Chronic daily headache- one disease or two? Diagnostic role of serum ionized magnesium

The entity of chronic daily headache (CDH) is well documented, but is not included in the current classification. We divided patients with CDH into groups with and without migrainous features. This division resulted in clearly distinguishable syndromes of daily migrainous headaches (DMH) and daily tension-type headaches (DTH). Family history of headaches was more common in patients with DMH. Patients in both groups had a high incidence of caffeine or drug overuse. The clinical division into DMH and DTH was supported by our finding of a higher incidence of disturbed magnesium (Mg) metabolism in patients with DMH. Of 26 patients with DMH, 8 (30.8%) had low serum ionized, but not total, Mg levels, and 16 (61.5%) had high ionized calcium/magnesium ratios. The corresponding numbers for the 22 patients with DTH were 1 (4.5%) and 8 (30.4%). These new laboratory measurements offer possible biological markers for the diagnosis of different headache syndromes.     

Recognising risk,influencing reality and mental healthcare in a regional emergency department

Mental health presentations to EDs continue to rise with associated challenges increasingly understood and well documented. Despite growing evidence of current and ongoing systemic issues contributing to this increase, there continues to be a lack of administrative engagement to address ED attendance, with avoidance and diversion strategies initiated during the COVID-19 pandemic no longer prioritised, despite growing need. Clear and well-documented reports of ED overcrowding and bed boarding is evidence that things need to change. Moreover, if innovative action is not taken, the risk and reality is that long waits, poor outcomes and exposure to unsafe conditions will continue. This is broadly unacceptable to consumers, their carers and the broader ED network. Delayed action in seeking alternative solutions only reinforces the risk and reality that people experiencing mental health concerns have ‘Nowhere Else To Go’.