Der Nervenarzt
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Headache in association with the cervical spine is often misdiagnosed and treated inadequately due to confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache described by Sjastaad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiating from occipital to frontal regions. ⋯ Ipsilateral blockades of the C2/ C3 root and/or the major occipital nerve allow a differentiation between migraine and other primary headache syndromes. Neither pharmacological nor surgical or chiropractic procedures lead to an improvement or remission of cervicogenic headache. Pain of various anatomical regions possibly join into a common anatomical pathway then presenting as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.
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Review Comparative Study
[Differential therapy of cerebral arteriovenous malformations. An analysis with reference to personal microsurgery experiences].
A total of 126 patients (63 female, 63 male) underwent microsurgical removal of their cerebral arteriovenous malformations (AVMs) by the same surgeon. The mean age at surgery was 34.7 (6-72) years. The symptoms were intracerebral hemorrhage (37.3%), seizure disorder (34.9%) or focal neurological deficits and minor symptoms. ⋯ It should only be considered for AVMs that are expected to be fully obliterated afterwards, or for primary inoperable AVMs that are to be changed into operable ones by embolization. Size reduction of otherwise operable AVMs does not justify the additional risk of embolization. Close collaboration of the specialties involved is desirable.
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The exteroceptive suppression period (ES) of the temporalis muscle activity is a trigemino-trigeminal brain stem reflex. It will be elicited most when stimulating trigeminal sensory afferents by painful stimuli and typically leads to a biphasic interruption of voluntary muscle activity. The first phase of decreased voluntary activity is called the early exteroceptive suppression period (ES1), the second, the late exteroceptive suppression period (ES2). ⋯ Furthermore, some substances used in pain therapy, such as serotonin agonists or antagonists, acetylsalicylic acid or naloxone, may also alter the general appearance of the ES. This review will summarize different parameters that influence the ES reflex answer. Furthermore, the diagnostic value of changes in the ES for pathophysiological processes regarding pain perception and processing in certain pain syndromes will be discussed.
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This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. ⋯ Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type].
The effect of a locally applied peppermint oil preparation on tension-type headache was examined in the design of a randomized, placebo-controlled double-blind crossover study for the first time. The preparation was tested against both the reference substance acetaminophen and to the corresponding placebo. The liquid test preparation contained 10 g of peppermint oil and ethanol (90%) ad 100 (test preparation LI 170, Lichtwer Pharma, Berlin); the placebo was a 90% ethanol solution to which traces of peppermint oil were added for blinding purposes. ⋯ The patients reported no adverse events. This controlled study showed for the first time that a 10% peppermint oil in ethanol solution efficiently alleviates tension-type headache. Peppermint oil thus proves to be a well-tolerated and cost-effective alternative to usual therapies.