Current pain and headache reports
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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
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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Myofascial pain is a common cause of regional chronic pain. Myofascial trigger points can refer pain to the head and face in the cervical region, thus contributing to cervicogenic headache. When identified properly, cervical myofascial pain is a treatable component of headache management. This article reviews current literature on the pathophysiology, diagnosis, and management of cervical myofascial pain.
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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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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.