Flammer syndrome is a group of vascular and nonvascular symptoms. These find their cause in the misregulation of blood flow and increased sensitivity of the patient to various stimuli.
What is Flammer syndrome?
Flammer syndrome describes a variety of symptoms that are significantly caused by primary vascular dysfunction (PVD). The cause of this PVD is an innate increased sensitivity of blood vessels to external stimuli such as cold or stress. The vascular dysregulation is accompanied by non-vascular symptoms. For example, perceptions such as smells, pain, or vibration may be heightened by the increased sensitivity. Externally, Flammer syndrome is sometimes thought of as the counterpart of metabolic syndrome. Patients often present with a lean, athletic, and agile appearance. The causes of the syndrome’s occurrence are not clearly understood, but appear to be hereditarily predisposed. The syndrome is accompanied by some unfavorable symptoms, such as low blood pressure, and can thus promote the development of various diseases. It is therefore understood to be a risk factor for diseases such as normal-tension glaucoma since 2013.
Causes
The cause of the symptoms summarized under the name Flammer syndrome is a congenital increased sensitivity of the affected individuals, which on the one hand relates to the perception of external stimuli, but in particular is characterized by a dysregulation of the blood vessels. The primary vascular dysfunction manifests itself on the one hand by spasms of the vessels. On the other hand, by an inadequately strong or weak dilation of the blood vessels in response to stimulation. The cause of the hypersensitivity is probably hereditary, and a clustered occurrence of the syndrome in family history has been observed. Women are more frequently affected than men and there is evidence of a hormonal connection. Thus, the symptoms increase during puberty and decrease again in old age, especially after menopause. Lack of exposure to light is considered a risk factor, as Flammer’s syndrome is less common in occupational groups that work outdoors. Affected individuals often exhibit underweight.
Symptoms, complaints, and signs
The symptoms of Flammer syndrome are largely characterized by circulatory disturbances. Classically, cold hands and feet occur. Affected individuals suffer from low blood pressure and often inhomogeneity of skin temperature, which is manifested by white or red patches when agitated. Blood pressure drops may occur at night. Consequential symptoms are often tinnitus, migraine or dizziness, also nocturnal myocardial perfusion disturbances or muscle cramps in general. In Flammer syndrome, the vascularly caused symptoms are typically accompanied by a variety of non-specific symptoms. For example, affected individuals often complain of difficulty falling asleep or exhibit a reduced sense of thirst. In addition, there may be sensitivities to medications, odors, pain, or vibration. Weather sensitivity or greater susceptibility to altitude sickness have also been described. Individuals affected by Flammer syndrome are often conspicuous for their conscientiousness bordering on perfectionism.
Diagnosis and course
Flammer syndrome is diagnosed primarily by a history of illness. In addition, nail palpation capillary microscopy may be performed, which reveals small hemorrhages at the fingertips due to exposure to cold. Thermography of the extremities may provide information about impaired circulation. Measurement of retinal venous pressure or endothelin levels is performed infrequently. Quantification of lymphocyte gene expression or dynamic vascular analysis are also used for confirmation only in special cases. In the diseased eye, some typical changes are found which are indicative of Flammer’s syndrome as the cause. These include reduced autoregulation of blood flow and changes in diameter and flexibility of retinal blood vessels. Persons affected by Flammer’s syndrome are not considered ill and do not necessarily suffer from secondary diseases. There is even a lower risk for arteriosclerosis. More often, the persons suffer from accompanying symptoms such as migraine, tinnitus or muscle tension.The risk of Flammer’s syndrome is the likelihood to entail diseases of the eye. The most common associated disease is normal tension glaucoma.
Complications
Many different complications occur with Flammer syndrome. In general, the affected person reacts very strongly to external stimuli, limiting daily life. Cold extremities and low blood pressure occur. The overall body temperature and skin temperature are also lower. In this case, stressful situations or physical exertion cause red spots on the body. These can cause problems, especially on the face, as patients feel disfigured. In addition to the spots, tinnitus also occurs. This causes sleep disturbances and problems with concentration. Also, a strong sensitivity to weather develops in the affected person, so that even low fluctuations in air pressure can lead to earaches or headaches. These complications can be treated well. In most cases, a change in lifestyle and diet helps. Relaxation exercises and yoga also help. If flammer syndrome is due to stress, antioxidants can be helpful and relieve symptoms. These are mainly contained in various juices. There is no direct treatment with medication. However, omega-3 fatty acids can promote blood circulation. Likewise, magnesium has a positive effect on blood circulation and can be taken in the form of tablets. In this case, there are no further complications from Flammer’s syndrome.
When should one go to the doctor?
Since Flammer’s syndrome does not heal itself and in most cases the symptoms worsen, a doctor must always be consulted. The doctor should be consulted if the affected person suffers from circulatory disorders. These can be manifested by low blood pressure or by parts of the body that are too cold or too warm. Red spots on the skin may also indicate Flammer’s syndrome. Likewise, patients often suffer from tinnitus or severe headaches and migraines. Muscle cramps also very often indicate Flammer’s syndrome and need to be investigated. Most patients are very sensitive to weather changes and also suffer from dizziness or sleep disturbances. Therefore, if these complaints persist over a long period of time and without any particular reason, a doctor must always be consulted. Tension in the muscles can also indicate the disease. Treatment is carried out by a general practitioner and with various therapies and exercises. As a rule, the symptoms of Flammer’s syndrome can be very well limited by this. However, treatment is only necessary when the complaints significantly restrict the daily life of the affected person and reduce the quality of life.
