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Migraine patients with frequent and disabling attacks should be given the opportunity to test prophylactic medicines, and general practitioners should know the indications and the main principles of treatment. When testing a preventative drug, it is important that the patient has realistic expectations, keeps a headache diary, increases the doses gradually, and takes an adequate dose for at least two months before the effect is assessed. Drugs licensed in Norway with adequate scientific documentation for use as migraine prophylactics include some antihypertensives (beta-blockers, candesartan and lisinopril), antiepileptics (topiramate, valproate and gabapentin), an antidepressant (amitriptyline), and botulinum toxin for chronic migraine. In the choice of medicine, one should consider scientific evidence, side effects and contraindications, effect on comorbid conditions, simplicity of use, and price. Patients who are severely affected should try at least three different drugs in succession.

In some countries a seemingly large number of patients suffer from chronic whiplash syndrome, whereas in other countries whiplash is not known or is considered to give only moderate symptoms over a brief period of time. In this paper, this discrepancy is accounted for by a biopsychosocial model, a central element of which is the existence of a large pool of spontaneously occurring symptoms in the population, among them head and neck pain. By the mechanisms of attribution, expectation ("nocebo") and reinforcement, common symptoms may be experienced by the patient as caused exclusively by a mild or moderate trauma. Inappropriate behaviour and harmful treatment may worsen and prolong symptoms. To this one should add the effects of conscious exaggeration of symptoms, under-performance in neuropsychological testing, and underreporting of pre-accident symptoms in a medico-legal context. When assessing litigation claims, it is emphasised that a causal relation between common whiplash injuries and chronic complaints has not been demonstrated; a causal relationship can be accepted in exceptional cases only if a set of minimal criteria are fulfilled.

In this article we describe five patients with acute or subacute weakness of flexor pollicis longus and flexor digitorum profundus. A possible diagnosis of an isolated lesion (entrapment) of the anterior interosseus nerve was considered. However, clinical and neurophysiological findings suggested a diagnosis of neuralgic amyotrophy. Three patients experienced acute shoulder pain at the onset. Sensory loss at the base of the thumb was observed in two patients, and two patients were affected bilaterally. All patients had EMG signs of involvement outside the anterior interosseus nerve innervation area. Low amplitude sensory action potentials were observed in three patients. One patient was operated upon and entrapment was not observed during surgery. Reinnervation was not seen after five months, but was noted in three patients who were investigated 13, 13.5, and 30.5 months after the onset. Thus, the prognosis in this unusual form of neuralgic amyotrophy seems to be rather good, and the length of time before reinnervation supports the theory that the site of the lesion must be located proximally, e.g. in the brachial plexus.

In the recent last decades, important advances have been made in the understanding of the mechanisms behind headache. This has resulted in more efficient treatment. New forms of headache have been described where a specific treatment can be used. Therefore, in order to give rational therapy to headache patients, the physician must be able to distinguish between the most important primary headaches. He should also be aware of the warning signals that should prompt further investigations or admission to hospital in search of underlying causes. The article describes the most important primary headaches and the current treatment, and discusses the problem of unclassifiable and untreatable headaches.

In 26 patients with multiple sclerosis 100% responded abnormally to magnetic resonance imaging of the brain. Lesions in the posterior fossa were observed in 18 patients. The auditory brain stem response was abnormal in 15 patients, and 22 had abnormal immunoglobulins in the cerebrospinal fluid. The correlation between abnormalities of the auditory brain stem response and the magnetic resonance images was greatest in a subgroup where the two investigations were performed within a ten day interval. Results from magnetic resonance imaging, evoked potentials and cerebrospinal fluid investigations were used to reclassify 13 of 15 patients with clinically "possible" or "probable" multiple sclerosis to a higher level using Poser's criteria. Evoked potentials (the auditory brain stem response in particular) correlated best with clinical multiple sclerosis category. We recommend that magnetic resonance imaging is established as a first-hand investigation in evaluations of multiple sclerosis. Evoked potentials and cerebrospinal fluid investigations may prove to be more specific, however, and these investigations should also be performed as a routine.