SYNOPSIS This paper presents a retrospective study of 84 headache patients seen in the Behavioural Medicine Unit of Sunnybrook Medical Centre, of whom 53 were treated with biofeedback. Of the 84 patients assessed, half were tension headache and half were migraine. Both groups were treated in one of three ways: 1. Frontal EMG FB only. 2. Hand skin temperature (HST) only. 3. EMG FB followed by HST FB. Assessment results showed the migraine group to have longer headache histories and more severe headaches than the tension group. The tension group had significantly higher frontal muscle tension than the migraine group, while the migraine group had significantly colder peripheral hand temperature. No differences were found in psychometric assessment data. EMG feedback results showed significant decreases in frontal EMG for both headache groups. Both groups showed a moderate improvement in headache at the end of treatment. HST feedback treatment results showed significant increases in peripheral temperature and a significant improvement in headache for those migraine patients who achieved a pre‐determined criterion level of performance. Non‐significant increases in skin temperature occurred for the tension headache group. HST feedback after EMG feedback did not provide further improvement for the tension group. The results are discussed in the context of the differential effects of treatment and highlight the importance of a “trials to criterion” training paradigm.

Over the past three years we have seen twelve patients who have become depressed while taking cimetidine. Clinically the depression is similar to that seen in a Primary Affective Disorder. Two representative cases are presented. It is suggested that cimetidine has precipitated a depressive reaction is vulnerable patients. Tricyclic antidepressants are effective in relieving the depression. It is postulated that cimetidine, by blocking H2 receptors in the CNS, produces an imbalance between H1 and H2. This imbalance may be an etiological factor in precipitating the depression. Tricyclic antidepressants have little effect on H2 but are potent H1 receptor blockers. This H1 blockade could restore the balance between H1 and H2, thereby relieving the depression.

A 55 year old man developed an acute confusional state with grossly impaired short-term memory accompanied by a Status Petit Mal epilepsy pattern on EEG, one to two weeks after abruptly discontinuing a large amount of oxazepam and a smaller amount of alcohol. Both his mental status and EEG pattern normalized markedly after intravenous diazepam. On 5 year follow-up the patient was seizure-free and medication-free without any significant residual cognitive deficit.

The authors review the literature on Munchausen's syndrome and speculate about possible underlying psychological mechanisms. The proposed DSM III classification of factitious illnesses suggets a continuum from hysteria on one end of the spectrum to malingering on the other. Two case studies are presented which represent variants of this syndrome. Both patients were given a sodium amytal interview, a procedure not previously reported in the Munchausen's literature. The procedure was helpful in eliciting a more accurate history and a clearer sense of the underlying dynamics. Some suggestions for further research are made.