Kusum L. Kumar

Recent advances in the acute management of migraine and cluster headaches

SummaryI have discussed the pharmacokinetics, efficacies, and side effects of the various nonnarcotic drugs available for the treatment of patients who have headache. Sumatriptan, the newest one, is expensive but may be cost-effective for those who have failed traditional migraine treatment, who visit the ER frequently, who have potential for drug abuse, or who have to miss time from school or work due to the headache. Studies are in progress to compare sumatriptan with other available drugs such as DHE-45 and to determine its possible role in the prophylaxis of migraine. A new 5-HTID receptor agonist with more efficacy and fewer side effects may be developed in the future. When sumatriptan and DHE-45 are contraindicated due to hypertension or coronary artery disease, other drugs such as metoclopramide, ketorolac, and butorphanol can be used as alternatives.

Gynecomastia. A worrisome problem for the patient.

Gynecomastia is common in obese or elderly men. Drug-induced breast enlargement is also frequent, whereas other causes of gynecomastia are relatively uncommon. Standardized measurement of breast tissue should be routinely performed in male patients. Diagnostic evaluation should be individualized on the basis of clinical suspicion. Therapy most often involves treating an underlying condition or discontinuing use of an offending drug.

Teaching headache management to medicine residents.

Background.—To evaluate the effect of teaching headache management to PG‐1 medicine residents.

Uncommon headaches: Diagnosis and treatment

SummaryHeadaches associated with exercise, cough, and sexual activity may present a diagnostic challenge in the emergency room or primary care provider’s office. The majority of these patients have no underlying intra-cranial pathologic condition and have a good prognosis. However, new onset of these types of headache, with or without accompanying neurologic deficit, is an indication to exclude life-threatening conditions such as subarachnoid bleeding with neuroimaging and CSF examination. Since the pathophysiology is poorly understood, derstood, treatment choices are limited. Further research is needed to elucidate the pathophysiologic mechanisms of these uncommon headaches and to assess the cost — effectiveness of various diagnostic and follow-up strategies.

Visual Symptoms after Atenolol Therapy for Migraine

Excerpt To the Editor:Chronic headache is common in the general population. Ten to twenty percent of chronic headaches are migraine. Beta blockers have been used widely to prevent both common and c...

Determination of Medical Disability

Excerpt To the editor: The article by Carey and Hadler (1) on medical disability determination was very informative. However, we would like to add that the federal government, under auspices of the...