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 Jung's 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.

Smoking in women.

Smoking has numerous increased health risks for women, including the risks for cancer, cardiovascular disease, chronic obstructive pulmonary disease, gastric and duodenal ulcers, reduced fertility, ovulatory dysfunction, ectopic pregnancy, spontaneous abortion, sudden infant death, and earlier menopause. Such health risks, smoking cessation therapy, and unique obstacles to smoking cessation in women are the focus of this article.

Methylergonovine maleate as a cluster headache prophylactic: a study and review.

Methylergonovine maleate (Methergine), an ergot derivative with vasoconstrictive properties, has been cited as an effective treatment for vascular headaches. Few studies are available to support its use in headache management. An uncontrolled pilot study of 20 episodic cluster headache patients confirmed its effectiveness and tolerability as an adjunct cluster headache prophylactic. Decreased headache frequency was reported by 19 of 20 patients (95%), and 15 of 20 patients (75%) reported decreased intensity of headaches within 1 week of initiating therapy. A review of methylergonovine's pharmacokinetic, molecular, and tolerability profile clarifies its mechanisms and clinical role in headache management.

Use of the Beck Anxiety and Depression Inventories for Primary Care with Medical Outpatients.

The effectiveness of the Beck Anxiety (BAI-PC) and Depression (BDI-PC) Inventories for Primary Care for discriminating 56 primary care patients with and without revised, third edition Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) diagnosed anxiety and mood disorders was studied. The Anxiety and Mood modules from the Primary Care Evaluation of Mental Disorders (PRIME-MD) were used to establish diagnoses. The coefficient alphas for the BAI-PC and BDI-PC were, respectively, .90 and .88. A BAI-PC cutoff score of 5 and above yielded the highest clinical efficiency (82%) with 85% sensitivity and 81% specificity for identifying patients with and without panic, generalized anxiety, or both disorders, whereas a BDI-PC cutoff score of 6 and above afforded the highest clinical efficiency (92%) with 83% sensitivity and 95% specificity for detecting patients with and without major depressive disorders. The use of these instruments to screen primary care patients before conducting extensive diagnostic evaluations with them was discussed.

Vasospasm-induced 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 a 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.

Analgesic use in cluster headache.

Cluster headache is a brutal affliction characterized by excruciating pain with relatively brief, but frequent attacks. Because of the short duration of the attacks and the tremendous intensity of pain, symptomatic analgesics are often not effective. However, inhalation oxygen, while being cumbersome, is reported to be effective in the majority of sufferers. To assess the practical effectiveness and use of analgesics and/or oxygen, a review of 60 cluster patients was conducted. At initial evaluation, 48 patients had accepted oral analgesics and 51 patients accepted inhalation oxygen for breakthrough headaches. After acceptable prophylactic treatment was established, 65% of patients who accepted analgesics continued their use, although most reported only minimal relief. Only 31% of patients who accepted oxygen continued its use, in spite of the fact that most sufferers reported significant relief. From this brief study, it appears that cluster headache patients prefer to use analgesics for reasons that are not solely for relief of pain, and that patients decline the use of oxygen for reasons other than lack of effectiveness.