file.newsgroup.med.59128 Maven / Gradle / Ivy
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From: [email protected] (Jim Zisfein)
Subject: Re: Could this be a migraine?
GB> From: [email protected] (Gordon Banks)
GB> >(I am excepting migraine, which is arguably neurologic).
GB> I hope you meant "inarguably".
Given the choice, I would rather argue .
No arguments about migranous aura; in fact, current best evidence is
that aura is intrinsicially neuronal (a la spreading depression of
Leao) rather than vascular (something causing vasoconstriction and
secondary neuronal ischemia).
Migraine without aura, however, is a fuzzier issue. There do not
seem to be objectively measurable changes in brain function. The
Copenhagen mafia (Lauritzen, Olesen, et al) have done local CBF
studies on migraine without aura, and (unlike migraine with aura,
but like tension-type) they found no changes in LCBF.
From one (absurd) perspective, *all* pain is neurologic, because in
the absence of a nervous system, there would not be pain. From
another (tautologic) perspective, any disease is in the domain of
the specialty that treats it. Neurologists treat headache,
therefore (at least in the USA) headache is neurologic.
Whether neurologic or not, nobody would disagree that disabling
headaches are common. Perhaps my fee-for-service neurologic
colleagues, scrounging for cases, want all the headache patients
they can get. Working on a salary, however, I would rather not fill
my office with patients holding their heads in pain.
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. SLMR 2.1 . E-mail: [email protected] (Jim Zisfein)