Treatment and therapy
Flammer syndrome is usually accompanied by harmless symptoms. Treatment becomes necessary only when the affected person’s quality of life suffers or when secondary diseases develop. Classically, therapy is based on changes in lifestyle and diet, as well as drug intervention. Triggering factors such as cold or vasoconstrictive factors should be avoided. Stress can be counteracted with autogenic training or yoga. A healthy sleep schedule and regular light exercise can alleviate symptoms. A low BMI is considered a risk factor for Flammer syndrome. Affected individuals should therefore aim for a healthy normal weight and keep it as constant as possible. Prolonged food abstinence such as fasting cures are contraindicated. In the case of low blood pressure, increased intake of salt and fluids helps. The increased oxidative stress due to circulatory disturbance must be counteracted by a diet rich in antioxidants. Omega-3 fatty acids strengthen the function and health of blood vessels. Medication can be used to mitigate the circulatory disorder by taking magnesium. Ginko bilboa has also been shown to be effective. If normal pressure glaucoma is already present, in addition to glaucoma therapy, it is also necessary to adjust the patient’s blood pressure. Here, especially the nocturnal drop in blood pressure should be prevented with dietary measures or low-dose steroids.
Outlook and prognosis
The prognosis of Flammer syndrome is usually very good. Often, it has no disease value at all.Only the increased sensitivity to cold, the appearance of cold feet and hands and the low blood pressure are perceived as disturbing. Due to the low blood pressure, there is even a reduced probability of developing certain diseases such as arteriosclerosis or cardiovascular diseases. However, there is a higher risk for the development of normal pressure glaucoma. Normal-tension glaucoma is characterized by the development of glaucoma damage despite normal intraocular pressure. Patients with this disease usually also suffer from Flammer’s syndrome. However, the eye disease is produced by increased pressure in the veins of the retina. If normal tension glaucoma is not treated, there is increasing damage to the optic nerve with the development of visual loss and visual field defects. Vein occlusion in the eyes can also lead to other eye diseases. In severe cases, complete blindness is imminent. Sometimes Flammer’s syndrome also leads to hearing loss or tinnitus. Not infrequently, migraine-like headaches occur. A possible connection of Flammer’s syndrome with other diseases such as multiple sclerosis or breast cancer is currently being investigated in studies, but has not yet been proven. Symptoms of the condition can be alleviated by lifestyle with plenty of exercise, a balanced diet with increased intake of omega-3 fatty acids, increased fluid and salt intake, and possibly blood pressure-regulating medications.
Prevention
The expression of Flammer syndrome can be symptomatically counteracted. It is important to protect against triggering factors such as cold or stress. A healthy lifestyle with a diet rich in antioxidants and omega-3 fatty acids can significantly attenuate the severity of symptoms. Foods with high antioxidant potential include red and blue fruits, vegetables such as tomatoes and kale, and beverages such as green tea and coffee. Fatty fish is considered an optimal source of omega-3 fatty acids.
Aftercare
In most cases of Flammer syndrome, the options for aftercare are very limited. In this case, the affected person is first dependent on proper and medical treatment by a doctor to prevent further complications and also, in the worst case, to prevent the death of the affected person. The earlier Flammer’s syndrome is detected, the better the further course of this disease usually is. For this reason, a doctor should be consulted at the first signs and symptoms of Flammer syndrome. The syndrome is usually treated with the help of various relaxation exercises or yoga. Many exercises from such therapies can also be done at home, which may speed up the healing process. A healthy lifestyle with a healthy diet can also have a positive effect on the course of Flammer’s syndrome and prevent further complications. The affected person should take a lot of antioxidants and avoid smoking or alcohol if possible. The care and support of family and friends can also have a very positive effect on Flammer’s syndrome. In some cases, contact with other people affected by the syndrome can also be helpful and useful.
What you can do yourself
In many cases, the affected person can counteract the symptoms of Flammer syndrome himself and thus avoid complications. As a rule, a healthy lifestyle has a very positive effect on the course of the disease and on the complaints. This includes a healthy diet and the performance of sporting activities at regular intervals. However, the complaints can be relatively well limited by yoga or by other relaxation techniques. Especially light and relaxing sports own are doing to combat the Flammer syndrome. Furthermore, a too low BMI factor should be avoided in this syndrome. For this reason, the affected person should pay attention to his diet and avoid underweight in any case. Stress should also be avoided. In terms of nutrition, antioxidants have a very positive effect on the course of Flammer’s syndrome. Taking magnesium can limit the circulatory disorders well. However, if self-help measures fail to eliminate the symptoms, the affected person should also resort to drug treatment.Talking to friends or acquaintances about the disease can also help prevent the development of psychological symptoms or depression.
