Grant s Migraine * Appendix 1

Transcription

1 Appendix 1 Grant s Migraine * By virtue of its prevalence and profound clinical effect on the afflicted, it is inevitable that migraine should exert some influence on the course of human history. One especially poignant example involves a man who ranks among the greatest of military leaders, Ulysses S. Grant. Like his commander-in-chief and spiritual soul mate, Abraham Lincoln, Grant suffered from attacks of clinically severe migraine throughout the years of the American Civil War. In April 1865, at Appomattox Courthouse (Virginia), Grant finally cornered the sparse remnants of Robert E. Lee s Army of Northern Virginia. Grant s fear * From Personal Memoirs of US Grant, New York: Smithmark; 1994 and Shelby Foote s, The Civil War. A Narrative. Red River to Appomattox, New York: Vintage Books;

2 146 APPENDIX 1 that Lee once again would elude his grasp, slipping away to join Joe Johnston s force in North Carolina and potentially prolonging the war by a year or more, thankfully had proved groundless. Lee was finished, realized it, and so sent across the lines a note requesting terms of surrender. He did so with some trepidation, as Grant was a commander known variously as Butcher for his apparent tolerance of high casualty rates and Unconditional Surrender for his harsh treatment of defeated foes. The previous day, racked by anxiety and impatient to bring his pursuit of Lee to a close, Grant developed a migraine. In his personal memoirs he wrote, I was suffering very severely with a sick headache... I spent the night in bathing my feet in hot water and mustard, and putting mustard plasters on my wrists and the back part of my neck. Despite his efforts, the headache persisted into the following morning. He wrote later that he suffered still with the sick headache, but when Lee s note arrived, the instant I saw the contents of the note, I was cured. Even so, Grant s mood was muted when later on that Palm Sunday he sat opposite the defeated Lee in Wilmer McLean s parlor drawing up the formal terms of surrender. He wrote that Lee s feelings... were entirely concealed from my observation; but my own feelings, which had been quite jubilant on the receipt of his letter, were sad and depressed. I felt like anything but rejoicing at the downfall of a foe who had fought so long and valiantly, and had suffered so much for a cause, though that cause was, I believe, one of the worst for which a people ever fought and for which there was the least excuse.

3 Appendix His terms of surrender reflected his subdued mood. Lee s officers would retain their side arms, and all troopers their horses... so as to work their little farms. There would be no arrests, imprisonment, or public spectacle. When the Union batteries began to roar in celebration shortly after the surrender ceremony, Grant sent word to have the guns stopped. The war is over, he told his staff. The rebels are our countrymen again. The war indeed was over. The Union was preserved. The

4 148 APPENDIX 1 great experiment (Lincoln s words) in social democracy would not fail, and the South would retain its place in the national community. Lee s response then and later would mirror Grant s tolerance and compassion. For him there would be no endless guerilla warfare in the hills, no flight to a sympathetic foreign land, no continued defiance. Rejecting more prominent and lucrative positions, he chose to accept the presidency of a small, failing college in the Virginia mountains and spent his remaining years quietly devoted to the education of his countrymen. How much of Grant s behavior on April 9, 1865 was rooted in migrainous biology? Did his generous terms of surrender result from the dysphoria of a migraine postdrome? Absent acute migraine, how much compassion would he have tendered his defeated foe? In contemplating history, be it that of a country or that of an individual, is it really possible to tease out what is purely psycho (logic) from that which is somatic?

5 Appendix 2 Migraine Myths Myth Fact 1. Migraine is a direct result of Migraine is a biologic 1. stress, anxiety, another mood condition that probably is 1. disorder or an intrinsic defect genetic in origin and is 1. in one s personality. typically inherited. Many factors, including stress, anxiety or other mood disorders-may affect clinical expression of this fundamentally biogenetic condition. 2. Migraine is curable. Migraine may be controlled via appropriate therapy; as a genetic condition that is inherent to the individual, however, it cannot be cured per se. 3. Migraine is untreatable. There are a wide variety of 1. Learn to live with it. options available for effective treatment of migraine. 149

