Migraine

CHAPEL HILL, N.C. -- Men and women who get migraines without aura are more likely to develop retinopathy, researchers here found.

BOSTON -- Migraine headaches among veterans of combat in Iraq indicate a more than twofold risk for depression, post-traumatic stress disorder, and anxiety, reported military researchers.

BOSTON -- Children whose mothers took valproate (Depakene) during pregnancy for control of epilepsy are at risk for significantly lower IQs than children whose mothers used other anticonvulsants, reported researchers here.

ROCHESTER, N.Y. -- A mouse with an induced migraine also appear to be suffering brain damage similar to transient ischemic attacks, suggest researchers here.

A 31-year-old Korean woman with migraine headaches during menstruation was found to have a hemoglobin level of 16 g/dL as part of routine blood work. This was confirmed by a repeated complete blood cell count. The patient was referred to a hematologist, who discovered her arterial oxygen saturation (SaO2) on room air was 92% at rest and 81% after exercise. The patient was sent for a pulmonary consultation.

The headaches vary in severity, but she usually has severeheadaches (8 on a 10-point visual analog scale[VAS]) once or twice a week; she describes the latter assevere throbbing or pounding pain on the top of thehead but also involving the occipital and frontalareas and occasionally one or the other temple.

BOSTON -- Even though men are much less likely to suffer from migraine than women, both genders have the same elevated heart disease risk, researchers reported here.

BALTIMORE -- Patients who have a lifetime history of migraine with aura may retain cognitive skills longer than those who don't suffer from migraine, investigators here suggested.

NASHVILLE, Tenn. -- Sumatriptan, the migraine drug, may be significantly more effective for two-hour to 24-hour sustained pain relief when augmented by a common analgesic, researchers here found.

DALLAS, April 3 -- Amphetamine and cocaine abuse appear to promote the risk of stroke among young adults, according to a large hospital database.

Oral Contraceptives: Five Vignettes Illustrate Dx and Rx Problems-- and Solutions

ROCKVILLE, Md. -- The FDA has ordered 20 firm to stop marketing grandfathered prescription versions of the vasoconstrictor ergotamine tartrate, an old remedy for treatment of vascular headaches, including migraine.

BOSTON -- Even healthy women with no history of heart disease or stroke need to keep their cholesterol down to help head off stroke risk, researchers here said.

PHILADELPHIA -- A look beneath the surface of chronic subjective dizziness, in which there's no clear evidence of vestibular problems, usually comes up with tangible diagnoses.

SAN FRANCISCO -- Women under age 35 who suffer migraine with aura should consider avoiding oral hormonal contraception because of their elevated risk of a stroke, a Canadian team suggested.

BETHESDA, Md. -- Nearly three million Americans are living after a stroke, reported government researchers. There are more than two million patients with epilepsy, and migraine affects more than 35 million lives.

TOLEDO, Ohio -- Migraine sufferers often have more than a headache, according to investigators here.

BOSTON -- Clinical and research developments in neurology in 2006 seemed to be as much about prevention as treatment.

A 30-year-old woman complains that her headaches no longer respond to triptans; instead, they have increased in frequencyand severity. The pain interferes with her ability to work part-time and to take care of her 16-month-old daughter.

In the first case study featured in the article by Drs Jagoda and Riggio, “WhatYou Forgot About the Neurologic Exam, Part 1: History, Mental Status,Cranial Nerves” (CONSULTANT, December 2004, page 1773), a 46-year-oldwoman with a history of migraine presented with a bilateral headache thatradiated to the occiput.

A 12-year-old boy complains of severe weekly headaches that last 2 to 3 hours. The pain involves both sides ofthe head and the frontal and occipital areas. Occasionally during a headache, the patient complains of some abdominaldiscomfort and pain. He becomes passive and irritable during the headache; he does not want to be aroundpeople, play, or even watch TV. The patient’s parents note that a few hours before a headache, he becomes somewhatrestless and agitated. The headaches started about 1 year earlier, and the headache pattern (frequency, duration,location of pain, and associated symptoms) has not changed since that time. The patient’s mother and maternalgrandmother suffer from migraine.

A 30-year-old woman complains that her headaches no longer respond to triptans; instead, they have increased in frequencyand severity. The pain interferes with her ability to work part-time and to take care of her 16-month-old daughter.About 12 years earlier, the patient started having migraine headaches. She had no significant medical history, norwas there any obvious precipitating event. Typically, she had 1 or 2 debilitating headaches a month. These were accompaniedby photophobia, nausea, and vomiting-but not by auras. Oral triptans usually relieved the pain and associatedsymptoms within 1 hour.

Which antithrombotic regimen is most appropriate for apatient with systemic lupus erythematosus and anticardiolipinantibody syndrome who has had a previous infarct?

A 53-year-old woman, who has a remote history of acne, says that facial rednessappears each time she has a migraine. Her migraine medication, fiorinalwith codeine, ameliorates the headache, but the erythema lingers for days.

Primary care doctor: Because of the patient’s age and theabsence of a headache history, I first considered such secondarycauses as tumor and temporal arteritis. However,MRI of the brain and erythrocyte sedimentation rate werenormal. I now suspect a sleep-related headache becausethe attacks occur only at night and awaken the patientfrom a sound sleep. How can I determine which type ofsleep-related headache is involved?

Clinician: The patient’s symptom profile is confusing, especiallybecause his test results are normal. Are his amnesicepisodes related to his migraine?

Which of these scenarios is familiarto you? •A local pharmacist calls to say thatyour patient wants another refill for thecombination analgesic containing aspirin,caffeine, and butalbital that youprescribed last week. Pharmacy recordsindicate that this patient has received250 tablets of this medication inthe last 34 days.

A 60-year-old man has had anterior neck discomfort for the pastseveral weeks. He also has right-sided cephalalgia and occasional jaw discomfortwhile eating but no dysphagia or odynophagia. The cephalalgia, which hasbeen present for the past week, is moderately severe and is associated withblurred vision.

A 40-year-old woman reports increasingly frequent and severe headaches during the past few months. She has had boutsof severe headaches since college, and episodic migraine was diagnosed a decade ago. She uses over-the-counter products(ibuprofen, ketoprofen, or aspirin) at the onset of an attack; if these fail to relieve symptoms, she takes hydrocodone/acetaminophen. During her worst attacks, she is typically forced to halt her activities, is unable to eat or drink, and mayvomit. For unresponsive or persistent (more than 24-hour) attacks, her husband drives her to the urgent care centerfor intravenous hydration, intramuscular promethazine, and additional doses of hydrocodone/acetaminophen. Accordingto the patient, a visit to the urgent care center “completely ruins our day.”

A 45-year-old man has a history of migraine that started shortly after puberty. The headaches became more frequent andsevere 3 years ago, when the patient was promoted from metal worker to shift boss.