Der Nervenarzt
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Although chronic pain is common, especially in elderly patients, its treatment often remains inadequate. One of many reasons for this is that insufficient therapy of acute pain carries the risk of making the pain chronic. Sooner or later most patients suffering from chronic pain will consult a neurologist. ⋯ In Germany, only specialised centres have associated pain outpatient clinics, so it is almost impossible for neurologist trainees to improve their knowledge in pain treatment. This review provides a synopsis of procedures regarding chronic pain treatments, with particular focus on the most frequent pain disorders. The treatment recommendations follow the current guidelines of the German Society of Neurology.
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Drug prevention of migraine is recommended if more than three attacks occur per month, acute drug treatment is insufficient, or very severe attacks with aura are the main problem. Besides beta blockers, a variety of substances have proved efficacious in migraine prevention. Thus individualised treatment of migraine patients is possible. ⋯ Drugs of first choice, besides beta blockers, are flunarizine, valproic acid, and topiramate. Second-choice drugs with lower efficacy or less well published evidence include amitriptyline, venlafaxine, gabapentin, naproxen, acetylsalicylic acid, butterbur root, vitamin B2, and magnesium. Flunarizine or propranolol are recommended for children.
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At the moment atypical Parkinson syndromes have unfavorable prognoses and show little response to dopaminergic medication. Early differential diagnosis of these disorders from idiopathic Parkinson syndrome is of pivotal clinical relevance. ⋯ Additional electrophysiological, imaging, and nuclear medical investigations may support the clinical diagnosis. During disease progression clinical signs indicative of an atypical Parkinson syndrome should always warrant reevaluation of the diagnosis.