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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Fibromyalgia is a disorder of unknown etiology characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, poor sleep, gastrointestinal complaints, and psychologic problems that are similar to those experienced by patients with hormone deficiencies. This review summarizes the available data on the neuroendocrine function in fibromyalgia, including data on hormone secretion, circadian phase, and autonomic nervous system function. ⋯ The reduced hormonal and autonomic responses appear to reflect an impairment in the hypothalamic or central nervous system response to stimuli rather than a primary defect at the level of the pituitary gland or the peripheral glands. A combination of multiple, mild impaired responses may lead to more profound physiologic and clinical consequences as compared with a defect in only one system, and could contribute to the symptoms of fibromyalgia.
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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
ReviewThe relationship of neck injury and post-traumatic headache.
Although there may be several causes of post-traumatic headache, neck injury is perhaps the most common. This paper primarily reviews the relationship of neck injury, whiplash, and post-traumatic headache. Mechanisms may include structural damage from acceleration or extension of the neck, development of myofascial pain and trigger points, interaction of the trigeminal nociceptive system with the upper cervical (occipital) nerves, and psychologic and emotional factors. Although some healing will occur, the outcome may depend on a number of human factors (awareness of an impending collision) and the fact that repaired tissue is different from normal, uninjured tissue.
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Fibromyalgia is a chronic pain syndrome of unknown etiology characterized by diffuse pain and tender points, which have been present for more than 3 months. Many patients with systemic illnesses can have diffuse pain similar to that found in fibromyalgia, including rheumatic diseases such as polymyalgia rheumatica, rheumatoid arthritis, idiopathic inflammatory myopathy, systemic lupus erythematosus, and joint hypermobility. ⋯ In addition, there has been interest throughout the past 10 years in infectious diseases including hepatitis C, Lyme disease, coxsackie B, HIV, and parvovirus infection, which may cause or trigger fibromyalgia. This paper provides a framework to use when identifying these diseases as part of the evaluation of a patient with chronic widespread musculoskeletal pain.