Medication Disability Research Articles

Exploring the Use of Socially Assistive Robots Among Socially Isolated Korean American Older Adults.

This pilot study explored whether a socially assistive robot (SAR) would have positive effects on Korean American immigrant older adults' health behaviors and emotional well-being and whether the older adults would be receptive to the SAR. A total of 30 participants (age 65+) in a large metropolitan area participated in the study, and each participant was provided a SAR named Hyodol for 4 months and interacted with it in ways that they saw appropriate. We used one-group pre- and post-test design to assess changes between baseline and follow-up in medication adherence, depressive symptoms, loneliness, and disability. Additionally, we employed in-depth qualitative interviews to explore participants' perceptions about the SAR. At post-test, participants showed improved medication adherence, reduced depressive symptoms, and a slightly and statistically nonsignificant decrease in loneliness scores. Qualitative data suggested high adoptability of this particular SAR among the participants.

Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US Veterans.

Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment-related TBI, where combat/blast may be more common, may have different outcomes than nondeployment-related TBI. This work examined associations of all TBI exposures (not just combat), and epilepsy, while adjusting for comorbidities associated with epilepsy, among veterans by deployment status. The cohort included post-9/11 veterans with ≥2 years of care in both Veterans Health Administration and Defense Health Agency systems. We identified epilepsy using ICD-9/10-CM codes, antiseizure medication, and service-connected disability for epilepsy. We conducted a logistic regression model with interaction terms for conditions by deployment history that adjusted for demographics and military characteristics. The cohort (n = 938,890) included post-9/11 veterans of whom 27,436 (2.92%) had epilepsy. Most veterans had a history of deployment (70.64%), referred to as "deployed." Epilepsy was more common among veterans who were never deployed ("nondeployed") (3.85% vs 2.54%). Deployed veterans were more likely to have had TBI, compared with the nondeployed veterans (33.94% vs 14.24%), but nondeployed veterans with moderate/severe TBI had higher odds of epilepsy compared with deployed veterans (adjusted odds ratio [aOR] 2.92, 95% CI 2.68-3.17 vs aOR 2.01, 95% CI 1.91-2.11). Penetrating TBI had higher odds of epilepsy among the deployed veterans (aOR 5.33, 95% CI 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Although most neurologic conditions were more prevalent among the nondeployed veterans, they were often associated with higher odds of epilepsy in the deployed veterans. Deployment history had a significant differential impact on epilepsy predictors. As expected, penetrating TBI had a greater epilepsy impact among deployed veterans perhaps due to combat/blast. Some epilepsy predictors (moderate/severe TBI, multiple sclerosis, and Parkinson disease) had a stronger association in the nondeployed veterans suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurologic conditions (e.g., brain tumor, Alzheimer disease/frontotemporal dementia) had a greater epilepsy impact in the deployed veterans. This may be attributable to deployment-related exposures (combat injury, occupational exposures). A better understanding of deployment effects is critical to provide targeted epilepsy prevention in veterans and military service members.

Psychiatrists’ awareness of the cost of medication, rates of social disability pension, and their attitudes regarding knowledge of treatment costs

BackgroundMedication is a significant component of the cost of mental health care. Studies from different countries indicate that physicians are often not aware of medication costs, despite the impact of such knowledge on treatment plans. The purpose of this study was to examine Israeli psychiatrists’ knowledge regarding the cost of medication and rates of disability pension, and the impact of these factors on treatment decisions.MethodsCross-sectional study. A questionnaire was distributed by e-mail to psychiatry specialists and residents, including: (a) socio-demographic and professional information; (b) knowledge regarding rates of National Insurance disability pension and medications’ costs; (c) attitudes regarding relevance of knowledge of treatment costs. Correlations between socio-demographic variables and knowledge regarding treatment costs and attitudes were examined.ResultsOf the 175 psychiatrists who completed the questionnaire, 55% were men. The level of knowledge regarding cost of psychotropic medication and disability pension rates was low. Sixty-eight percent rated economic considerations as important or very important, yet 75% were informed of medication prices by their patients, and 57% by pharmaceutical companies. Doctors who worked in regions other than the center of the state were more aware of the economic aspects of treatment. Physicians who reported easy access to information regarding drug prices were less likely to err in estimating the price of medications.ConclusionsPsychiatrists in Israel are not sufficiently informed of the costs of psychotropic medications, despite their awareness of the relevance of affordability to treatment compliance. Awareness of economic issues relating to treatment should be included in residency programs, and access to relevant information of medication cost and disability pensions should be more accessible to physicians both on national and local levels, by the government and health maintenance ogranizations (HMOs).

