Loretta Mueller

Vasospasm‐lnduced Myocardial Infarction With Sumatriptan

Sumatriptan, a 5‐hydroxytryptamine1 (5‐HT1) receptor agonist is an effective abortive agent for migraine headaches. A common side effect in 3% to 7.9% of patients is chest pain. Although most cases of chest pain are not thought to be of cardiac origin, its mechanism is not entirely understood. Rare examples of electrocardiogram changes consistent with transient ischemia have been reported. Isolated instances of angina, arrhythmia, myocardial infarction, and death have been temporally associated with sumatriptan administration. In most cases, it is unclear whether underlying cardiovascular disease existed or contributed to this adverse event. We report the history of a 56‐year‐old female patient with migraine who experienced myocardial infarction shortly after using sumatriptan, despite having had a normal cardiovascular evaluation. As she had a normal cardiac catheterization after the event, we find it probable that sumatriptan induced coronary vasospasm and myocardial infarction.

Efficacy and Tolerability of Oral Zolmitriptan in Menstrually Associated Migraine: A Randomized, Prospective, Parallel‐Group, Double‐blind, Placebo‐Controlled Study

Background.—Approximately 60% of female migraineurs report experiencing migraine in association with menstruation, while 7% to 25% experience attacks almost exclusively with menstruation.

Predictability of Exogenous Hormone Effect on Subgroups of Migraineurs

Objective.–To evaluate whether self‐reported past migraine response to reproductive life events (menses, pregnancy, menopause) alters the likelihood of worsening of migraine with exogenous hormone use.

Rizatriptan for the acute treatment of ICHD-II proposed menstrual migraine: two prospective, randomized, placebo-controlled, double-blind studies

These are the first prospective studies to use criteria for menstrual migraine proposed in the 2004 revision of the International Classification of Headache Disorders (ICHD-II) to examine the efficacy of rizatriptan for treatment of a menstrual attack. Two identical protocols (MM1 and MM2) were randomized, parallel, placebo-controlled, double-blind studies. Adult women with ICHD-II menstrual migraine were assigned to either rizatriptan 10-mg tablet or placebo in a 2 : 1 ratio. Patients treated a single menstrual migraine attack of moderate or severe pain intensity. The primary end-point was 2-h pain relief and the secondary end-point was 24-h sustained pain relief. A total of 707 patients (MM1 357, MM2 350) treated a menstrual migraine attack. The percentage of patients reporting 2-h pain relief was significantly greater for rizatriptan than for placebo (MM1 70% vs. 53%, MM2 73% vs. 50%), as was the percentage of patients reporting 24-h sustained pain relief (MM1 46% vs. 33%; MM2 46% vs. 33%). Rizatriptan 10 mg was effective for the treatment of ICHD-II menstrual migraine, as measured by 2-h pain relief and 24-h sustained pain relief.

Deficiency of tumor necrosis factor alpha in a subclass of menstrual migraineurs.

Objective.—The objective of this study was to determine whether differences in urinary proinflammatory cytokines, interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6), and tumor necrosis factor α (TNF‐α), exist between migraineurs and nonheadache control subjects, and between nonhormonal migraine and menstrual migraine. Any differences noted would expand and clarify a neuroimmune hypothesis of migraine pathogenesis and lead to future diagnostic markers or therapeutic options or both for the disorder.

Rizatriptan Efficacy in ICHD-II Pure Menstrual Migraine and Menstrually Related Migraine

Objective.— To examine the efficacy of rizatriptan for the treatment of pure menstrual migraine (PMM).

Headache in medical education : Medical schools, neurology and family practice residencies

Objective.—To explore the extent of headache education received by medical students and residents.

Tension-type, the forgotten headache. How to recognize this common but undertreated condition.

PREVIEW Tension-type headache is the most prevalent headache type, affecting most women and men at some time in their lives, and can impair job productivity and interfere with family and social time. However, despite its impact, tension-type headache is also the most misunderstood headache type. Because of these misperceptions, many affected people are reluctant to seek medical treatment. In this article, Dr Mueller discusses possible triggers of tension-type headache, appropriate evaluation, and management with pharmacologic, nonpharmacologic, and alternative therapies.

Increased prevalence of sensing types in men with cluster headaches.

To ascertain whether the percentage of men who suffer with cluster headaches and are classified as sensing types according to Jungs theory of psychological types was comparable to the percentage (74%) of Sensing types that was found by Gallagher, et al. among women who experience migraine headaches, the Myers-Briggs Type Indicator® was administered to 25 male cluster-headache patients. There were 19 (76%) male Sensing types, and this was comparable to the percentage of Sensing types for migrainous women. The results are discussed as supporting previous contentions that Sensing types may be prone to developing psychosomatic symptoms related to stress.