Current neurology and neuroscience reports
-
Migraine is a disorder with variable natural history. In some sufferers, migraine evolves over time into a state of headaches on more days than not. This process of migraine chronification is poorly understood, but risk factors have been clearly identified. ⋯ We follow with a discussion of the role of comorbid conditions and environmental exposures. We suggest that clinicians consider risk factor modification as part of migraine management, aspiring to not just relieve current pain and disability, but to avoid migraine progression. Reducing attack frequency, avoiding medication overuse, appropriately using preventive drugs and behavioral therapies, and encouraging weight loss should be part of migraine therapy to improve current pain and disability and also to avoid future pain and disability by preventing chronification.
-
Ocular pain is most commonly associated with redness and inflammation; however, eye pain can also occur in the absence of grossly visible pathology. Pain in the quiet eye can be the first sign of a number of threatening conditions. ⋯ The article also reviews pertinent ocular, orbital, referred, and other causes of eye pain in the quiet eye. The neurologist and headache specialist should recognize when consultation with an ophthalmologist is necessary.
-
Curr Neurol Neurosci Rep · Apr 2011
ReviewHypocretin and its emerging role as a target for treatment of sleep disorders.
The neuropeptides hypocretin-1 and -2 (orexin A and B) are critical in the regulation of arousal and maintenance of wakefulness. Understanding the role of the hypocretin system in sleep/wake regulation has come from narcolepsy-cataplexy research. ⋯ Research for the hypocretin agonist and the hypocretin antagonist for the treatment of sleep disorders has vigorously increased over the past 10 years. This review will focus on the origin, functions, and mechanisms in which the hypocretin system regulates sleep and wakefulness, and discuss its emerging role as a target for the treatment of sleep disorders.
-
Although theories regarding headache originating in the neck have existed for more than 150 years, the term "cervicogenic headache" originated in 1983. Early descriptions pinpoint the characteristic symptoms as dizziness, visual disturbances, tinnitus, and "posterior" headache, conceivably as a consequence of arthrosis, infliction upon the vertebral artery, or with a "migrainous" background and occurring in "advanced age." Cervicogenic headache (mean age of onset, 33 years) displays a somewhat different picture: unilateral headache, starting posteriorly, but advancing to the frontal area, most frequently the main site of pain; usually accompanied by ipsilateral arm discomfort, reduced range of motion in the neck, and mechanical precipitation of exacerbations (eg, through external pressure upon hypersensitive, occipital tendon insertions). Treatment options in treatment-resistant cases include cervical stabilization operations and extracranial electrical stimulation. In a personal, population-based study of 1,838 individuals (88.6% of the population), a prevalence of 2.2% "core" cases was found.
-
Curr Neurol Neurosci Rep · Apr 2011
Newly postulated neurodevelopmental risks of pediatric anesthesia.
Recent animal and human studies have raised concern that exposure to anesthetic agents in children may cause neuronal damage and be associated with adverse neurodevelopmental outcomes. Exposure of young animals to anesthetic agents above threshold doses and durations during a critical neurodevelopmental window in the absence of concomitant painful stimuli causes widespread neuronal apoptosis and subsequent abnormal behaviors. The relevance of such animal data to humans is unknown. ⋯ Retrospective observational human studies have suggested a dose-dependent association between multiple anesthetic exposures in early childhood and subsequent learning disability, the causality of which is unknown. Ongoing prospective investigations are underway, the results of which may clarify if and what neurodevelopmental risks are associated with pediatric anesthesia. No change in current practice is yet indicated.