Cephalalgia : an international journal of headache
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Randomized Controlled Trial
In-patient versus out-patient withdrawal programmes for medication overuse headache: a 2-year randomized trial.
Medication-overuse headache (MOH) management usually includes a medication withdrawal. The choice of withdrawal modalities remains a matter of debate. ⋯ Given that we did not observe any difference in efficacy between the in- and out-patient withdrawals, we would recommend out-patient withdrawal in the first instance for patients with uncomplicated MOH.
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Case Reports
Microvascular decompression of the pterygopalatine ganglion in patients with refractory cluster headache.
Cluster headache is an invalidating form of headache. Although cluster headache can be managed pharmacologically, some patients require surgical treatment with varying results. Microvascular decompression of the pterygopalatine ganglion could be an alternative to traditional surgical management in patients with cluster headache. ⋯ These preliminary data suggest that microvascular decompression of the pterygopalatine ganglion does not provide pain reduction or improvement of quality of life in patients with refractory cluster headache.
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Cluster headache (CH) is the most painful and debilitating primary headache syndrome. Conventional treatment combines acute and prophylactic drugs. Also with maximal therapy a substantial proportion of patients do not experience a meaningful prevention or pain relief. Recent case series and early trials have suggested that occipital nerve stimulation can be very effective in the management of intractable CH. ⋯ In this prospective series, high cervical spinal cord stimulation shows an effect size equal or larger than occipital nerve stimulation with immediate onset after surgery and may serve as a valuable additional treatment option of intractable cluster headache in the future.
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Central facilitation of trigeminal pain processing and deficient habituation was observed in different headache and facial pain disorders. This overactivation seems to be primarily associated with chronic pain states. ⋯ Central facilitation and change in habituation do not seem to be a crucial part in the pathophysiology of HH despite the chronic nature of this disease. Facilitation or habituation deficit does not seem to be exclusively related to chronic pain disorders in general. Further research is needed to illuminate the pathophysiology of HH.
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Patients with chronic or difficult to treat headaches are generally under the care of general practictioners or neurologists in private practice. Some are referred to a headache specialist for evaluation and advice. ⋯ This is called integrated headache care. This review summarizes experiences in integrated headache care settings in Europe and the USA, describes these settings, and reports outcome data.