6 150 APPENDIX 2 4. The pain of migraine Migraine attacks may involve 1. headache is always severe. no pain (i.e., aura only) or any degree of pain, ranging from mild to excruciating. 5. Migraine is a woman s Although migraine is roughly 1. disease. three times more common in women than in men, millions of men also suffer from migraine. 6. Accurate diagnosis of Migraine is diagnosed most 1. migraine requires that a accurately via the elicitation 1. brain scan be performed. of clear headache history and the performance of a thorough physical examination. Brain scans rarely are useful in diagnosing migraine. 7. Migraine is a sign of a Migraine is associated with 1. psychological disorder. depression, anxiety disorders and bipolar illness, but the individual patient may not have any of these. Ones attitude and emotional state influence the body s ability to battle disease and the physical outcome of those battles influences attitude and emotional state.

7 Appendix 3 Baseline Headache Questionnaire 151

8 152 APPENDIX 3 1. DATE: TO ALL HEADACHE CLINIC PATIENTS:: We would appreciate your cooperation in filling out this form. In our evaluation of headache, your history is typically our most valuable tool for diagnosis and subsequent treatment. If you have any questions regarding this form, please ask. A. Identification: 2. Name: 3. Age: 4. Sex: 5. Address 6. Phone(s) home: work: other 7. Name of your primary physician and location of his/her office, if known: 8. How were you referred to us? B. Headache History:: 9. How old were you when you first had a headache bad enough to keep you from continuing with your normal daily routine? 10. Within the past 30 days, how many days did you have a headache (of any severity: mild, moderate or severe?) 11. Are your headaches ever incapacitating (e.g., have to leave work or school or lie down undisturbed)? No Yes 12. If yes to #11, how many days out of the last 30 were you incapacitated by headache? 13. How long do your worst headache attacks tend to last? a) 0 1 hr b) 1 3 hr c) 4 12 hr d) hr e) hr f) hr g) 72 hr h) too variable i) unknown 14. Has there been any recent change in your headaches? No Yes (If yes, please specify what type of change:

9 Appendix Check any of the following factors which seem to trigger a headache attack in you: alcohol (specify types ) certain foods (please specify which types: menstruation emotional stress odors (please list ) too much or too little sleep missing meals other (please specify 16. With your most severe headaches, does physical activity worsen the pain? No Yes 17. Is your headache pain ever throbbing? No Yes Unknown 18. Is your headache ever localized to one side of the head? No Yes Unknown 19. Do you ever experience nausea in association with your headache attacks? No Yes Unknown 20. Do you ever experience vomiting in association with your headaches? No Yes Unknown 21. Do you ever experience inability to tolerate bright light (photophobia) with your headache attacks? No Yes Unknown 22. Do you ever experience sensitivity to sound with your headache attacks? No Yes Unknown C. Medical and Social History 23. What is your occupation? Are you currently having difficulties with your sleeping (insomnia, nocturnal awakenings; always sleepy, etc.)? No Yes (explain ) 24. Do you consider yourself to be under a significant amount of stress? No Yes (explain 25. Are you currently depressed, chronically anxious or prone to anxiety attacks? (explain )

10 154 APPENDIX Are you currently receiving formal treatment (counseling and/or medications) for anxiety or depression? No Yes 27. Your medical history (please check the appropriate boxes). hypertension (high blood pressure) allergies (list ) treated for depression in past do you smoke cigarettes now? (# of cigarettes per day ) any significant head injury? (If yes, within past 6 months? No Yes any other significant medical or psychiatric problem or conditions for which you are under medical care? If yes, please explain: 28. What medications are you presently taking? (Please include over-the-counter medications, birth control pills, and provide doses for all drugs, if known): 29. If you are female and of child-bearing potential, are you practicing birth control? No Yes (if yes, what method? ) 30. Have you had brain CT scan or MRI scan in the past? No Yes Unknown D. Family History: 31. Has anyone in your family had a significant problem with headaches or been diagnosed as having migraine or sick headaches? No Yes Unknown (if yes, who? ) 32. How would you rate your current headache status? excellent (headache-free or nearly so) very good (occasional headaches but no disability) good (occasional headaches, rare disability) fair (frequent headaches, rare disability) poor (frequent headaches, frequent disability)

