Post-traumatic headache: emphasis on chronic types following mild closed head injury.

The syndrome known as chronic post-traumatic headache (CPTH) is controversial, particularly when it occurs following mild closed head injury or "whiplash". Problems with the diagnosis include issues related to classification, epidemiology, pathophysiology (psychogenic vs. organic) and treatment. In addition, there are cultural differences that may influence prevalence and diagnosis, as in some countries with little medico-legal recourse the disorder is virtually unknown. In this paper we review some of these controversies clinicians are left to formulate their own understanding based on available evidence and clinical experience. This is perhaps as it should be given that the best practice combines knowledge of the evidence with individual clinical experience.

Cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib.

BACKGROUND: Evidence suggests that both selective cyclooxygenase (COX)-2 inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular events. However, evidence from prospective studies of currently available COX-2 inhibitors and non-selective NSAIDs is lacking in patients at high cardiovascular risk who are taking aspirin. OBJECTIVE: To determine the cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib. METHODS: The Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) of 18 325 patients with osteoarthritis comprised two parallel substudies, comparing lumiracoxib (COX-2 inhibitor) with either ibuprofen or naproxen. A post hoc analysis by baseline cardiovascular risk, treatment assignment, and low-dose aspirin use was performed. The primary composite end point was cardiovascular mortality, non-fatal myocardial infarction, and stroke at 1 year; a secondary end point was the development of congestive heart failure (CHF). RESULTS: In high risk patients among aspirin users, patients in the ibuprofen substudy had more primary events with ibuprofen than lumiracoxib (2.14% vs 0.25%, p = 0.038), whereas in the naproxen substudy rates were similar for naproxen and lumiracoxib (1.58% vs 1.48%, p = 0.899). High risk patients not taking aspirin had fewer primary events with naproxen than with lumiracoxib (0% vs 1.57%, p = 0.027), but not for ibuprofen versus lumiracoxib (0.92% vs 0.80%, p = 0.920). Overall, CHF developed more often with ibuprofen than lumiracoxib (1.28% vs 0.14%; p = 0.031), whereas no difference existed between naproxen and lumiracoxib. CONCLUSIONS: These data suggest that ibuprofen may confer an increased risk of thrombotic and CHF events relative to lumiracoxib among aspirin users at high cardiovascular risk. The study indicates that naproxen may be associated with lower risk relative to lumiracoxib among non-aspirin users. This study is subject to inherent limitations, and therefore should be interpreted as a hypothesis-generating study.

Stabbing headache as the presenting manifestation of intracranial meningioma: a report of two patients.

Stabbing headache may occur as a primary headache disorder, may accompany other primary headaches, or, in rare instances, may be associated with secondary headache syndromes. We report two patients with intracranial meningioma in whom stabbing headache was the heralding symptom. Headache remitted promptly following surgical resection. These cases stress the importance of excluding underlying pathology in patients presenting with new-onset stabbing headache.

Menstrual migraine: diagnosis and treatment.

Of the nearly 20 million American women suffering with migraine, approximately 12 million experience a worsening of their migraines in association with their menstrual cycle. Prior to puberty the prevalence of migraine is slightly higher in boys; however, after puberty there is an emerging female predominance. Estrogen likely plays an important role in explaining this gender difference; however, hormones unlikely explain the entire epidemiologic variation. This article reviews the diagnosis and treatment options for menstrually associated migraine.

Posttraumatic hemicrania continua.

Hemicrania continua is a rare, benign headache disorder characterized by a low-level baseline hemicranial headache with superimposed exacerbations of more severe pain. Exacerbations last from minutes to days and may be associated with ipsilateral autonomic features such as ptosis, miosis, conjunctival injection, lacrimation, or rhinorrhea; when present, these features tend to be less pronounced than those seen with cluster headache. Response to treatment with indomethacin, in doses ranging from 25 to 300 mg per day, has been deemed a sine qua non of diagnosis. To date, in the majority of instances, hemicrania continua appears to have arisen de novo, without any identifiable trigger. We report four patients in whom the onset of hemicrania continua was temporally linked to head trauma.

A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine.

Headaches associated with menstruation are often resistant to abortive and preventative medications. We performed an open-label study in 20 female migraineurs, employing oral sumatriptan perimenstrually as short-term prophylaxis of menstrual migraine. In 126 sumatriptan-treated cycles, headache was absent in 52.4% and reduced in severity by 50% or greater in 42%. Breakthrough headaches were rare and significantly reduced in severity compared with baseline headaches.

The new improved silastic band for ligation of fallopian tubes.

Twelve different sizes of elastic bands were tried in animal experimentation for tubal sterilization. Reversible sterilization was not successful in any of the animals after removal of the various-sized bands. A new elastic Silastic band is reported which is larger and wider than those previously described. Over a 4-year period, no serious complications have been reported and extremely low pregnancy rates have been achieved by utilizing the new, wider bands and our applicators for human sterilization.

Clinical trial of intramuscular injection as contraceptive compound.

PIP: 99 women of proven fertility received 778 intramuscular contraceptive injections. An injectable compound containing 150 mg dihy droxyprogesterone acetophenide and 10 mg of estradiol enanthate (Deladroxate) in castor oil was prepared in a 1-cc disposable syringe. The injections were administered intramuscularly in the upper outer glut eal region on Day 8 of each menstrual cycle. The study was initiated in September 1965 and was completed by February 1969, with all data being recorded on a computer for future analysis. No pregnancies occurred. No serious side effects were noted. There were improvements in cases of dysmenorrhea and premenstrual tension. Minor complaints were not a problem in the use of the contraceptive except for intermenstrual spotting, which prompted 8 patients to discontinue the method. It is concluded that the long-acting intramuscular injection of estrogen-progesterone given once a month is effective and useful in difficult contraceptive patients in a public health clinic.^ieng