Clinical Briefs
By Louis Kuritzky, MD
Ice Cream-Evoked Headaches Study: A Randomized Trial of Accelerated vs Cautious Ice Cream Eating Regimen
Ice cream headache (ICH) is a commonplace phenomenon induced by ingestion of cold substances, of which ice cream is but one of many potential precipitants. The limited literature on this topic had suggested that ICH only occurs in hot weather, as if the contrast between hot ambience and cold palatal or pharyngeal stimulation might foster ICH. Kaczorowski and Kaczorowski, "in order to fill this important knowledge gap . . . " as they so state in their publication, carried out a winter-time randomized trial (n = 145) amongst high-school students to determine whether, indeed, ICH is an experience only attained in hot weather. Additionally, subjects were divided into 2 different ingestion modes, one "accelerated" (eating 3 ounces of ice cream within 5 seconds) the other "cautious" (3 ounces within 30 seconds). There were no refusals, dropouts, or subjects lost to follow-up.
Overall previous experience with ICH was 79% amongst participants. In this trial, cautious eaters reported less than half the incidence of ICH than accelerated eaters (13% vs 27%). ICH is readily precipitated in cold weather, as demonstrated in this trial. Kaczorowski and Kaczorowski graciously acknowledge that the funding of the study was supported "by an unrestricted grant from mum and dad."
Kaczorowski M, Kaczorowski J. BMJ. 2002;325:1445-1446.
Treatment of Antidepressant-Associated Sexual Dysfunction with Sildenafil
Sexual dysfunction (SXD), weight gain, and sleep disturbance comprise as much as 75% of the adverse events that ultimately lead to antidepressant medication discontinuation. Of course, premature medication discontinuation is associated with a substantial risk of depression relapse, with its attendant morbidity and mortality.
Between 30-70% of persons who take SSRIs experience sexual dysfunction and will subsequently prematurely discontinue medication. The favorable retrospectively observed results of providing sildenafil to persons suffering SSRI-induced SXD prompted this prospective, randomized, placebo-controlled trial (n = 90).
Inclusion criteria required at least 6 weeks stable dosing of SSRI, and at least 4 weeks duration of SXD. Subjects were randomized to sildenafil 50-100 mg or placebo, and instructed to attempt intercourse at least twice weekly.
Sildenafil recipients showed significant improvements in erectile function, orgasm, intercourse satisfaction, and overall satisfaction compared with placebo. No serious adverse events attributable to sildenafil were seen. Overall, sildenafil allowed over 55% of recipients to experience much/very much improved’ sexual function, as compared to 4-6% in the placebo group.
Nurnberg HG, et al. JAMA. 2003;289: 56-64.
Prophylactic Treatment of Migraine with an Angiotensin II Receptor Blocker
Despite the very favorable effect of triptans upon migraine morbidity, a substantial population of persons either does not respond to, or chooses not to use, these agents. Expert advice has suggested that prophylaxis be considered predicated upon headache frequency, typically 2-4 headaches per month providing sufficient burden to merit a preventive pharmacotherapeutic agent. Recently lisinopril has been found to be an effective agent for migraine prophylaxis. Similarities in neurohumoral modulation of ACE inhibitors, when compared with angiotensin I receptor blockers (ARBs), would suggest that the latter might also be of benefit. Indeed, clinical trials in hypertension patients have consistently found a lower frequency of headache amongst ARB-treated patients than with placebo.
This randomized, double-blind placebo-controlled crossover study (n = 60) compared candesartan (CAN) 16 mg/d with placebo, in 2 12-week periods of observation (after a 4-week placebo run-in to verify attack frequency). Study subjects were normotensive throughout the trial, but did experience a 11/7 decline in BP. CAN was found to produce a statistically significant reduction in number of days with headache (13.6 vs 18.5), headache severity index, and level of disability. ARBs may be a new tool for prevention of migraine, especially because of their very favorable tolerability profile.
Tronvik E, et al. JAMA. 2003;289: 65-69.
Ice Cream-Evoked Headaches Study: A Randomized Trial of Accelerated vs Cautious Ice Cream Eating Regimen; Treatment of Antidepressant-Associated Sexual Dysfunction with Sildenafil; Prophylactic Treatment of Migraine with an Angiotensin II Receptor Blocker
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