Current pain and headache reports
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Curr Pain Headache Rep · Aug 2002
ReviewCervicogenic headache: interventional, anesthetic, and ablative treatment.
Cervicogenic headache is becoming an accepted clinical syndrome in which headache pain is thought to originate from the cervical spine. Unfortunately, there are no diagnostic imaging techniques of the cervical spine and associated structures that can determine the exact source of pain. ⋯ This suggests that consistent reproducible anatomic and neurophysiologic pathways exist for the reproduction of typical clinical pain patterns and the ability of neuroblockade to consistently interrupt these pain pathways. This article describes the essential anatomy required to understand the use of diagnostic nerve blocks, and their predictive value in anticipating response to neuroablative and interventional therapy with a review of the major interventional, anesthetic, and ablative techniques for cervicogenic headache.
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The use of botulinum toxin for movement disorders and cosmesis led to an accidental discovery of its beneficial effect on headaches. Extensive anecdotal evidence and several controlled trials suggest that intermittent and chronic migraines and chronic tension headaches may respond to this treatment. The effect of a single treatment, which is simple to administer, can last for 3 months. ⋯ Prophylactic pharmacotherapy of migraine headaches is limited in its efficacy and has a potential for systemic side effects. This makes botulinum toxin a preferred treatment for many patients. The large controlled trials that are underway may lead to a wider acceptance of this treatment by neurologists and pain specialists.
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Curr Pain Headache Rep · Aug 2002
ReviewHeadache and Chiari I malformation: clinical presentation, diagnosis, and controversies in management.
The Chiari I malformation is a cerebellar anomaly of uncertain origin, defined in part as tonsillar herniation of at least 3 to 5 mm below the foramen magnum; it is associated with crowding of the craniocervical junction. It is the most frequent of the Chiari malformations and is associated with headaches, syringohydromyelia, and hydrocephalus. The clinical manifestations are related to direct compression of neural tissues and abnormal cerebrospinal fluid dynamics. ⋯ Incidental magnetic resonance imaging discovers Chiari I in one third of patients who do not have clinical symptoms. Headaches in the occipital-suboccipital region or those that are of cough-type suggest symptomatic Chiari I malformation. Suboccipital craniectomy is performed for patients with Chiari I malformation who have neural compression syndromes of the brainstem and spinal cord, select headache types, and other uncommon conditions that are not the topic of this review.
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Curr Pain Headache Rep · Aug 2002
ReviewInflammatory mechanisms in cervicogenic headache: an integrative view.
Cervicogenic headache is a relatively common and still controversial form of headache that originates from the neck structures. The pathophysiology probably results from various local pain-producing factors, such as intervertebral dysfunction, but the frequent coexistence of a history of head traumas still plays an important role. This report represents a series of pathophysiologic studies performed for patients with cervicogenic headache and the results achieved by a new pharmacologic treatment for the disease.
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Curr Pain Headache Rep · Aug 2002
ReviewPeripheral and central sensitization in fibromyalgia: pathogenetic role.
Characteristic symptoms of fibromyalgia syndrome include widespread pain, fatigue, sleep abnormalities, and distress. Patients with fibromyalgia show psychophysical evidence of mechanical, thermal, and electrical hyperalgesia. Peripheral and central abnormalities of nociception have been described in fibromyalgia. ⋯ They include sensitization of vanilloid receptor, acid-sensing ion channel receptors, and purino-receptors. Tissue mediators of inflammation and nerve growth factors can excite these receptors and cause extensive changes in pain sensitivity, but patients with fibromyalgia lack consistent evidence for inflammatory soft tissue abnormalities. Therefore, recent investigations have focused on central nervous system mechanisms of pain in fibromyalgia.