11 Appendix E. If there is other specific information you wish for your health care provider to know, please summarize it here: PHYSICIAN ONLY 33. Diagnosis: a) migraine without aura only b) migraine with aura only c) migraine both with and without aura d) migraine with prolonged aura e) migrainous infarction f) active chronic daily h/a (how long daily: ) g) tension type only h) cluster i) probably migraine, but does not meet IHS criteria j) other (specify ) k) type I CDH (no migrainous features) l) type II CDH (daily from start/migrainous features) m) type III CDH (transformed/evolution migraine) n) multiple (as checked above) 34. Current frequency/severity (HD/FIHD) ratio? 35. MIDAS score 36. HIT-6 score F. Management Plan 37. Prophylactic therapy? No Yes (what? ) 38. Prescription abortive therapy? No Yes 39. Triptan? No Yes (which? ) UNBLINDED COINVESTIGATOR ONLY 40. Headache School? No Yes

12 Appendix 4 Headache Diary MONTH Headache? Highest Intensity Abortive Therapy What Abortive (Y/N) (1, 2 or 3)* Used? (Y/N) Therapy? 1 mild 2 severe but not disabling 3 disabling: cannot carry out usual activities for at least a portion of the day 157

13 Appendix 5 Medications Previously Tried for Migraine Treatment 159

14 160 APPENDIX 5 Appendix 5 Medications Previously Tried for Migraine Treatment Preventive Medications Tried? Reason for stopping? Other (list reason ) Depakote Yes No Unknown Ineffective side effects (list ) Topamax Yes No Unknown Ineffective side effects (list ) Neurontin (gabapentin) Yes No Unknown Ineffective side effects (list ) Zonegran (zonisamide) Yes No Unknown Ineffective side effects (list ) Elavil (amitriptyline) Yes No Unknown Ineffective side effects (list ) Pamelor (nortriptyline) Yes No Unknown Ineffective side effects (list ) Inderal (propranolol) Yes No Unknown Ineffective side effects (list ) Corgard (nadolol) Yes No Unknown Ineffective side effects (list ) Verapamil (Isoptin, Calan) Yes No Unknown Ineffective side effects (list ) Prozac Yes No Unknown Ineffective side effects (list ) Others: Yes No Unknown Ineffective side effects (list ) Yes No Unknown Ineffective side effects (list ) Yes No Unknown Ineffective side effects (list ) Acute treatment medications Tried? Effective? Side effects? Imitrex (sumatriptan) tablet Yes No unknown Yes No No Yes (list ) Maxalt tablet or melt Zomig tablet or melt Axert tablet Relpax tablet Frova tablet Imitrex nasal spray Zomig nasal spray DHE nasal spray (Migranal) Injectable Imitrex Narcotic (list ) Prednisone Other steroid (list ) Indomethacin (Indocin) Naproxen sodium (Anaprox) Others:

15 Index A Abortive drug therapy, guidelines, 83 86, 98 99, 142 medications used, Acephalgic auras, 55 Acetaminophen, 62, 92, 100 Acute migraines, Acute sinusitis, Advil, 95 Age of onset, 47 Alarm clock headaches, 69, 71, 119 Alcohol and cluster headaches, 32, 71, 73 intolerance and migraine, 71, 76 more/less problem liquors, 140 as trigger, 116 Aleve, 95, 100 Allergy to contrast dye, 40 headache myth, 19 Almotriptan, 102 Alternative therapy, butterburr extract, 105 feverfew, 105, 121 hot pepper extract, 74 magnesium, 60, 105, 121 oxygen, relaxation methods, 104 riboflavin (vitamin B2), , 121 safety factors, 121 Altitude headaches, 36 Amerge, 102 Amitriptyline, 94 Analgesic overuse headaches, chronic/pervasive type,

