American family physician
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Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least three months. The most common types of chronic daily headache are chronic migraines and chronic tension-type headaches. If a red flag for a secondary cause of headache is present, magnetic resonance imaging of the head should be performed. ⋯ Several prophylactic treatments for chronic daily headache can reduce headache frequency and severity, as well as improve overall quality of life. Nonpharmacologic treatments include relaxation techniques, cognitive behavior therapy, acupuncture, osteopathic manipulation, and cervical exercises. Pharmacologic therapies include amitriptyline, gabapentin, onabotulinumtoxinA, propranolol, tizanidine, topiramate, and valproate.
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Homelessness affects men, women, and children of all races and ethnicities. On any given night, more than 610,000 persons in the United States are homeless; a little more than one-third of these are families. Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population. ⋯ Complex, advanced medical problems and psychiatric illnesses, exacerbated by drug and alcohol abuse, in combination with the economic and social issues (such as the lack of housing and proper transportation) make this subset of the population a unique challenge for the health care system, local communities, and the government. An integrated, multidisciplinary health care team with an outreach focus, along with involvement of local and state agencies, seems best suited to address the components needed to ensure quality of care, to help make these patients self-sufficient, and to help them succeed. Family physicians are well suited to manage the needs of the homeless patient, provide continuity of care, and lead these multidisciplinary teams.
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The overhead athlete is at unique risk for injury because of the mechanics associated with rapid shoulder elevation, abduction, and external rotation. Angulation of the humeral head against the posterosuperior glenoid can cause rotator cuff tendon and labral impingement. The throwing or striking motion of baseball, softball, water polo, tennis, racquetball, and volleyball may result in scapular dyskinesis, partial articular-sided supraspinatus avulsions, and posterosuperior labral tears. ⋯ Special physical examination maneuvers and magnetic resonance imaging may be helpful in diagnosing intra-articular pathology. Rehabilitation of injuries associated with internal impingement of the shoulder should include three basic components: strengthening, stretching, and sport-specific exercises. Arthroscopic surgery may be considered if symptoms do not improve after three months of conservative management.