High-frequency repetitive transcranial magnetic stimulation at dorsolateral prefrontal cortex for migraine prevention: A systematic review and meta-analysis.

To evaluate the efficacy of high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex as a migraine prevention by conducting a systematic review and meta-analysis. The efficacy of high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex as preventive migraine treatment remains debatable. PubMed, Scopus, CINAHL, CENTRAL, and BioMed Central databases were searched from their inception until December 2020. Randomised trials comparing high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex with sham for migraine prevention were included. The risk of bias was assessed using the Cochrane guidelines. Headache days, pain intensity, acute medication intake, and disability were extracted as study outcomes and the mean difference with a random-effects model was used to determine the effect size. Meta-analysis revealed that high-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex significantly reduced acute medication intake (Mean Difference = 9.78, p = 0.02, 95%CI: 1.60, 17.96, p = 0.02) and functional disability (Mean Difference = 8.00, p < 0.05, 95%CI: 4.21, 11.79). However, no differences were found in headache days and pain intensity reduction, although there was a slight trend favouring high-frequency repetitive transcranial magnetic stimulation. High-frequency repetitive transcranial magnetic stimulation over dorsolateral prefrontal cortex may be effective in reducing acute medication intake and disability. However, more studies are needed to strengthen this preliminary evidence.

Medication Non-Adherence and Disability among Outpatients with Schizophrenia in North-Central Nigeria

Background: About fifty percent of patients with Schizophrenia do not take their medication as prescribed. This scenario often results in disease progression and increased relapse rates, resulting in poor outcomes, including functional disability. Aim: This study was design to evaluate the relationship between medication non-adherence and disability in patients with Schizophrenia attending the outpatient clinic at the Jos University Teaching Hospital, north-central Nigeria, from June 2017 to November 2017. Methods: We carried out a cross-sectional study that employed a systematic sampling method to select 301 eligible subjects. We used the Medication Adherence Rating Scale (MARS) 10 and World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.00) to assess medication adherence and levels of disability. Results: The results show that 39.9% of the respondents were medication nonadherent. Medication adherence correlated negatively with the total disability score and all the domains of disability. A low level of education and poor social support were significant predictors of non-adherence. Conclusion: Medication non-adherence and its associated factors, if identified early and proper interventions instituted, a disability could be avoided or minimized among people with Schizophrenia. Therefore, we recommend regular screening of patients with mental disorders for early identification and intervention for medication adherence.

Acceptance and commitment therapy for high frequency episodic migraine without aura: Findings from a randomized pilot investigation.

We compared the incremental effects of adding acceptance and commitment therapy (ACT) to pharmacological treatment as usual (TAU) in a sample of patients with high frequency episodic migraine without aura (HFEM), assessing impact on a spectrum of measures across multiple domains. Patients with HFEM are at risk of developing chronic migraine and medication overuse headache. ACT has been shown to be effective for the treatment of various chronic pain conditions, but little attention has been given to its therapeutic value in the management of recurring headaches. In this single-blind (masking for outcome assessor), open-label, randomized clinical trial, 35 patients with HFEM, with a monthly headache frequency ranging from 9 to 14days, were recruited at the headache center of C. Besta Neurological Institute and randomized to either TAU (patient education and pharmacological prophylaxis; n=17) or TAU+ACT (n=18). Patients assigned to the combined treatment arm additionally received six 90-min weekly group sessions of ACT therapy and two supplementary "booster" sessions. All patients were on a stable course of prophylactic medication in the 3months prior to initiating either treatment. Monthly headache frequency served as the primary outcome measure, with all other data collected being considered as secondary measures (medication intake, disability, headache impact, anxiety and depression, catastrophizing, allodynia, cognitive inflexibility, pain acceptance, mindful attention and awareness). A total of 35 patients were enrolled: 17 randomized to TAU, of whom three dropped out, and 18 to TAU+ACT (no dropouts in this group). Headache frequency and medication intake decreased in both groups over 12months, with patients in the TAU+ACT group showing statistically significant reduction earlier, that is, by month 3. Headache frequency was reduced by 3.3days (95% CI: 1.4 to 5.2) among those randomized to ACT+TAU, whereas it increased by 0.7days (95% CI: -2.7 to 1.3) among those randomized to TAU only (p=0.007, partial η2 =0.21), the difference being 4days (95% CI: 1.2 to 6.8). Medication intake was reduced by 4.1 intakes (95% CI: 2.0 to 6.3) among those randomized to ACT+TAU and by 0.4 intakes (95% CI: -1.8 to 2.5) among those randomized to TAU only (p=0.016; partial η2 =0.17), the difference being 3.8 intakes (95% CI: 0.7 to 6.8). At 6 and 12months, the variations were not different between the two groups for headache frequency and medication intake. The opposite was found for measures of headache impact and pain acceptance, where the differences over time favored patients allocated to TAU. Both groups improved with regard to measures of disability, anxiety and depression, catastrophizing, and cognitive inflexibility, whereas measures of allodynia and pain acceptance were stable over time. Our preliminary findings indicate that supplementing TAU with ACT can enhance the main clinical outcomes, namely headache frequency and medication intake of patients with HFEM.