16 162 INDEX Analgesic overuse headaches (continued) drug administration guidelines, 66 67, 92 negative aspects of, 88 and opioids, 103 paroxysmal type, withdrawal treatment, Anaprox, 95, 100 Aneurysms, death from, detection of, 26, 28, 40 prevalence of, Angina, 109 Antidepressants for migraine prevention, 95 SSRIs, 95 for tension-type headaches, Antiemetics, 85, Anxiety disorder, 76, 109, 112 Aretaeus of Cappadocia, 5 Arterial dissection, and thunderclap headache, 27 Aspirin, 99 Asthma, 109 Auras, manifestations of, 53 56, 129 and medical assessment, 129 versus neurologic symptoms, 37 prevalence of, 52 rare forms, sensory, visual, 53 54, 120, 129 without head pain (acephalgic), 55 Axert, 102 B Basilar migraine, Belladonna, 9 Benign exertional headache, 22 23, 27 Benign sexual headache/explosive type, 23, 27 Berry aneurysms, Beta-blockers, 93 Bextra, 95 Bilious vapors, 5 6 Biofeedback and skin temperature changes, 51 for tension-type headaches, 68 Bipolar disorder, 76, 109 Birth control pills, 59, 90 Bloodletting, 6 7 Blood pressure elevation. See Hypertension Blood tests, erythrocyte sedimentation rate (ESR), 33, 44 BOTOX, 96 Brain and migraines auras, 52 56, 120 cortical spreading depression, historical view, 7 10 hypersensitivity theory, 75 78, 89, , imaging studies. See Diagnostic tests neurological exam, pain signal, direction of, and pediatric migraines, unified theory of migraine biogenesis, Brain tumors headaches myth, and secondary headaches, 15 16, 32 Butalbital, 62, 66 67, 103 Butorphanol, intranasal, 99 Butterburr extract, 105

17 Index 163 C Cafegot, 99 Caffeine as early treatment, and gastric emptying, as trigger and remedy, 79, 104, 118, 140 withdrawal from, 91 Calan, 95 Capsaicin, 74 Carry-over effect, 89 Carsickness, and pediatric migraines, 58 Celexa, 95 Change, migraineur sensitivity to, 108 Cheese, 116, 140 Children. See Pediatric migraines Chinese restaurant syndrome, 117 Chiropractic therapy, 68 Chocolate craving, and prodrome phase, Chronic daily headache (CDH), and prophylaxis, 87 Chronic headache, transformed migraines, Chronic/pervasive analgesic overuse headache, Chronic sinusitis, 18 Cialis, 36 Cigarette smoking, and cluster headaches, 73, 75, 141 Cluster headaches, and alcohol use, 32, 71, 73 and cigarette smoking, 73, 75, 141 diagnostic criteria for, 69 features of, 32 and gastric ulcers, 72 gender differences, pain of, 32, sleep as trigger, 69, 71, 119 treatment of, Codeine, 103 Comorbidity, and migraines, 76, Compazine, 103 Compliance, 134 Computerized tomography (CT) scan, aneurysm detection, 26, 28 contrasted and noncontrasted, Crash migraines defined, 21 and thunderclap headaches, 21 22, 27 D Darwin, Erasmus, 8 9 Decadron, 102 Decongestants, 18 Demerol, 103 Depakote, 62, 93 Depression comorbidity with migraines, 109 nonpharmacological treatment, 111 and prodrome phase, 50 DHE (dihydroergotamine), 91, 100 Diagnostic tests, computerized tomography (CT) scan, electrocephalogram (EEG), 43 erythrocyte sedimentation rate (ESR), 33, 44 lumbar puncture (LP), magnetic resonance imaging (MRI), in medical assessment, 133 Diary, headache, 133, 157 Diet and migraine food triggers, headache prevention guidelines,

