Faculty Bibliography

Migraine and other headache conditions are relatively common during pregnancy. Physicians and other primary health care providers should not assume that because a patient presents with headache alone, such symptoms can be taken lightly. Most patients do not develop new-onset headache during pregnancy, and all patients who do develop such a condition must be evaluated thoroughly. Similarly, patients who develop any change in their headache condition must undergo a careful evaluation. Fig. 3.1 is an algorithm to aid in evaluating pregnant patients with headache. Postpartum headaches also must be evaluated and treated appropriately. In most cases of headache during pregnancy and postpartum, the patient is suffering with a benign medical condition. Even so, quality of life is an important consideration in preserving the patient's physical and emotional well-being (102, 103). A stepwise approach to symptomatic treatment should be provided for all patients. A high index of suspicion for nonbenign causes of headache will assist in decreasing morbidity and mortality to the mother and fetus

Growth failure is a recognized feature of the Prader-Willi syndrome (PWS). Despite evidence that hypothalamic dysfunction accompanies the syndrome, the etiology of this growth failure remains controversial because most patients with PWS are obese. In order to contribute to resolution of this controversy, we performed a retrospective analysis of 16 obese and non-obese PWS children. GH deficiency was diagnosed in 12 of the 16 subjects and occurred independently of weight status. All of the non-obese subjects were GH deficient. Of the 4 GH-sufficient children, 2 were moderately obese and 2 were morbidly obese. One of these children had clinical evidence of GH deficiency including a low IGF-1 level. Only one of the children had evidence of GH deficiency and a normal IGF-1 level, a pattern that could be attributable to obesity. We conclude that most short children with PWS have growth hormone deficiency and that this deficiency probably results from hypothalamic dysfunction

We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment

Low back injuries occur commonly in tennis, but the pathophysiologic, biomechanical, and clinical characteristics are not well defined. Tennis players may be at an increased risk of lumbar disc pathology from rotational and hyperextension shearing effects. Treatment of low back injury at present is empiric, but sport-specific lumbar stabilization and unloading of the lumbar disc should be developed. Prospective longitudinal research protocols are needed to study the lumbar spine in tennis players

Headache is very common among women of childbearing age and can be influenced by hormonal fluctuations. When pregnant women develop headache, the cause is usually tension-type headache or migraine, but headache may be a symptom of a more serious neurologic or medical condition. This article discusses the differential diagnosis and management of major causes of headache during pregnancy

Sports medicine physicians should be able to recognize and manage peripheral nerve injuries in athletes. Most often, the injury is a result of repetitive microtrauma, linking peripheral nerve injury to other musculoskeletal injuries in athletes. As with other musculoskeletal injuries, rest and a modification of the athlete's regimen often lead to clinical improvement. If the physician is uncertain about the diagnosis, if the athlete develops a rapid worsening of symptoms and signs, or if the athlete is refractory to treatment, a physician who specializes in peripheral nerve injuries should be consulted