Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.

Objective : Parkinson’s disease (PD) is a disease treated by polytherapy. This time, the authors report the role of pharmacists in one of the few Parkinson’s disease facilities in Japan (https://sunwels.jp/pdhouse/; abbreviated as PD House), which was born from the voices of PD patients. Methods : The backgrounds of 52 patients admitted to the PD House and prescriptions for them were analyzed to mainly clarify: the percentages of patients aged 75 or over and those using 7 or more prescribed drugs; and frequently used drugs to be carefully administered to the elderly. The approaches provided by pharmacists through interprofessional collaboration were also analyzed. Results : The percentages of patients aged 75 or over and those receiving benefits for individuals requiring care were 71.2 and 92.3%, respectively. Those using 7 or more prescribed drugs accounted for 75.0%. In multidisciplinary collaboration, pharmacists were involved in not only pharmacotherapy but also nutritional evaluation of patients with severe nutritional disorders, proposal of appropriate nutritional therapy, understanding of swallowing function, and appropriate medication teaching. Conclusion : The actual situation of PD patients, where they used multiple drugs, and their backgrounds suggest that interprofessional collaboration is indispensable for PD treatment, and the roles of pharmacists were shown to be important.