Trainee Headache Education and Management Enhancement (THEME) Study.

We investigated the association between clinical rotation at a specialized headache center and headache knowledge of resident trainees. Using standardized pre- and post-questionnaires, change in self-reported knowledge of headache disorders and management in 31 participants undertaking clinical rotations were evaluated. There was a statistically significant improvement in self-reported measures of headache disorder knowledge post-rotation [mean score (SD), 3.19(0.543), p < 0.001] and significant improvement in overall knowledge measured using case-based questionnaires pre- vs. post-rotation [7.1(1.4) vs. 7.9(1.5), p = 0.003]. Rotation at a specialized headache center improved trainees' self-reported knowledge and test-based scores, suggesting that such rotation should be included in postgraduate curriculum.

Preventive Treatment of Migraine.

Migraine significantly impacts individuals from all walks of life and from all around the globe. Chronic or high-frequency episodic migraine has similar disability and burden on the healthcare system and can be challenging to manage. The focus of this article is to provide an outline of the available pharmacological and nonpharmacological evidence-based strategies that clinicians can employ to build a "toolbox" for their patients.

Women and Migraine: the Role of Hormones.

PURPOSE OF REVIEW: Migraine is a debilitating disease, that is encountered in countless medical offices every day and since it is highly prevalent in women, it is imperative to have a clear understanding of how to manage migraine. There is a growing body of evidence regarding the patterns we see in women throughout their life cycle and how we approach migraine diagnosis and treatment at those times. RECENT FINDINGS: New guidelines regarding safety of medication during pregnancy and lactation are being utilized to help guide management decisions in female migraineurs. There is also new data surrounding the risk of stroke in individuals who suffer from migraine with aura. This article seeks to provide an overview of a woman's migraine throughout her lifetime, the impact of hormones and an approach to management.

The effects of a CXCR1/CXCR2 antagonist on neutrophil migration in mild atopic asthmatic subjects.

BACKGROUND: Neutrophils are effector cells recruited to airways in patients with asthma. Migration of neutrophils occurs predominantly through activation of the CXCR1 and CXCR2 receptors by CXC chemokines, including IL-8 and Gro-α. The dual CXCR1/CXCR2 antagonist SCH 527123 has been developed to target neutrophil migration to alleviate airway neutrophilia. This study investigated the effects of SCH 527123 on neutrophil levels within the bone marrow, peripheral blood and airways, and on isolated bone marrow and peripheral blood neutrophil migration from mild allergic asthmatics. METHODS: Thirteen subjects with mild allergic asthma completed a double blind, placebo-controlled, multi-center crossover study and were randomized to daily dosing of 30 mg SCH 527123 and placebo for 8 days. Subjects provided bone marrow, peripheral blood and sputum samples pre-dosing and on the last day of dosing. Neutrophil numbers were quantified in all samples and chemotaxis assays were performed on neutrophils purified from bone marrow and peripheral blood. RESULTS: Neutrophil numbers fell significantly in the peripheral blood and sputum following treatment with SCH 527123 compared to placebo treatment. No change in neutrophil numbers was observed in bone marrow. SCH 527123 reduced IL-8-induced migration of purified peripheral blood neutrophils (p < 0.05), but had limited effects on migration of neutrophils purified from bone marrow. CONCLUSIONS: The results from this study demonstrate that oral administration of the dual CXCR1/CXCR2 antagonist SCH 527123 reduces neutrophil levels in the circulation and airways through inhibition of migration. There were no toxic effects of SCH 527123 on granulocytic progenitor cells in the bone marrow.

Effect of testosterone therapy on migraine frequency and disability in two transgender patients: a case report.

With an increasing number of patients seeking gender-affirming hormone therapy (GAHT), the clinical impact of testosterone treatments on headache needs to be determined. Our case report looks at the potential effect of testosterone on migraine among transgender patients. We present two transmasculine patients who used masculinising hormone therapy with testosterone. Both patients described their headache as moderate-to-severe pain with features that fulfilled the criteria for chronic migraine without aura. Following GAHT, one patient improved in both frequency and intensity of headache symptoms while the other noted improvement in headache intensity alone. Our report postulates that testosterone therapy may have a positive impact on headaches in individuals participating in GAHT, highlighting the need for further research on the role of testosterone therapy on headache in transmasculine individuals.

Ramelteon ingestions reported to Texas poison centers, 2005-2009.

BACKGROUND: The only data that currently exist on ramelteon (Rozerem(®); Takeda Pharmaceuticals North America, Inc., Deerfield, IL) ingestions is from clinical trials. To fill this gap, data on ramelteon ingestions reported to Texas poison centers during 2005-2009 were collected and analyzed. OBJECTIVES: The objective of this study was to describe how reported ramelteon ingestions were handled by Texas poison center staff and when known, the patient's final medical outcome. In cases where the dosage was significant enough to refer the patient to a health care facility, adverse clinical reactions and treatments are also described. METHODS: Cases were analyzed for selected demographic and clinical factors. Of 222 total patients, 67.6% were women and 73.9% were over the age of 19 years. Cases were analyzed by motivating factors (e.g., unintentional, intentional), management site, adverse reactions, and final medical outcome. RESULTS: Of the ramelteon ingestions reported to Texas poison centers, 67.6% involved adult women and were suspected attempted suicides; 75% of ramelteon ingestions not involving other substances were managed at a health care facility. However, 88.3% of these ingestions resulted in no significant clinical effect. CONCLUSION: The management strategies used by Texas poison centers for the 56 cases reported in this study were adequate.

Enhanced education for adult patients with persistent post-concussion headaches: a randomized controlled trial.

Aim & Patients: We conducted a randomized clinical trial to determine if an e-learning intervention can enhance recovery in adult patients with persistent post-concussion headaches (PPCH). Materials & Methods: The intervention consisted of three e-learning modules administered at baseline, 6 and 12 weeks. Data were collected on symptoms, community integration, quality of life and healthcare utilization at baseline and 12-week follow-up. ANCOVA was conducted to compare changes. Results: No statistically significant difference was observed on symptoms although we observed a trend toward reduced healthcare utilization and improved quality of life in the intervention group. Conclusion: E-learning modules for patients experiencing PPCH warrant further investigation with data on participant compliance and measures focusing on simpler short-term outcomes.Clinical Trial Registration: NCT03391583 (ClinicalTrials.gov).