Headache
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The International Headache Society (IHS) headache classification, while a major advance, does not adequately classify the daily and near-daily headache disorders known as chronic daily headache (CDH). We believe that chronic daily headache is a group of disorders which includes chronic tension-type headache (CTTH), transformed migraine (TM), new daily persistent headache (NDPH), and hemicrania continua (HC). We propose specific criteria for transformed migraine, new daily persistent headache, and hemicrania continua, and have modified the criteria for chronic tension-type headache.
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Neuropeptide Y (NPY) is widely distributed throughout sympathetic nerve endings where it is co-stored and co-secreted with noradrenaline. It is considered a marker of noradrenergic function. To determine the role of NPY in the pathogenesis of juvenile headache, we determined its plasma levels in two groups of young migraine patients (with and without aura), in a group of episodic tension-type headache patients and in a group of age and sex-matched healthy subjects. ⋯ No significant variations were observed between headache-free periods and attacks in tension-type headache patients. Reduced NPY levels in the interictal period can be considered further evidence of the derangement of the sympathetic function in the course of migraine, particularly that with aura. The increase in NPY levels during migraine attacks could be an expression of sympathetic activation, even though the functional status of this system is less efficient.
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Randomized Controlled Trial Clinical Trial
The effects of streptomycin/lidocaine block on trigeminal neuralgia: a double blind crossover placebo controlled study.
This study investigated the long term effect of a peripheral sensory block using streptomycin sulphate on trigeminal neuralgia. A total of twenty subjects, thirteen with idiopathic trigeminal neuralgia (ITN) and seven with traumatic trigeminal neuralgia (TTN) were studied. A double-blind placebo controlled randomized design was used. ⋯ The sensory function of the treated nerves was also not affected. Side effects including facial swelling and pain were a common finding in the patients receiving streptomycin. This study demonstrated no beneficial effects of streptomycin blockade for idiopathic and traumatic trigeminal neuralgia.
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Exteroceptive suppression of temporalis muscle activity was studied in patients with chronic headache and in healthy controls. Among different methods of recording, averaging 10 full-wave rectified EMG responses produces results with acceptable variability and discomfort. The late temporalis exteroceptive suppression period (ES2) is reduced on average in patients with chronic tension-type headache; this finding has been reproduced by several independent laboratories. ⋯ In chronic tension-type headache, excitability of these interneurons is decreased because of inadequate control by the serotonergic raphe magnus nucleus and the periaqueductal gray matter. Dysfunctioning of the latter structures might be caused by abnormal limbic inputs to the brain stem. Some steps of this pathophysiological hypothesis can be verified by modern neurophysiological techniques.
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Depression is a common concomitant of headache. Conflict with regard to anger or the expression of anger has also been discussed in terms of its relationships to headache. The direction of the relationship between headaches and depression and/or anger is not clear from available research literature. ⋯ Therefore, the second hypothesis was not supported. Anger-in, however, was strongly and positively related to depression. Although the causal direction of the relationships cannot be stated with certainty, the suppression of anger appears to be a moderating variable that amplifies the experience of depression among chronic headache patients.