Migraine

Patients with migraine are more likely than nonmigraineurs to have temporomandibular disorder (TMD). According to the results of a new study presented at the 14th annual International Headache Conference in Philadelphia, TMD may also be associated with increased headache frequency.

It is only within the past 40 years that the term "migraine art" was introduced; yet artists may have been creating works inspired by migraine aura since the Stone Age. Early depictions of migraine continue to influence newer artists with this illness. This is a natural progression that is common in all types of art, according to Klaus Podoll, MD, senior physician in the department of psychiatry and psychotherapy, University Hospital Aachen, RWTH Aachen University, Germany. But Dr Podoll has found that artists with migraine are often particularly attracted to the works of other artists who share their migraine experiences. These shared experiences "act like a filter," contributing to the an artist's perspective and leading to "elective affinities between migraine-inspired artists," he said.

The results of a meta-analysis indicate that intensive glycemic control significantly reduces the risk of coronary events in patients with type 2 diabetes mellitus. The meta-analysis, conducted by Ray and colleagues,1 included 5 randomized controlled trials that compared intensive with standard glucose-lowering regimens in more than 33,000 patients. The general treatment protocols are shown in the Table.

Medication spend for workers’ compensation claims continues to increase despite decreases in overall occupational injury rates. Medication costs increased by 5.4% in 2008 following a 3.3% rise in 2007 (Cover Figure), according to findings of the 2009 Annual Drug Trends Report for Workers’ Compensation. The report was compiled and analyzed by PMSI, Tampa, Fla.

About 50% of pregnanciesin the United States areunplanned.

The total direct and indirect costs for treating patients with chronic migraines (CM) are 2.6 times higher than costs associated with episodic migraine (EM). Containing those costs through better management of the illness should be a priority, according to migraine researchers who led a nationwide study comparing the costs of CM and EM as part of the American Migraine Prevalence and Prevention (AMPP) Study.

Prevalence of migraine is higher in men and women who have total body obesity (TBO) or abdominal obesity (Abd-O), according to the results of a study by Lee B. Peterlin, DO, assistant professor in the Department of Neurology, and colleagues at Drexel University College of Medicine in Philadelphia.

About 50% of pregnancies in the United States are unplanned.1 Thus, an awareness of which medications are safe and which are contraindicated in pregnancy is essential for good primary care-even in practices that do not include obstetrics.

Financial incentives offered by employers significantly increased rates of smoking cessation, according to results of a study published in the February 12 issue of the New England Journal of Medicine. The study, one of the largest of its kind, was funded by the CDC and the Pennsylvania Department of Health. The CDC reports that smoking costs employers about $3400 per employee annually, or about $7.18 per pack of cigarettes smoked, in health care costs, presenteeism (lost productivity), and absenteeism.

A 47-year-old Hispanic woman with severe headaches of 1 month’s duration presents to the emergency department (ED). The pain encompasses the entire head, is constant and crushing (10 on a scale of 1 to 10), and has progressively worsened.

Two weeks before admission, he had visited the emergency department (ED) because of the headache. Migraine was diagnosed and ibuprofen had been prescribed. The headache persisted despite NSAID therapy, and the patient returned to the ED 2 days later.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.

The numerous symptom domains of fibromyalgia syndrome (FMS) include pain, fatigue, sleep disturbance, mood disturbance, function impairment, irritable bowel syndrome, tension and migraine headache, and cognitive dysfunction. Its pathophysiology is rooted in neural dysregulation in the spinal cord and brain.

A 14-year-old boy presents with frequent severe headaches characterized by sharp, throbbing pain behind his left eye and left temple.

A 28-year-old woman presents with milky discharge in both breasts and throbbing occipital headaches of 4 months' duration. The headaches begin gradually, do not radiate, and have no apparent triggers or relieving factors.

A new FDA policy requires pharmaceutical manufacturers to examine whether study participants become suicidal during clinical trials of new medications.1 The policy derives from the belated recognition that antidepressants seem to slightly increase suicidality in children, adolescents, and young adults early in the course of treatment. This is not the only news about medications linked to possible increases in suicidal ideation or behavior.

Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise.

Medical residents with depression are approximately 6 times more likely to make medication errors than those without depression, according to a study published online on February 7 in the British Medical Journal. A team led by Amy M. Fahrenkopf, MD, instructor of pediatrics, Harvard Medical School, Boston, conducted the prospective cohort study.

Depression was diagnosed 6 years earlier in a 37-year-old woman; it has been successfully managed since then with fluoxetine and outpatient psychotherapy. Since her teenage years, the patient has also experienced sporadic (fewer than 3 or 4 per year) mild or occasionally severe headaches, which she has usually self-treated with over-thecounter (OTC) agents or "just slept off."

Adherence is a complex behavioral process strongly influenced by environmental factors. Six posters designed to improve medication adherence were displayed in a medical clinic, with each poster displayed for 1 month. These posters were seen by clinic patients but, as passive measures, required no additional time on the part of clinicians. Medication adherence to antidepressant therapy was assessed for two 18-month periods. Days of therapy and median gap (the number of days a patient goes without medication before filling the next prescription) were similar between the periods. Medication possession ratio (MPR) was increased in the intervention period (0.974 vs 0.994 days). During the 6-month period that the adherence posters were displayed, persistence decreased by only 10% (versus 22% for the nonintervention period). Use of passive measures may improve patient medication adherence. In this prospective study, both the MPR and persistence were improved. (Drug Benefit Trends. 2008:20:17-24)

CHARLOTTESVILLE, Va. -- Topiramate (Topamax), a migraine agent, appeared to help alcoholic patients curtail their heavy-drinking behavior, according to investigators here.

BOSTON -- Panic attacks may be an independent risk factor for cardiovascular events in older women, researchers said.

A 47-year-old woman complains of severe headaches that involve only the right orbital, temporal, and occipital areas. She describes the pain as sharp and stabbing, and she rates its severity as 9 or 10 on a 10-point visual analog scale.

ROCKVILLE, Md. -- Adverse events including deaths have been linked to Fentora, a drug for breakthrough pain in cancer patients who are opioid tolerant, according to the FDA.

STAMFORD, Conn. -- For cluster headaches with their intractable pain, intranasal zolmitriptan (Zomig) may be an effective addition to the slim armamentarium against the condition, researchers said.

BALTIMORE --Women who have migraine with visual symptoms have a 50% greater risk of ischemic stroke than women without the headaches, researchers reported.

NEW YORK -- Showing evidence of a link between environmental factors and migraine, investigators here found that a higher family income may protect adolescents against migraine -- if they have no genetic predisposition to it.

LOS ANGELES -- Strokes in middle age -- though less common than in older age -- strike women more than twice as often as they do men, researchers found.

CINCINNATI -- For treating the chronic pain and other symptoms of fibromyalgia, the anticonvulsant gabapentin (Neurontin) proved safe and effective, researchers here reported.

VANCOUVER, British Columbia -- A patient undergoing emergency surgery stunned an OR team here with greenish-black arterial blood. Surgeons and anesthesiologists were totally puzzled.