Migraine

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.

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.