Current pain and headache reports
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New daily persistent headache was first described by Vanast in 1986 as a benign form of chronic daily headache that improved without therapy. In the headache specialist's office, new daily persistent headache is anything but benign and is thought to be one of the most treatment refractory of all headache conditions. ⋯ It is unique in that the headache begins daily from onset, typically in a patient without a history of headache, and can continue for years without any sign of alleviation despite aggressive treatment. This article discusses the epidemiology, diagnostic criteria, clinical characteristics, and treatment strategies for new daily persistent headache.
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The genetics of migraine is a fascinating and moving research area. Familial hemiplegic migraine, a rare subtype of migraine with a Mendelian pattern of inheritance, is caused by mutations in the chromosome 19 CACNA1A gene in approximately 75% of the families. ⋯ The genetics of the more frequent variants, migraine with and without aura, is more complex. Several loci have been studied in families and case-control studies, but need to be confirmed.
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Pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis is a self-limited syndrome of unknown origin characterized by headache accompanied by transient neurologic symptoms and cerebrospinal fluid lymphocytosis. Patients with this condition are between 15 and 40 years of age. The syndrome is more frequent in men. ⋯ Single photon emission computed tomography reveals transient focal areas of decreased uptake consistent with the clinical symptoms. It is possible that pseudomigraine with temporary neurologic symptoms and lymphocytic pleocytosis could result from an activation of the immune system secondary to a recent viral infection, which would produce antibodies against neuronal or vascular antigens. This autoimmune attack may induce an aseptic leptomeningeal vasculitis, accounting for the headache and the transient symptoms likely through a spreading depression-like mechanism.
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Curr Pain Headache Rep · Jun 2003
ReviewIs there a role for botulinum toxin in the treatment of migraine?
In this review, the studies and case reports that are available from reference systems and published congress contributions on the treatment of migraine with botulinum toxin are evaluated. The studies and reports were analyzed with respect to the study design, the efficacy parameters, and the significance of results. ⋯ As a result of this analysis, there is no sufficient scientific evidence for a treatment recommendation of migraine with botulinum toxin. Further studies are needed for a definite evaluation of subgroups with probable benefit from such a treatment and for the comparison of botulinum toxin with other migraine prophylactic drugs.
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Curr Pain Headache Rep · Jun 2003
ReviewComplex regional pain syndrome: a review of evidence-supported treatment options.
Complex regional pain syndrome consists of pain and other symptoms that are unexpectedly severe or protracted after an injury. In type II complex regional pain syndrome, major nerve injury, often with motor involvement, is the cause; in complex regional pain syndrome I, the culprit is a more occult lesion, often a lesser injury that predominantly affects unmyelinated axons. In florid form, disturbances of vasoregulation (eg, edema) and abnormalities of other innervated tissues (skin, muscle, bone) can appear. ⋯ Some common treatments (eg, local anesthetic blockade of sympathetic ganglia) are not supported by the aggregate of published studies and should be used less frequently. Other treatments with encouraging published results (eg, neural stimulators) are not used often enough. We hope to encourage clinicians to rely more on evidence-supported treatments for complex regional pain syndrome.