18 164 INDEX Dihydroergotamine (DHE), 91, 100 Diuretics, and menstrual migraines, 60 Divalproex, and Divalproex sodium, 73, 93 Dizziness, basilar migraine, Drug treatment abortive therapy, 83 86, and analgesic overuse headaches, 66 67, 83, 90 92, 98 for cluster headaches, drug-drug interactions, 98 historical view, 5 9 latency period, 88 mechanisms of action, for menstrual migraines, 60, 90, 95 for migraines during pregnancy, 62 for nausea/vomiting, 85, prophylactic therapy, rebound headaches, 66 67, 98 for tension-type headaches, Duragesic patch, Duration of headache, medical assessment information, E Egyptians, ancient, 4 Elavil, 94 Electrocephalogram (EEG), 43 Eletriptan, 102 Elimination diets, Encephalitis features of, 42 lumbar puncture (LP) diagnosis, 27 29, Epidural blood patch, 28 29, 43 Epilepsy, 76, 109 Episodic migraine, 82 Ergots DHE, 100 ergotamine tartrate, 62, 91, 99 Erythrocyte sedimentation rate (ESR), 33, 44 Esgic, 62, 66, 103 Estrogen and migraines, estrogen replacement therapy (ERT), estrogen withdrawal headaches, 59 menstrual migraines, 59 60, 90 treatments, Estrogen patch, Euphoria, and prodrome phase, 50 Evil spirits, 2 3 Exercise benefits of, 68, 79, 141 and thunderclap headaches, 22 23, 36 Exorcism, 3 Extremities, cold, 50 Eyes and cluster headaches, 32, 69 and idiopathic intracranial hypertension, 32, 34 ophthalmoplegic migraine, 55 and referred pain, Eyestrain, F Family, genetics and migraines, 58, 109, 131 Fermented foods, 116 Fetadolex, 105 Feverfew, 105, 121 Fioricet, 62, 66, 103 Fiorinal, 62, 66, 103 Fluorescent light, 120 Focal neurologic deficits, types of, 37

19 Index 165 Food cravings, and prodrome phase, triggers, Frequency of migraines medical assessment information, 126 and preventive treatment, 87 variations in, Freud, Sigmund, 9, 112 Frova, 102 Frovatriptan, 90 Functionally incapacitating headache days, 127 G Gabapentin, 94 Galen, 6 Gastric paresis, and acute migraine, Gastric ulcers, and cluster headaches, 72 Gender differences cluster headaches, pediatric migraines, 59 Genetic factors in medical assessment, 131 migraine headaches, 58, 109 Giant cell arteritis, 44 GnRH analogs, Grant, Ulysses S., 113, Greeks, ancient, 4 5 H Hallucinations and neuronal stimulation, 76 visual auras, Hangovers, and migraineurs, 76 Headache myths, 15 21, allergies, 19 brain tumors, eyestrain, hypertension, 21 sinus disease, temporomandibular joint (TMJ) problem, Headache questionnaire, 133, Headaches diagnostic tests, famous sufferers of, 10 11, historical view, 2 11 medical attention, time for, primary and secondary, 15 See also Migraine headaches; Primary headaches; Secondary headaches Hemicrania, 6 Hemp, 9 Heterocrania, 5 6 Hippocrates, 4 5 Holistic approach, Native Americans, 5 Hormones estrogen and migraines, medical assessment information, 132 menstrual migraines, pregnancy and migraines, 59, Hot pepper extract, 74 Humoral theory, 4 5, 7 Hypersensitivity theory, 75 78, 89, , Hypertension headache myth, 21 malignant, 32 I Idiopathic intracranial hypertension features of, 32, 34 pain of, 32, 34 Imaging, brain. See Diagnostic tests Imitrex, 62, 66, 75, 80, 101

20 166 INDEX Inderal, Indocin, 95, 100 Indomethacin, 23, 24, 100 Infections, and headache, 29 International Headache Society (IHS) on cluster headaches, 69 on migraine, 50 on tension-type headache, 64 Isometheptene, 100 J Jet lag, and migraineurs, 76, 109 L Laudanum, 9 Levitra, 36 Lexapro, 95 Light sensitivity, 55, 120 Lithium carbonate, 73 Liveing, Edward, 9 Locus of control, 135 Lorcet, 103 Lortab, 103 Lumbar puncture (LP), 27 29, blood patch for headache, 28 29, 43 headache caused by, 28 29, procedure, 28, 42 Lyme disease, 29 M Magnesium for menstrual migraines, 60, 90, 105 for migraine prevention, 105, 121 Magnetic resonance imaging (MRI), Maimonides, Moses, 7 Malignant hypertension, features of, 32 Mandragora, 6 Massage, 68 Maxalt, 102 Medical assessment, of auras, 129 diagnosis, aspects of, family history, 131 frequency/severity/duration profile, headache diary, 133, 157 headache questionnaire, 133, imaging studies, 133 intake information, changes related to migraines, medical history, medication history, , 160 neurological exam, onset of headache syndrome, social history, 131 symptom review, 132 triggers, 128 Medication history, , 160 Medication for migraines. See Abortive drug therapy; Drug treatment; Prophylactic drug therapy; specific drugs Meningitis features of, 29, 32, 42 lumbar puncture (LP) diagnosis, 27 29, pain of, 29 Menopause clinically induced, and migraines, Menstrual migraine, 59 60

