The Clinical journal of pain
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This article reviews the literature and describes clinical methods of providing analgesia for acute pain using epidural and intrathecal (spinal) opiates. The mechanism of action of these drugs, their basic pharmacology and spinal pharmacodynamics, and useful drugs and dosages are presented. The side effects of these drugs when administered by injection and possible ways to diminish their incidence and severity are discussed. A clinical protocol for the dosage and selection of these drugs is included.
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Migraine headache variants consist of the complicated migraine headache subtypes such as basilar artery migraine, migraine equivalents, and late-life migraine accompanients. Although these disorders occur infrequently, diagnosis may be more difficult. Generally, comprehensive diagnostic studies are required to rule out underlying pathogenic conditions that may present with similar symptom complexes. Standard migraine treatment is often useful in these disorders; however, migrainous variants deserve special therapeutic considerations.
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Muscle contraction headache is the most common headache afflicting mankind. Acute muscle contraction headache usually presents no problem in treatment and is a self-limited condition. Chronic muscle contraction headache presents a very difficult treatment problem. ⋯ The pathophysiology of muscle contraction headache is unknown. There is much controversy as to whether muscle contraction is the primary cause of this condition or whether muscle contraction is merely another component of this syndrome. The extensive research now going on in the field of chronic pain should help clarify the issue.
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The recent development of new drug therapies for headache disorders has allowed for the tailoring of treatment to specific patient needs. This paper reviews the pharmacologic management of patients with both headache and concomitant medical illness. The discussion specifically includes the treatment of hypertension, coronary artery disease, mitral valve prolapse, asthma, peptic ulcer disease, obesity, and chronic Epstein-Barr virus infection, occurring concomitantly in patients with headache. Medications that can exacerbate either the headache or concurrent medical condition are noted, and alternative therapies are advised.