Managing migraine: strategies for successful patient outcomes.

This article highlights information from the 2000 National Conference for Nurse Practitioners symposium held in Washington, D.C., on November 9, 2000. It was sponsored by The Nursing Institute of Springhouse Corporation and funded by an unrestricted educational grant from Merck & Co., Inc. The firsttopic, "Overview of Migraine: Compelling Effects on Patients and Society," was presented for Dedie Downey Russell, CNP, ANP/GNP, MS. The second topic, "Understanding Pathophysiology: Evolving from Traditional to Current Therapeutic Options," was presented by Dara G. Jamieson, MD. Maureen Moriarty-Sheehan, MS, CRNP, who also served as chairperson, presented the third topic, "Developing a Management Plan for Optimal Patient Benefit."

Headache evaluation and management.

Headache is one of the most common complaints in primary care, virtually affecting all persons at some point. Headache may be a symptom of other pathology (secondary headache) or due to a primary headache disorder. Tension headaches, migraines, and cluster headaches are three primary headache syndromes, in order of most frequently occurring to least. The key to effective management of these chronic syndromes is differential diagnosis through history, physical exam, and possibly diagnostic studies. Pharmacologic management may include abortive, adjunctive, and prophylactice medications.

No evidence for chloroquine-associated retinopathy among missionaries on long-term malaria chemoprophylaxis.

Chloroquine continues to have a limited role in the chemoprophylaxis against malaria. Although periodic ophthalmologic examinations are recommended with weekly suppressive dosing, the occurrence of retinopathy associated with this regimen is unproven. Surveillance of career missionaries was conducted to explore the association between total body burden of chloroquine and the development of retinopathy. Five hundred eighty-eight missionaries, reflecting 6,250 person-years of chloroquine exposure were surveyed; 53 persons reflecting 560 person-years exposure with a median cumulative chloroquine dose in excess of 300 g were examined. Only one case of chloroquine-induced retinopathy was detected. This occurred in a missionary who had inappropriately taken chloroquine daily for at least six years as an anti-inflammatory agent for a connective tissue disorder. We also observed that expatriates often overused chloroquine because of apprehension about malaria and used the drug for unrelated conditions. Our results failed to demonstrate an association between a weekly chloroquine dosing regimen and drug-induced retinopathy.