Der Schmerz
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Review Case Reports
[Psychological treatment of headache in times of COVID-19].
The coronavirus disease 2019 (COVID-19) pandemic has substantially changed life worldwide in 2020. This also influences the psychological treatment options of patients with headache. ⋯ The digital implementation of psychological approaches makes a major contribution to maintaining psychological treatment of headache patients, so that the individually changed needs can be addressed. With respect to content, stress regulation techniques and increased acceptance gain in importance. Regarding biofeedback there are limitations, which may be overcome by improved technical devices.
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This article presents secondary headache syndromes caused by life-threatening disease as well as symptomatic headaches requiring immediate treatment to prevent irreversible deficits. Clinical signs and symptoms indicating a secondary headache syndrome are summarized in the so-called SNOOP list (SNOOP: systemic symptoms, neurological symptoms, acute onset, older patients and previous history). The main topic of this publication is the diagnostic procedure, with a discussion of the pitfalls of computed tomography and magnetic resonance imaging investigations and the specificities of other methods such as lumbar puncture and duplex sonography.
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The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. ⋯ In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression.
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Review
[Cluster headaches-proven and novel approaches : A critical evaluation of treatment studies].
Trigeminal autonomic cephalalgias are characterized by unilateral headaches accompanied by cranial autonomic symptoms and a sense of restlessness. Clinical trials have been conducted on acute therapy and prophylaxis of cluster headache in recent years. ⋯ Recent trials provide data on the efficacy of prednisolone, galcanezumab, fremanzeumab and noninvasive vagal nerve stimulation. Methodological difficulties arise in terms of patient recruitment for clinical trials, clinical endpoints and potential differences in the pathophysiology of episodic and chronic cluster headache.
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Migraine is a frequently underdiagnosed disease that is associated with a high burden on affected patients. There are a variety of prophylactic treatment options available, that have been expanded with the introduction of the CGRP-(receptor-)antibodies. ⋯ A variety of medicinal and non-medicinal measures are available for the treatment of migraine, which should be used multimodally.