Migraine is a very common medical condition. Migraine headaches are the second most common cause for work absences secondary only to low back pain. Unfortunately migraine is the most prevalent in the working population age group. Fortunately many new migraine treatments have been developed. The newest migraine medication that has been FDA approved is Treximet. Treximet is a combination medication. It has Imitrex with RT technology in combination with naproxen sodium (the active ingredient in Aleve.) Imitrex was the first drug in the class of triptan medications that are migraine treatment specific. Studies have shown that the Treximet formulation of the two component drugs is more effective in migraine treatment than with either drug alone. Overall, Treximet has about a 10% greater effectiveness in stopping a migraine attack with the first dose, over either of the other migraine drugs, taken alone or together.

There are several other migraine treatment medications including Maxalt, Zomig, Relpax, Frova, Amerge and Axert. All of these medications are “designer drugs” formulated specifically to treat an acute migraine attack. The most important step for any patient who suffers from headaches is to get in to see a headache specialist. Migraine and headache treatment has become a specialized area in neurology. Neurologists who treat migraine, cluster and other headache disorders take a different approach to treatment of headaches and improving the patient’s quality of life. For additional information on migraine and headache treatment click here.


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Normal pressure hydrocephalus once again appears in the news. Zig Ziglar, a well known motivational speaker, recently was diagnosed with normal pressure hydrocephalus. About a year ago, Mr. Ziglar had suffered a fall down a flight of stairs, as referenced on a blog from Michael Pink. His family had noticed that Mr. Ziglar was having some memory loss associated with gait unsteadiness.  The characteristic clinical symptoms of normal pressure hydrocephalus are gait unsteadiness, memory loss and urinary incontinence. The exact cause of this condition is unknown but what happens is there is a build up of water (spinal fluid) on the brain. Diagnosis is difficult to make and one should see a neurologist familiar with the condition. The treatment for this is putting a special tube in the brain, known as a shunt. This is a fairly routine neurosurgical procedure.

For the diagnosis of normal pressure hydrocephalus, a patient should first have a CT scan or MRI brain scan. If the spaces in the brain that contain spinal fluid (ventricles) are enlarged, the patient should then have a spinal tap. About an ounce of spinal fluid taken drained off. Then the patient will have gait testing to see if their walking improves. If it does but then worsens a few hours later, the diagnosis is made. A brain shunt can then be permanently put in by a qualified neurosurgeon. Patient’s with true normal pressure hydrocephalus can show dramatic improvements in their ability to walk with gait training rehabilitation. The urinary incontinence will also improve. Unfortunately, if they have a degree of short term memory loss, this procedure will have little if any effect on restoring memory. It is this author’s hope that Zig Ziglar has improved and is doing well with his new brain shunt. To find out more about Zig Ziglar, check his blog site.


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