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The aim of this article is to provide a nuanced analysis of the transformation of sexuality that occurs with age. Drawing on several ethnographic narratives of married men and women over the age of 60 in Japan, this article provides insight into gender-specific experiences of marital sexuality, the impact of extra-marital sexual activity on marital relationships, and the development of "sibling-like" relationships as couples grow older. It also highlights the continuing importance of sexual desire in later life, especially to men's sense of self. This article contributes to the growing scholarship on the sexuality of older persons around the world and makes a case for the importance of the life history interview as a methodology for illuminating the complex relationship between gender, sexuality, and aging. [ABSTRACT FROM AUTHOR]

In most cases, successful preventive therapy for migraines requires daily medication for months or years. Perimenstrual use of a preventive agent is a common exception. Preventive therapy is usually undertaken in patients who have more than two headache episodes per month or those very much disabled by headaches. Beta blockers are usually the first choice for preventive therapy, and amitriptyline is also commonly used. Despite widespread use of calcium channel blockers for prevention of migraine, their benefits are controversial. Although effective for prevention of migraine, methysergide and phenelzine are usually relegated to last-resort use because of potentially serious side effects. The migraine patient who is refractory to standard preventive therapy may have rebound headache related to overuse of abortive migraine medications, or concomitant psychopathology. [ABSTRACT FROM AUTHOR]

Most migraine patients need only abortive treatment for their headaches. By the time they present to a physician, they have already tried many over-the-counter medications for headache relief. Prioritizing treatment according to headache severity and associated symptoms will help the physician determine the most appropriate medications to use. Narcotics should be reserved for use only in patients unresponsive to adequate trials of non-narcotic agents. In some patients, the recurrent nausea and vomiting can be as disabling as the pain; antiemetic agents are an important adjunct to analgesic therapy in these patients. Sumatriptan and dihydroergotamine are more expensive than other migraine agents but have distinct therapeutic advantages in patients with moderate to severe headaches. Some patients experience rebound headache from overuse of analgesics and other headache medications. Educating patients about self-help measures and avoidance of triggers is an important element in the effective management of migraine headaches. [ABSTRACT FROM AUTHOR]