21 Index 167 medical assessment information, 128 prophylaxis for, 87, 90 treatment of, 60, 90, 95, 105 Mepergan, 103 Meperidine, 103 Methadone, Metoclopramide, 85 Midrin, 100 Migraine headaches, age of onset, 47 auras, 52 56, 82, 129 basic features, 32 basilar migraine, and brain, unified theory of biogenesis, classification of, 46 comorbidity, 76, costs of, crash migraine, 21 22, 27 diagnostic criteria, 50 episodic migraine, 82 and estrogen levels, frequency, variations in, genetic factors, 58, 109 headache phase, historical view, 3 11 hypersensitivity theory, 75 78, 89, , medical assessment, ophthalmoplegic migraine, 55 origin of term, 6 pain of, pediatric migraine, postdrome phase, 57 prevalence of, 47 prodrome phase, and quality of life, 48 relationship to tension-type headaches, and sensitivity to change, 108 and stress, transformed migraines, treatment. See Abortive therapy; Alternative therapy; Drug treatment; Prophylactic therapy triggers, 6 8, 79, worsening, common causes, 16, 30 Migraine personality, 114 Migranal, 100 Mitral valve prolapse, 109 Mood, and prodrome phase, 50 Mood disorders bipolar disorder, 76, 109 depression, 109, 111 Motion sickness comorbidity with migraines, 76, 109 and pediatric migraines, 58 Motrin, 95 MSG (monosodium glutamate), 117, 140 Muscle contraction headache, 63 See also Tension-type headaches Muscle relaxants, for tensiontype headaches, 68 N Naprosyn, 95 Naproxen sodium, 90, 100 Naratriptan, 90, 102 Narcotics and addiction, 74 ancient use, 6 Native Americans, 5 Nausea/vomiting, medication for, 85, Navaho, 5 Neck pain in later stage, 65 and prodrome phase, 50, 65 Neurological exam, Neuroticism, 114

22 168 INDEX Neurontin, 94 Nitrites, 117 Nonsteroidal anti-inflammatory medication, 60, 79, 90, 100 brands of, 95 Numbness, sensory aura, O Obesity and idiopathic intracranial hypertension, 32, 34 and sleep apnea, 120 Occipital nerve blocks, 96 Occupation, and headaches, 7 8 Odors, as triggers, 57, 120 Ophthalmoplegic migraine, 55 Opioid therapy indications for, and overuse headaches, 103 side effects, 97, 103 types of drugs, 96 97, 103 Opium, 6 Osler, William, 10 Overuse of medication and drug tolerance, 85, 103 and headaches. See Analgesic overuse headache Oxycontin CR, 96 97, 103 Oxygen, for cluster headaches, P Pain and eyes, of meningitis, 29, 42 referred pain, See also specific form of headaches Panic disorder, 76, 109 Paroxysmal analgesic overuse headache, Paxil, 95 Pediatric migraines, gender differences, 59 signs of, Percocet, 103 Percodan, 103 Petadolex, 105 Petasites, 105, 121 Phenergan, 103 Phenols, 116 Phosphenes, 76 Photophobia, 120 Photopsias, 53 Phrenilin, 62, 66, 103 Physical exertion, and thunderclap headaches, 22 23, 36 Physical therapy, 68 Physician intake. See Medical assessment Polysomnogram, 120 Postdrome phase, 57 Postlumbar puncture headache, Prednisone, 73, 102 Pregnancy, migraines during, 59, Premarin, 61 Prevention of headaches. See Prophylactic drug therapy Primary headaches cluster headaches, 32, defined, 15 migraine headaches, tension-type headaches, 32, Prodrome phase, 49 52, 65 Prophylactic drug therapy, and carry-over effect, 89 cases requiring, effectiveness of, guidelines for, 87 89, 97 98, 142 medications used, 93 97