Medication-overuse headache: The effect of a patient educational programme-A randomized controlled trial.

Little is known about the effects of non-pharmacological interventions among medication-overuse headache (MOH) patients, although non-pharmacological approaches combined with pharmacological treatment are recommended. The objective was to evaluate the effect of an educational programme as an add-on to standard treatment. Medication-overuse headache patients were randomized (1:1) in a single-centre setting to standard treatment with 12weeks of education (I-group) versus standard treatment (C-group). The primary outcome was measurement of reduction in headache days/last month at 9 months' follow-up. Secondary outcomes were headache intensity, acute medication intake, bothersomeness, disability, physical activity and patient satisfaction. The between-group differences were analysed using a mixed-effects model for repeated measurements with a between group factor (I-group vs. C-group) and a time factor (baseline, 4 and 9months). Ninety-eight patients were randomized (I-group: n=48, C-group: n=50), with 40 and 39 patients completing the study, respectively. Intention-to-treat analyses showed that both groups experienced statistically significant reductions in headache days/last month (I-group: -4±6days (95% CI 2.47; 5.95), p<.001) versus C-group: -4±9days ([95% CI 1.53; 6.79], p=.003), but there were no significant differences between groups (mean±SE):Δ: 0.7days ([95% CI, -2.50; 3.93], p=.66). At follow-up, 85% from the I-group and 86% from C-group, no longer fulfilled the criteria for MOH. The compliance rate was high, indicating that patients were motivated for receiving education, but we found no additional benefits of adding an educational programme to standard treatment. Future research focusing on the MOH complexity, group heterogeneity, duration and content of educational programmes is warranted. Randomized controlled trials (RCTs) of non-pharmacological intervention such as patient educational programmes are of great importance, as this approach is common in the clinical practice. Medication-overuse headache (MOH) is a heterogenetic patient group, which must be taken into account when conducting RCTs of non-pharmacological interventions. An educational programme based on Motivational Interviewing is well-tolerated among MOH patients, however, no superior effects were found from adding the educational programme to standard treatment versus standard treatment alone.

Plasma Growth Factors in Pain A New Dimension of Treatment

Pain control has become a medical discipline that costs million dollars to administration in medication, health care and work disability every year. Analgesic units often have difficulty controlling the related pain symptoms in patients, that translates into repeated consultations and hospital admissions with disappointing results for the professionals involved and desperate for the patients who suffer. Without a doubt, the most frequent cause of pain related consultation and functional disability units is related to mechanical low back pain of both traumatic and degenerative origin

Medication non-adherence in inflammatory bowel diseases is associated with disability.

Background/AimsMedication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence.MethodsConsecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes.ResultsA total of 173 subjects on IBD maintenance medications were recruited (98 Crohn’s disease, 75 ulcerative colitis: median IBD-DI, –5.0; interquartile range [IQR], –14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (–16.0 vs. –2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50–9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14–6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11–5.92; P=0.028).ConclusionsMedication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.

Medication use among pediatric patients with chronic musculoskeletal pain syndromes at initial pain clinic evaluation.

To characterize medication use by adolescents with chronic musculoskeletal pain syndromes before an initial multidisciplinary clinic visit. A cross-sectional sample of 120 adolescents and parents reported on standardized assessment measures, with medication use data extracted from the medical chart and categorized. On average, 3.2 medications were reported; 70% used more than one pain-specific medication including opioids (17%), nonopioids (31%), psychotropics/neuropathics (45%) and other medications (13%). Adolescents with complex regional pain syndrome consistently reported greatest use of opioid, psychotropic/neuropathic and other pain medications. A regression model explained 17% of the variance in pain medication use. Nonpain medication use and disability contributed unique variance - pain duration and intensity did not. Greater attention to factors contributing to prescriptive practices, medication use and long-term outcomes is warranted.

