A few days ago Health Canada advised Canadians about new safety information for carbamazepine, a drug used to treat epilepsy, mania, bipolar disorder and trigeminal neuralgia. Carbamazepine is sold under the more common brand name Tegretol as well as other generic names. Serious and sometimes deadly skin reactions known as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) have been known to occur with carbamazepine. This applies to ALL patients treated with carbamazepine. However the risk is approximately 10 times higher in Asian countries than in Western countries. Further, studies have suggested that patients of Asian ancestry may also be at increased risk if they take carbamazepine. There is a genetic test that may be useful in identifying a particular genetic marker in patients.  Patients of Asian ancestry, particularly Han Chinese, may wish to discuss this test with their doctors … Read more

The other day I was watching Mystery Diagnosis on TLC. For those who don’t know what it is Mystery Diagnosis tells the stories of patients with medical mysteries. In each personal story, the patients, doctors and everyone involved discover the importance of being vigilant.  Medicine is often more of an art than a science, and the journey to diagnosis can be a twisted path full of many surprises. Recently I saw an episode that featured a middle age women develop a new daily headache. She had an MRI done which showed a few dots of white matter, but besides that everything was normal.  It was eventually found by a cardiologist that the aura she was also experiencing was due to a Patent Foramen Ovale. She had a hole in her heart that never fully closed. Eventually surgery was done and … Read more

I found an interesting read on migraines and headaches over at http://www.migraineprevention.com/ It discusses that “While the current medical models for migraine pathophysiology include afferent input from the meningeal arteries to the trigeminal sensory nucleus, the effect of any other acute or chronic noxious afferent input from the other divisions of the trigeminal, primarily the mandibular (third) division and how that noxious afferent input effects sensory modulation, has been essentially ignored.” Then “as a result of genetic properties of the host as a result of a pre-sensitization of the sensory nucleus inflammation of the arteries, which is thought to be primarily responsible for the patient’s pain, throbbing and aversion to movement [occur].” The site goes into greater detail and also discusses an elevated sympathetic tone in patients.