Current pain and headache reports
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Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.
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Vestibular symptoms such as vertigo and dizziness are quite common in migraine. There is no specific category in the new International Headache Society Classification for vestibular migraine. However, given the symptomatology often described, it would fit best under basilar-type migraine, even though by definition monosymptomatic attacks with rotational vertigo for a few seconds to minutes do not strictly fit the criteria. Vestibular migraine must be regarded as a migraine equivalent because it is a prominent symptom in many migraineurs.
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Curr Pain Headache Rep · Aug 2004
Review Case ReportsThe role of the outpatient clinic nurse in monitoring opioid therapy.
Outpatient clinical nurses specialize in patient care in a particular area of nursing practice. Typically, the registered nurse also holds a professional certification in that specialty or subspecialty. The only nursing certification related to pain and symptom management is the Hospice and Palliative Care certification. ⋯ A nurse is one of the first contacts in the health care system that the patient encounters. Nurses must possess unique qualifications and be able to deal compassionately with a demanding and sometimes hostile group of patients. How the patients are accepted into a pain medicine practice and managed is discussed in this article.
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Sports-related or sports-associated headaches are common. They can be benign as in primary exertional headache or may signal serious pathology as in headache associated with traumatic subdural hematoma. Specific sports activities are associated with unique headache conditions such as decompression sickness headache or high-altitude headache, which mountain climbers experience along with other symptoms of chronic mountain sickness. The management of sports-related headaches requires an adequate understanding of its underlying etiology with subsequent cause-directed treatment plan.
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The numbers of older people, particularly those older than 85 years of age, are increasing rapidly. Aging and chronic conditions contribute to the limitation in response to stress or insults in the elderly and impact assessment and management of pain. ⋯ Physiological alteration in body composition and renal and hepatic function alter distribution and elimination of medications and metabolites. Non-medical treatments also may be effective in managing pain and should be considered for older patients.