23 Index 169 for menstrual migraine, 87, 90 occipital nerve blocks, 96 purpose of, 89 Propranolol, 93 Prozac, 95 Psychological disorders, comorbidity with migraines, Q Quality of life (QoL), and migraine headache, 48 Questionnaire, headache, 133, Quinine, 9 R Ramazzini, Bernardo, 7 Raynaud s syndrome, 109 Rebound headaches. See Analgesic overuse headaches Red wine, 116, 118, 140 Referred pain to eyes, to teeth, Reglan, 85 Relaxation methods, 104 Relpax, 102 Riboflavin (vitamin B2), Rizatriptan, 102 Romans, ancient, 6 S Scalp, tenderness, and temporal arteritis, Secondary headaches, and brain tumor, 15 16, 32 common causes of, 27 defined, 15, 29 and focal neurologic deficits, 37 and idiopathic intracranial hypertension, 32, 34 and infections, 29 and malignant hypertension, 32, and medical attention, 27 and meningitis, 29, 32 and subarachnoid hemorrhage, 24 27, 32 and temporal arteritis, 32 Selective serotonin reuptake inhibitors (SSRIs), 95 Sensory auras, Serotonin and sleep, 79 SSRIs and treatment, 95 Severity of migraines, medical assessment information, Sexual activity, headache caused by, 23, 36 Sinfulness, 6 7 Sinusitis, 16 18, 29 acute/chronic, signs of, Sinus medications, 18 Sleep analgesic overuse headache during, 91 cluster headache during, 69, 71, 119 as migraine intervention, 79 sleep apnea syndrome, 120 as trigger, Sleep problems, and migraineurs, 76, 109 Social history, 131 Spinal tap. See Lumbar puncture (LP) Spreading depression, Stadol, 102 Status migrainosus, 128 Steroids, 73 74, 79, 102 Stress,

24 170 INDEX coping techniques, 141 individual reactions to, relaxation methods, 104, 141 as trigger, , 141 Stroke, and thunderclap headache, 27, 109 Subarachnoid hemorrhage. See Aneurysms Substance P, 74 Sulfites, Sumatriptan, 75, 80, 90, 99, 101 Supernatural, attribution of headache to, 2 5 T Tachyphylaxis, 85, 103 Talmud, 6 7 Teeth, and referred pain, Teichopsias, 53 Temporal arteritis diagnosis of, 33 features of, pain of, Temporomandibular joint (TMJ) problem, Tension-type headaches, 32, chronic, diagnostic criteria for, 64 features of, 32, pain of, 32, relationship to migraines, treatment of, Thrombosis, and thunderclap headache, 27 Thunderclap headaches, and aneurysms, 24 27, 32 common causes, 27, 32 crash migraines, 21 22, 27 defined, and lumbar puncture (LP), pain of, and physical exertion, 22 23, 36 See also Secondary headaches Tingling, sensory aura, Tolerance to drugs, 85, 103 Topamax, Topiramate, 73, Transformed migraines, pain of, 30 Treatment and comorbidities, non-medication techniques, 68, 79 and patient compliance, 134 See also Abortive drug therapy; Alternative therapy; Drug treatment; Prophylactic drug therapy Trephining, 4 Tricyclic antidepressants, for tension-type headaches, Triggers, food, historical view, 6 8 and individual differences, 79, light, 55, 120 odors, 57, 120 sleep, stress, visual stimulii, 120 Triptans, 60, 80, 84, 90 brand names, Tylenol, 100 Tylox, 103 Tyramine, 116 U Unified theory, migraine biogenesis, 75 78

25 Index 171 V Verapamil, 73, 95 Viagra, 36 Vicodin, 103 Visual auras, 53 54, 120, 129 Visual stimulii, as triggers, 120 Vomiting, infants, W Willis, Thomas, 8 Wine, 116, 118, 140 Withdrawal for analgesic overuse, from opioids, 97. Women and cluster headaches, estrogen and migraines, Y Yawning, and prodrome phase, Z Zinisamide, 96 Zolmitriptan, 101 Zoloft, 95 Zomig, 101 Zonegran, 96