Current pain and headache reports
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Curr Pain Headache Rep · Feb 2004
ReviewPulsed radiofrequency neurotomy: advances in pain medicine.
In the past three decades, radiofrequency neurotomy (RFN) has been established as a safe and effective treatment for facet and sacroiliac arthropathy. However, early reports of deafferentation pain syndromes and motor deficit with the application of radiofrequency lesions to other neural structures effectively halted further development of this technology for other applications until recent years. ⋯ PRFN allows for application of radiofrequency current at markedly lower tissue temperatures, thereby minimizing the risk of adverse events. The initial clinical data on PRFN demonstrate response rates similar to conventional high temperature RFN lesions for facet and sacroiliac arthropathy and a host of other chronic pain disorders.
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Indomethacin-responsive headache syndromes represent a unique group of primary headache disorders characterized by a prompt and often complete response to indomethacin to the exclusion of other nonsteroidal anti-inflammatory drugs and medications usually effective in treating other primary headache disorders. Because these headache disorders can easily be overlooked in clinical practice, they likely are more common than previously recognized. ⋯ The paroxysmal and continuous hemicranias invariably respond in an absolute manner to indomethacin, whereas valsalva-induced and ice-pick headaches may respond in an equally dramatic, but somewhat less consistent fashion. Hypnic headache recently has been described as another primary headache disorder that may respond to indomethacin.
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This article describes the current and investigational agents for use in the treatment of acute pain. The use of spinal and epidural routes also are discussed.
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Curr Pain Headache Rep · Feb 2004
ReviewChronic daily headache and the revised international headache society classification.
Chronic daily headache (CDH) is surprisingly common. It is best defined as a primary headache disorder with head pain on most days. There are a number of possible secondary causes of persistent headache, including traumatic, vascular, neoplastic, and infectious processes, all of which must be ruled out when the patient with frequent headache is evaluated. ⋯ Several authors have proposed subdivisions of primary CDH such as chronic migraine, evolved migraine, transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. The International Headache Society (IHS) Classification published in 1988 did not address CDH other than to define a category "chronic tension-type headache." The revised IHS Classification (ICHD II) attempts to characterize CDH more thoroughly with the addition of chronic migraine and new daily persistent headache diagnoses, but this complex issue continues to defy easy categorization. This article provides a review of thinking about the nature of primary CDH and how ICHD II attempts to organize this category for much needed research purposes.