Description of spatio-temporal gait parameters in elderly people and their association with history of falls: results of the population-based cross-sectional KORA-Age study.

BackgroundIn this epidemiological study we described the characteristics of spatio-temporal gait parameters among a representative, population-based sample of 890 community-dwelling people aged 65 to 90 years. In addition, we investigated the associations between certain gait parameters and a history of falls in study participants.MethodsIn descriptive analyses spatio-temporal gait parameters were assessed according to history of falls, frailty, multimorbidity, gender, multiple medication use, disability status, and age group. Logistic regression models were calculated to examine the association between gait velocity and stride length with a history of falls (at least one fall in the last 12 month). Data on gait were collected on an electronic walkway on which participants walked at their usual pace.ResultsWe found significant differences within gait parameters when stratifying by frailty, multimorbidity, disability and multiple medication use as well as age (cut point 75 years) and sex, with p < 0.05 for all gait parameters (velocity, cadence, time, stride duration, stride length, step width). After stratification by history of falls, only stride length showed a significant difference (p < 0.05) between the groups of fallers and non-fallers. Logistic regression models showed that a decreased stride length was independently associated with falls in men aged older than 74 years (OR 1.34 (CI: 1.05-1.70 per 10 cm decrease)), while this was neither the case for women of similar age nor for men or women aged 65 to 74 years. A decreased walking speed was not associated with falls.ConclusionAge, frailty, multimorbidity, disability, history of falls, sex, and multiple medication use show an association with different gait parameters measured during gait assessment on an electronic walkway in elderly people. Furthermore, stride length is a good indicator to differentiate fallers from non-fallers in older men from the general population.

AB1154-HPR Men's Strategies of Handling Participation Restrictions Related to Rheumatoid Arthritis (The Swedish Tira Study)

BackgroundIn spite of early interventions and advancements in medication disability and restricted work capacity is closely related to rheumatoid arthritis (RA). Around 1/3 of diagnosed patients are men, however few...

The association between nutritional status and cognitive impairment in brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui study.

In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass.OBJECTIVETo investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly.METHODSParticipants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression.RESULTSCognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over).CONCLUSIONThere was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age.

Efficacy study of multimedia rheumatoid arthritis patient education program

The research goal of improving patient adherence was assessed in this randomized controlled trial of the outcomes of a 15-min multimedia educational program when compared to educational literature for rheumatoid arthritis (RA) patients. One hundred eight RA patients from a Midwestern rheumatology outpatient clinic completed the self-reported Medication Adherence Questionnaire (MAQ), the Brief Illness Perception Questionnaire (BIPQ), and Health Assessment Questionnaire (HAQ) at baseline and 1 month after education. A paired samples t-test was use for data analyses to determine if there was a significant difference in the change between the groups at preintervention and 1-month postintervention. There were no significant differences in the scores between the two groups from pretest to posttest. Results from this study showed that medication adherence, illness perception, and disability were not improved by use of multimedia or the literature within 1 month. Findings from this research study showed that a short multimedia educational program is as effective as printed materials to educate patients with RA about their disease and treatment. However, neither multimedia nor literature affects medication adherence, illness perception, or disability as self-reported by patients with RA.

Progression in disability and regional grey matter atrophy in relapsing–remitting multiple sclerosis

Background: In multiple sclerosis (MS) regional grey matter (GM) atrophy has been associated with disability progression. Objective: The aim of this study was to compare regional GM volume changes in relapsing–remitting MS (RRMS) patients with progressive and stable disability, using voxel-based morphometry (VBM). Methods: We acquired baseline and 1-year follow-up 3-dimensional (3D) T1-weighted magnetic resonance imaging (MRI) data of RRMS patients, using two 1.5-Tesla scanners. Patients were matched pair-wise with respect to age, gender, disease duration, medication, scanner and baseline Expanded Disability Status Scale (EDSS) into 13 pairs, with either progressive EDSS (≥ 1 point change y-1) or stable EDSS, as well as into 29 pairs with either progressive Multiple Sclerosis Functional Composite (MSFC) at ≥ 0.25% decrease in y-1 in any component, or stable MSFC. We analysed longitudinal regional differences in GM volumes in the progressive and stable EDSS and MSFC groups, respectively, using VBM. Results: Significant GM volume reductions occurred in the right precuneus, in the progressive EDSS group. Differential between-group effects occurred in the right precuneus and in the postcentral gyrus. Further longitudinal GM volume reductions occurred in the right orbicular gyrus, in the progressive MSFC group, but no between-group differences were observed (non-stationary cluster-wise inference, all Pcorrected < 0.05). Conclusion: These results suggested a direct association of disability progression and regional GM atrophy in RRMS.

