One does not commonly think of using asprin for migraine headaches. Actually, however, it is one of the ingredients in Excedrin which has been shown to be beneficial in migraine treatment. Even by itself, it seems to help sometimes.  Like a fairly high percentage of neurologists, I am a "migraineur" and have found that some of my migraines are helped by aspirin, Excedrin, and (interestingly) Anacin (which has 400 mg aspirin and 32 mg caffeine per tablet).  But until very recently, few in the United States ever thought of giving aspirin intravenously. In fact, few knew that there were preparations of aspirin capable of being given that way.

In Great Brittain, intravenous aspirin has been available for quite a while. A few years ago I heard Dr. Peter Goadsby, a British neurologist, describe excellent results using IV aspirin.  He is the lead author in a study noted in the Neurology News section currently displayed on this page (reported in the Sept 21 edition of the journal Neurology). The study is a non-controlled, non-blinded study in which 25% of the patients got significant reduction in pain and another 40% got some reduction from an intravenous infusion of 1 gram of aspirin. That is about the amount contained in three regular asprin tablets.

Those percentages may not seem high, but that's the way it generally is in headache studies. Headache is definitely not "one size (or one treatment) fits all."  To my knowledge, intravenous aspirin is not available in the United States but if it becomes available it will probably be another of the many weapons we can use to combat migraines and related headaches.

I was just checking the Guestbook and I noticed a comment with a link to a neurocritical care conference at Case Western. The link is http://clevelandneurocriticalcare.com/

After I read the note from Case Western, I realized that I did not have it in my list of neurology departments. I have added it now.

Turning back to the neurocritical care conference, it's interesting that after the conference on October 7th and 8th, there is another conference there on the 9th concerning neurocritical care and music. That seems like a very interesting topic. Actually, though it says on the top of the web page, "A Global Conference of Neurocritical Care and Music", the music offering is entitled,
"Music and Medicine Symposium." So it seems to potentially include medicine in general rather than the specific focus on neurocritical care.

The educational offering from Case Western also brings up a topic that I would like to throw out for discussion. Any physician, perhaps even any person with the entry fee, can attend such conferences. But, how do they fit into the newly developing subspecialty structure of neurology (and other specialties)? When I started in neurology, it was really one unified specialty. One could do a fellowship in some sub-field, but was not really "official." Clinical Neurophysiology was coming out as a seemingly official subspecialty boards just as I was finishing a related fellowship which included training in both EEG and EMG. So I took and passed those boards. But later, when I wanted to do more stroke neurology, I went to some courses similar to those offered at Case Western and for a number of years I was on the "stroke team" doing clinical trials and even involved in helping to train a few stroke fellows. I took a course in transcranial doppler at UCLA (probably similar to the Case Western course I now see advertised), though I never ended up actually doing them professional. There were others in line in front of me. But I am sure I could have worked into doing those studies simply from what I learned at the UCLA workshop. My question is, can a neurologist still do that? Has our subspecialty structure ossified to the point that one cannot add on a few skills via short courses and redirect one's focus?

To me it is more than passing strange that neurology is splitting into numerous subfields just at the time when experts in operations management are extolling the virtues of "cross training" and professional flexibility. One of things that creates bottlenecks and inefficiences in organizations is putting people in "silos" where their functions and communications are limited. Are we doing that too much in neurology? I am afraid that we are.

I grant that for some things, an extended period of training, such as a 1 to 3 year fellowship is probably the best way.  Interventional vascular procedures are a good example of that, though personally I think the interventional pathway has been made too long in deference to the demands of the radiologists. Another good example is clinical neurophysiology. One may not need a whole fellowship, but I have found that those who just "pick it up" are usually not as good as those who are fellowship trained. But is that true for every sub-field? I doubt it. In the past, many of the fellowship were basic science oriented. For example, I did several fellowships in molecular biology and then moved into neurodegenerative diseases. Would a person now have to do a specific "dementia" or "Alzheimers" or "neurogeriatric" fellowship in addition? Some of the best neurologists in the world started out from the basis of basic research fellowships and then linked back into the clinical. I think we are making the subspecialty structure too rigid and we should be able to "pick up" and later use new skills via short courses or even simply from our own individualized reading, study, and clinical experience. 

Here is another internet search interface that I did not previously list in my discussions:
http://www.unboundmedicine.com/medline/ebm

It is provided by Unbound Medicine, an outfit that provides medical content for PDA's, cell phones etc. Like most of the free medical search engines, it doesn't give you anything that you could get for free anyway. But it provides a certain organization that you might find useful. For example, if you just want "evidence based medicine" (EBM), you can do an EBM search. If you want recent medical news items on a certain topic, you can search for those. By the way, I have no commercial link with Unbound Medicine. However, now that I have thought of it, I may see if they have an affiliate program and put up a commercial link.