us — and for our children, too. But is it really necessary?

The short answer is no.

Obviously, there are days when washing up makes good sense — like if your child is grimy from a day in the dirt; covered in sweat, paint, or other visible dirt; or had an explosive poop. It’s also a good idea to wash up if your child has spent the day in a pool (the chlorine may be irritating to the skin), a body of water (there could be things in the water that are irritating or unhealthy), or used bug spray to ward off ticks and mosquitoes. And certainly, it’s best for everyone in the vicinity when a stinky teenager takes a soapy shower.

Sometimes a doctor may recommend daily bathing for certain skin conditions. And we all need to wash our hands regularly to prevent infection. But full-body washing just for the sake of washing? Not so much.

Why not bathe a child daily?

Lots of bathing can lead to dry, irritated skin. But also, the skin has natural protective oils, and natural bacteria, that help to keep us healthy and safe — and that can get washed away with daily bathing.

If your baby or preteen looks pretty clean, isn’t stinky, isn’t covered in bug spray, and hasn’t been in a pool or other body of water, it’s fine to skip the bath or shower. Really, bathing two or three times a week is fine. In fact, for many kids, even just once or twice a week is fine. You can always do a quick wipe with a wet washcloth to the face, groin area, and any dirty spots.

Stinky teenagers might need more bathing or showering, depending on activity level and deodorant use. But even they may be able to get away with washing their face and using a soapy washcloth on their groin and underarms.

Tips for healthy bathing

When you do bathe children, here are some tips for healthy bathing.

• Don’t use hot water — use warm water instead.
• Keep it short — preferably just enough time to get the washing done.
• Avoid antibacterial soaps and bubble baths. Use mild, unscented soap and shampoo.
• Make sure bathing is supervised for all babies and young children.
• Pat dry rather than rubbing dry. If your child tends to have dry skin, using a mild, unscented greasy moisturizer after the bath can be helpful.

If your child has eczema or any other skin condition, check with your doctor to get tailored advice for bathing your child.

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

Do you follow certain social media creators, music artists, actors, athletes, or other famous people? Are you a huge fan of particular fictional characters from a book, TV show, or movie? Perhaps you check in with them daily because you feel a connection, care about them, or just love keeping up with the minutiae of their lives.

These one-sided emotional ties to people you don't actually know (or those who don't actually exist) are called parasocial relationships. Like all relationships, they come with risks and benefits, says Arthur C. Brooks, a social scientist, best-selling author, and professor at both the Harvard Kennedy School and the Harvard Business School.

Why do we develop parasocial relationships?

Parasocial relationships tend to occur because of our natural tendency to link to others.

"Humans have evolved to thrive in groups, probably because 250,000 years ago you needed to rely on other people to survive by building social relationships. And so we become attracted to and care about people if we have a regular enough exposure to them," says Brooks.

We are all exposed regularly to tiny details about celebrities and fictional characters, watching their days unfold on social media or learning about them from a TV show or book. What hooks us is the emotional connection, especially if the person is exciting or compelling.

"That's the secret to the success of the Harry Potter book series and the TV show Breaking Bad. The writing is supposed to engage you emotionally," Brooks says. "People can form a bond even if the characters are psychopaths."

The upsides of parasocial relationships

Parasocial relationships can be a nice complement to your life. They might entertain you, inspire you, educate you, or bring you comfort. You might feel less lonely or like you're part of a tight group or a cultural moment, a feeling the shows Friends and Game of Thrones fostered for many people.

Bonding emotionally with famous or fictional people might also shape people's values. For example, children might learn lessons about right and wrong from characters they connect with on shows such as Sesame Street or Bluey. Teens or adults might feel moved to work harder if they're attached to champion athletes, or do good deeds if they admire selfless leaders.

One study of more than 300 people ages 18 to 35 even found that parasocial relationships might help reduce the stigma of mental health conditions. All participants watched one video of someone who shared personal information aimed at creating a social bond. Then, some participants also watched a video of the content creator sharing his challenges with bipolar disorder. Those who saw both videos scored lower on measures of prejudice about mental health conditions than those who only saw the first video.

The downsides of parasocial relationships

While parasocial relationships can enrich your life, these one-sided affairs can also hurt you.

• They won't love you back. "They're like fake food. They taste good, but they have no nutritional content and won't meet your needs. You need to love and be loved in return to thrive," Brooks says.
• They might contribute to loneliness and isolation if you rely on them too much. Loneliness and isolation are linked to increased risks of many chronic health problems such as depression, anxiety, dementia, and heart disease, and even premature death.
• They might have a negative influence on you. Are you picking up unhealthy ideas from the people you follow? Brooks says this should be a special concern for parents whose kids have parasocial relationships: The messages kids glean might be at odds with your values — perhaps because they are controversial political or adult themes.

Navigating parasocial relationships

A dollop of parasocial relationships in your life is fine as long as they don't crowd out real-life bonds or warp your thinking and values. But how would you know if this was becoming an issue?

Two red alerts:

• Ask yourself if you're too attached. For example, are you skipping dinner with friends because you prefer watching a TV show with a character you care about and want to connect with?
• Be wary. "If someone is trying to brainwash you, saying, 'I'm your friend, you can trust me,' that person is using a personal social bond to get you to do something — like vote a certain way," Brooks says. He points out that social media stars try to establish parasocial relationships with followers to get more clicks and make money. "That's what the new economy is all about — monetizing parasocial relationships on a mass scale," Brooks says.

Shifting from parasocial relationship to deeper connections

Parasocial relationships fill a need. Social scrolling, streaming shows, or following celebs may tamp down loneliness or offer curated moments of joy and connection. But if you're leaning too hard on these one-sided relationships, Brooks advises taking a hard look at what's missing from your life.

Forging warm connections in real life is worthwhile, though it isn't always easy. "It's a tall order for people who are shut-ins or introverted or don't have social skills, but you can start small. Have dinner with a friend. Spend more time with your family. Get more human eye contact. Touch, such as a hug, releases the bonding hormone oxytocin in the brain," Brooks suggests. "You'll care less about the characters and get what you really need."

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

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 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