In spite of the fact that migraine seems to have been present throughout the history of man (Areteus of Cappadocia gave a detailed description of it in the first century AD) and has a high prevalence, its pathophysiology is poorly understood. This is probably due to the fact that it is an episodic and self-limiting, although discomforting, disorder.

It is only in the last few decades that migraine has undergone systematic investigation exploring possible genetic, hormonal, biochemical, and psychological factors. As a result, its nature is now becoming less enigmatic, and some comprehensive models on the underlying mechanisms are available.

We review the most intriguing hypotheses related to the pathophysiology of migraine, focusing especially on theories of serotonin dysfunction, which may also explain the high prevalence of psychiatric disorders detected in migraine patients.

A high prevalence of comorbidity has been reported between migraines and psychiatric disorders. It has been proposed that migraine headaches are mediated by stimulation of serotonin (5-HT) receptors. Past studies have demonstrated that migraine-like headaches have been produced following administration of the partial 5-HT agonist m-chlorophenylpiperazine (m-CPP; believed to primarily affect the 5-HT2C receptor) in patients with migraines or eating disorders, especially bulimia, as well as in normal controls. We review the association between 5-HT dysfunction, as determined by response to m-CPP challenge, and migraines, looking specifically at the relationship between migraines and obsessive-compulsive disorder and gender effects.

In this article, we report a unique case of catatonic syndrome in an adolescent male. This patient did not have a primary psychiatric diagnosis before the onset of catatonia, and there was no evidence of any predisposing medical conditions. The episode occurred following the patient's immigration from his native country, an event associated with particular psychological stress. The episode was reversible and demonstrated a prompt but transient response to intravenous administration of lorazepam. Maintenance treatment included oral administration of lorazepam and risperidone. Lorazepam was tapered and eventually discontinued, and symptoms did not recur.

A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17–18,1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap?

Epidemiological studies have identified thermotaxic decline in the elderly, with lower temperatures than the general population by 0.36-0.54°F. Researchers consider the lower temperatures to be due to a diminished thermoregulatory discrimination sensitivity to environmental temperature oscillations. Every 1.8°F reduction in temperature from 98.6° Fahrenheit is known to effect a decrease in laminar cerebral blood flow (CBF) by approximately 6%-7%. This reduction in CBF, however, is not without significant central nervous system effects. Correlations between CBF and performance on tests of language, memory, attention, figure copying, judgment, and similarity discrimination have been described.

We have recently attempted to identify thermoregulatory changes occurring in a cognitively impaired population. We examined 39 subjects randomly selected from a clinical database (Statistical Analysis System) based upon NINCDS criteria for Alzheimer's dementia, probable and possible subtypes. Exclusion criteria included indications of abnormal endocrine or immune indices, histories of head trauma, cerebrovascular accidents, substance abuse, or current use of medications known to affect thermoregulation.