Clinical features and pharmacological treatment of migraine patients referred to headache specialists in Canada.

We set out to examine selected clinical characteristics of migraine patients referred to neurologists specializing in headache in Canada, and to document their pharmacological therapy both before and after consultation with the neurologist. Demographic, clinical and pharmacotherapy data were collected at the time of consultation for 606 patients referred to five headache clinics and who were given a migraine diagnosis by the neurologist. Data were analysed as part of the Canadian Headache Outpatient Registry and Database (CHORD) Project. The mean age of the migraine patients was 39.7 years; and 82.5% were female. The majority of patients suffered severe impact from their headaches. Prior to consultation, 48.7% were taking a triptan; after consultation, 97.2% were on a triptan. Before consultation, 30.9% were on a prophylactic drug; after consultation, 70.4% were. 20.8% of patients were medication overusers. Of these medication overusers, 42.4% were overusing an opiate, usually in combination with other analgesics; 21.6% were overusing a triptan. Medication changes made by the neurologists at consultation included a large increase in the use of both triptans and prophylactic medications. Medication overuse, particularly opiate overuse, remains a significant problem in patients with migraine in Canada.

Preferential injury of oligodendroblasts by a short hypoxic-ischemic insult.

One-week-old rat pups were subjected to an acute 10 min severe hypoxic-ischemic insult. Over the next 24 h, during the reperfusion period, O4 immunocytochemistry demonstrated that oligodendroblasts underwent degenerative changes that were coincident with induction of heme oxygenase. We suggest that the increased vulnerability of oligodendroblasts to oxidative stress following an hypoxic-ischemic insult may contribute to the pathogenesis of periventricular leukomalacia.