Variation Over Time in the Association between Polypharmacy and Mortality in the Older Population

In the older population, multimorbidity is common and 'best practice' may invite the prescription of multiple medications. To examine the association between polypharmacy, defined as the concurrent use of five or more prescription or nonprescription medications, and mortality in 12 423 participants aged ≥65 years representative of the older population of England and Wales. Data on self-reported medication use, disability and health conditions were collected at baseline in 1991-3. The cohort was followed for up to 18 years with full mortality notification. Cox proportional hazards regression adjusted for age, baseline institutionalization, smoking, disability and health conditions was used to investigate polypharmacy and mortality, stratified by sex. Various methods for modelling the time-varying effect of polypharmacy are presented. A strong independent association between polypharmacy and mortality existed in the short-term (first 2 years) for both men and women. This association remained, although attenuated, in the medium-long term (2-18 years of follow-up) for women, but became non-significant in the longer term for men. It remains unclear whether polypharmacy is a marker for poor health or is an independent risk factor for mortality. However, polypharmacy strongly predicts adverse outcomes, and multiple medication use should therefore be carefully monitored in the older population.

Upper gastrointestinal findings in Huntington’s disease: patients suffer but do not complain

We investigated, retrospectively, the prevalence of gastroesophageal inflammation in patients with Huntington's disease (HD) during 10 years in our center. We found a high prevalence of gastritis or esophagitis even in patients without complaints, indicating that gastrointestinal disease is more common in HD than patients' complaints. There was no correlation with motor disturbances but with the duration and severity of HD. Influences from the disease itself as well as secondary mechanisms like malnutrition, medication and general disability may contribute.

The Association Between a Tiered Pharmacy Benefit Plan and Medication Usage, Health Status, and Disability Absence Days—One Employer’s Experience

To examine the association of a three-tier pharmacy benefit plan with prescription drug spending and utilization, employee health status, and short-term disability (STD) absences in a large financial services corporation. Retrospective observational study of approximately 17,000 employees enrolled in the company's pharmacy benefit plan in anyone year from 2000 to 2004. Pharmacy claims compared before and after the plan implementation at the start of 2003. STD absences also compared each year. A self-report health status measure was compared before and after the plan change for a subset of employees who participated in a health risk appraisal. After the benefit plan change, a reduction in the number of filed pharmacy claims was observed in five drug categories for acute conditions whereas medications for cardiovascular, antihyperlipidemic, asthma, and diabetes remained unchanged. There was no significant increase in the percentage of employees filing an STD claim or the average duration per STD event. Self-reported health status did not change significantly from 2002 to 2004. Although the degree of employee cost-sharing for prescription medications increased from 2000 to 2004 and the utilization of some medication categories decreased, there was no observed association with overall employee health status or STD absenteeism during the 5-year study period.

In-patient vs. day-hospital withdrawal treatment for chronic migraine with medication overuse and disability assessment: results at one-year follow-up

Chronic headaches have increasingly become a focus within the field of head pain. Most patients with frequent headache eventually overuse their medications. The diagnosis of medication-overuse headache is clinically important, because patients rarely respond to preventive medications whilst overusing acute medications. Properly treating medication overuse and preventing relapse require specific therapeutic strategies and the recognition of the different factors that contribute to its development and perpetuation, including some behaviours and psychological elements that are important in sustaining the overuse of medication. Abrupt withdrawal is considered the first step for helping these patients to stop medication overuse. The possibility of withdrawal within a day-hospital setting is considered a therapeutic alternative for these patients and compared to in-patient withdrawal. Long-term results are discussed.

Subcutaneous Sumatriptan in an Adolescent With Acute Posttraumatic Headache

Acute posttraumatic headache is common and can evolve into chronic posttraumatic headache, which is associated with medication overuse and disability. However, there are few studies to guide treatment management of acute posttraumatic headache. We describe an adolescent with acute posttraumatic headache that did not respond to several initial medications but had rapid and sustained improvement in headache and associated migrainous features with subcutaneous sumatriptan.