Elegies

At the beginning of the 1970s, Pamela entered a decade of ill health. A migraine sufferer from childhood and long susceptible to depression (which she believed she inherited from her mother), the headaches and the mood swings became serious. The family doctor, David Sofaer, prescribed various medications, primarily tranquillizers. Also, after having suffered from gynaecological problems for many months, she underwent a hysterectomy. But during these years she never stopped writing and published four interesting and very different novels. Two feature the escape from working-class life of a male character and the price he pays for his social dislocation. The Honours Board is a moving depiction of life in a boys’ preparatory school, thought to be based upon her son Philip’s school. The Holiday Friend is a chilling story of erotic obsession and murder set in a Belgian seaside resort.

Recurrent Lilliputian Hallucinations as Visual Aura Symptom in Migraine

Since her early 30s a 72-year-old female migraine sufferer has experienced recurrent episodes of Lilliputian hallucinations occurring at the peak of her severe migraine attacks and lasting between 2 min and 5 min, suggesting that her miniature hallucinations represent a visual migraine aura symptom. The existence of Lilliputian hallucinations of a migrainous nature is confirmed by four similar case reports reviewed from the migraine literature. The occurrence of similar Lilliputian hallucinations in the syndrome of peduncular hallucinosis, due to mesencephalic and/or thalamic lesions, supports the notion that the patient's recurrent Lilliputian hallucinations might have been aura symptoms of basilar migraine.

Frequency of Severe Attacks in Migraine Sufferers of the Gazel Cohort

The concept of severe migraine was raised to define migraineurs most in need of care and for use in clinical practice. We aimed to measure the frequency of severe attacks in a working sample of 276 migraine sufferers using a diary over a 3-month period. Migraine sufferers recorded each attack's clinical features, the degree of their disability, their use of drugs and the effectiveness of the drugs. Since the definition of severe attack is not standardized, we studied the impact of different definitions on the frequency. The frequency of severe attacks was 0.9% and appeared to be very sensitive to the definitions, ranging between 0.4 and 13%. In France, the extrapolated number of severe attacks is nearly one million out of a total of 115 million. In the migraineurs who had had at least one severe attack, the individual variability of intensity, duration or disability was very high, so the proportion of severe attacks in a given sufferer was low—between 15% and 50%. We conclude that the global concept of severe migraine is not relevant and should be split into two componentssevere attack and severe migraine sufferer. The goals are different, too. Regarding treatment, for example, the severe attack concept is more valid for acute treatment strategies, whereas the severe migraine sufferer concept should be preferred to determine the need for prophylactic treatment. Since much work is being done nowadays to define a rate treatment strategies, definition of the criteria of severe attack and validation of a measurement tool should be a priority.

Ergotamine-Induced Headache can be Sustained by Sumatriptan Daily Intake

We describe the case report of a migraine sufferer who developed ergotamine-induced headache and subsequently replaced ergotamine with daily sumatriptan (100 mg p.o.). The features of the headache were unchanged except for the presence of superimposed migraine-like headaches that occurred every 24 h.