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Objective: To assess the effectiveness and adverse effects of acute cluster headache medications in a large international sample, including recommended treatments such as oxygen, commonly used medications such as opioids, and emerging medications such as intranasal ketamine. Particular focus is paid to a large subset of respondents 65 years of age or older. Background: Large international surveys of cluster headache are rare, as are examinations of treatments and side effects in older cluster headache patients. This article presents data from the Cluster Headache Questionnaire, with respondents from over 50 countries and with the vast majority from the United States, the United Kingdom, and Canada. Methods: This internet‐based survey included questions on cluster headache diagnostic criteria, which were used as part of the inclusion/exclusion criteria for the study, as well as effectiveness of medications, physical and medical complications, psychological and emotional complications, mood scores, and difficulty obtaining medications. The diagnostic questions were also used to create a separate group of respondents with probable cluster headache. Limitations to the methods include the use of nonvalidated questions, the lack of a formal clinical diagnosis of cluster headache, and the grouping of some medications (eg, all triptans as opposed to sumatriptan subcutaneous alone). Results: A total of 3251 subjects participated in the questionnaire, and 2193 respondents met criteria for this study (1604 cluster headache and 589 probable cluster headache). Of the respondents with cluster headache, 68.8% (1104/1604) were male and 78.0% (1245/1596) had episodic cluster headache. Over half of respondents reported complete or very effective treatment for triptans (54%, 639/1139) and oxygen (54%, 582/1082). Between 14 and 25% of respondents reported complete or very effective treatment for ergot derivatives (dihydroergotamine 25%, 42/170; cafergot/ergotamine 17%, 50/303), caffeine and energy drinks (17%, 7/41), and intranasal ketamine (14%, 5/37). Less than 10% reported complete or very effective treatment for opioids (6%, 30/541), intranasal capsaicin (5%, 7/151), and intranasal lidocaine (2%, 5/241). Adverse events were especially low for oxygen (no or minimal physical and medical complications 99%, 1077/1093; no or minimal psychological and emotional complications 97%, 1065/1093), intranasal lidocaine (no or minimal physical and medical complications 97%, 248/257; no or minimal psychological and emotional complications 98%, 251/257), intranasal ketamine (no or minimal physical and medical complications 95%, 38/40; no or minimal psychological and emotional complications 98%, 39/40), intranasal capsaicin (no or minimal physical and medical complications 91%, 145/159; no or minimal psychological and emotional complications 94%, 150/159), and caffeine and energy drinks (no or minimal physical and medical complications 89%, 39/44; no or minimal psychological and emotional complications 91%, 40/44). This is in comparison to ergotamine/cafergot (no or minimal physical and medical complications 83%, 273/327; no or minimal psychological and emotional complications 89%, 290/327), dihydroergotamine (no or minimal physical and medical complications 81%, 143/176; no or minimal psychological and emotional complications 91%, 160/176), opioids (no or minimal physical and medical complications 76%, 416/549; no or minimal psychological and emotional complications 77%, 423/549), or triptans (no or minimal physical and medical complications 73%, 883/1218; no or minimal psychological and emotional complications 85%, 1032/1218). A total of 139 of 1604 cluster headache respondents (8.7%) were age 65 and older and reported similar effectiveness and adverse events to the general population. The 589 respondents with probable cluster headache reported similar medication effectiveness to respondents with a full diagnosis of cluster headache. Conclusions: Oxygen is reported by survey respondents to be a highly effective treatment with few complications in cluster headache in a large international sample, including those 65 years or over. Triptans are also very effective with some side effects, and newer medications deserve additional study. Patients with probable cluster headache may respond similarly to acute medications as patients with a full diagnosis of cluster headache. [ABSTRACT FROM AUTHOR]

• A three year ethnography of seasonal magic mushroom pickers in rural Kent. • Naturally occurring magic mushroom production sites can be described as liminal or reluctant. • Magic mushroom picking was found to be a seasonal role, with participants often acting in a sociable, cooperative manner. • Findings thus present a challenge to existing drug market archetypes. This article presents an exploration of naturally occurring Class-A magic mushroom markets in the UK. It aims to challenge some of the mainstream narratives about drug markets and to identify features of this specific market, which will extend our understanding of how illegal drug markets operate and are structured more generally. The research presented comprises a three year ethnography of sites of magic mushroom production in rural Kent. Observations were conducted at 5 research sites over three consecutive magic mushroom seasons and interviews were conducted with 10 (8 male; 2 female) key informants. It finds that naturally occurring magic mushroom sites are reluctant and liminal sites of drug production, distinct from other Class-A drug production sites due to their: open and accessible nature; lack of invested ownership or evidence of purposeful cultivation; and lack of law enforcement disruption efforts, violence or organised crime involvement. Seasonal magic mushroom picker participants were found to be a sociable group, often acting in a cooperative nature, and without evidence of territoriality or violent dispute resolution. These findings have wider application in challenging the dominant narrative that the most harmful (Class-A) drug markets are homogenous in their violent, profit driven, hierarchical nature, and most Class-A drug producers/suppliers are morally corrupt, financially motivated and organised. A greater understanding of the variety of Class-A drug markets in operation can challenge archetypes and discrimination in understanding drug market involvement, will allow the development of more nuanced policing and policy strategies, and contributes to the presentation of a fluidity of drug market structure that permeates beyond bottom level street markets or social supply. [ABSTRACT FROM AUTHOR]

A repeated dose of an oral triptan has been shown in randomized controlled trials (RCTs) to be ineffective as a treatment for no or partial response 2 hours after initial dosing but effective as treatment for headache recurrence. In the official prescription information in the United States, the United Kingdom, and Denmark repeated dosing of all seven oral triptans are recommended for headache recurrence but some triptans are also recommended for no or partial response, a use of a triptan deemed to be not beneficial in European and Canadian migraine guidelines. In summary, not all recommendations are based on evidence from RCTs. In addition, some recommendations are ambiguous and patients need clearer instructions. An example of such a clear British instruction in a patient leaflet instruction is presented at the end of the paper. [ABSTRACT FROM AUTHOR]

Alpha-methyltryptamine (AMT) is a novel psychoactive substance available over the Internet. This study used European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Internet snapshot methodology to investigate the availability and cost of AMT in March/October 2012. From March to October 2012, there was a decrease in the number of Internet sites selling AMT (44 to 31). AMT powder was cheaper in 'bulk' (100 g) than in 'recreational-user' (100 mg) quantities, and there was a decrease in price. Data from Internet snapshot surveys complement and allow triangulation of data from other sources to build a more detailed picture on availability and use of novel psychoactive substances. [ABSTRACT FROM AUTHOR]

Background.— Previous observational studies reported an increased prevalence of asthma in migraine patients. Whether triptans affect the asthma risk has not yet been explored in an epidemiological study. Objective.— To estimate the risk of newly diagnosed asthma in patients with a general practitioner-diagnosed migraine in the UK between 1994 and 2001. Methods.— A population-based follow-up study and a nested case-control analysis were conducted using the General Practice Research Database. Results.— The study encompassed 51,688 migraineurs and the same number of matched controls. In the follow-up analysis, the relative risk of developing asthma in migraineurs compared with non-migraineurs was 1.3 (95% confidence interval [CI] 1.1-1.4). In the nested case-control analysis, the adjusted odds ratio for asthma in migraineurs overall was 1.17 (95% CI 1.01-1.35), and for those with a recent triptan prescription 1.12 (95% CI 0.65-1.94). Conclusion.— The risk of developing asthma was not materially altered for patients with a general practitioner-recorded migraine diagnosis, regardless of triptan use. [ABSTRACT FROM AUTHOR]