Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

982 Methemoglobinemia Migraine Headache

Side Effects & Complications

■Methylene Blue

➣High doses associated with SOB, chest pain, hemolysis

➣Interferes with measurement of methemoglobin by co-oximetry

Contraindications

■Methylene blue – G6PD deficiency as it induces hemolysis

follow-up

During Treatment

■May repeat methylene blue, but generally not necessary

■Cannot use co-oximetry to monitor methemoglobin after methylene

blue given

complications and prognosis

■Most congenital methemoglobinemias

➣Normal life expectancy

■Type 2 cytochrome b5 reductase deficiency

➣Dismal prognosis

➣Prenatal diagnosis possible

➣Hope for gene therapy

MIGRAINE HEADACHE

CHAD CHRISTINE, MD

history & physical

■Recurrent headaches develop over minutes to hours

■Headache often unilateral & pulsatile

■Visual auras (field defects, scotomas, scintillation, etc) in 10% of cases

■Often assoc w/ nausea, photophobia, phonophobia, malaise

■2–3 times more common in women, onset usually before age 40 yr

■Family history is common

■Headache duration is typically >2 hours & <1 day

■Neurologic deficits occur uncommonly

■Attacks can be precipitated by certain foods, fasting, emotional expe-

riences, menses, drugs, caffeine, alcohol, bright lights

■Usually normal

■Visual disturbance, mild hemiparesis or hemisensory deficit may

occur