Current pain and headache reports
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Curr Pain Headache Rep · Oct 2002
ReviewThe use of complementary medical therapies in the management of myofascial pain disorders.
Complementary medical therapies are commonly used for the treatment and management of myofascial pain. No universally accepted therapy for this condition exists; consequently, patients often seek alternative and complementary therapies. Many complementary treatments are available. ⋯ Although anecdotally claimed as effective, most of these modalities have not been rigorously investigated because of poor research quality. Appropriate controls, sample sizes, and blinding measures are often lacking. Despite these issues, the trend toward efficacy exists and further examination is warranted.
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Post-traumatic myofascial pain describes the majority of chronic head and neck pain seen in clinical practice. If conditions such as vascular headaches, neuropathic pain, degenerative cervical joint disease, and dental pain are excluded, myofascial tissues are directly or indirectly involved in all other forms of head and neck pain. The most common of these include temporomandibular disorders, neck pain such as whiplash-associated disorder, cervicogenic headaches, and tension-type headaches. The pathophysiology of these conditions is not widely understood; however, peripheral and central mechanisms appear to play a role.
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The first International Headache Society classification defined tension-type headaches by itemizing characteristics of migraines that tension-type headaches did not possess. As a result, tension-type headaches (episodic and chronic) remain the most nonspecific of all the commonly observed primary headaches. Until recently, there has been little impetus on the part of the pharmaceutical industry to investigate tension-type headaches; many of the potentially useful drugs are now generic and unprofitable. ⋯ The few studies that exist support the use of age-old standard drug classes, the tricyclic antidepressants and the nonsteroidal anti-inflammatory drugs. New research is emerging that points to the potential use of botulinum toxin and nitric synthase inhibitors. More scientifically rigorous clinical studies are needed.
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Curr Pain Headache Rep · Oct 2002
ReviewBehavioral and psychologic aspects of the pathophysiology and management of tension-type headache.
Behavioral and psychologic factors in tension-type headache are reviewed with reference to pathophysiology, comorbid psychiatric disorders, headache triggers, and behavioral treatment, including the efficacy of behavioral treatments, brief minimal contact administration of behavioral treatment, therapeutic mechanisms underlying the effectiveness of behavioral treatments, and the integration of drug and behavioral treatments. Anxiety or depression may contribute to central sensitization that underlies frequent tension-type headaches. ⋯ Available drug and behavioral treatments are effective for episodic tension-type headache, but are only moderately effective for chronic tension-type headaches. The combination of behavioral and preventive drug therapies may improve outcomes for patients with chronic tension-type headache.