Current pain and headache reports
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Epidemiology of headache has been the subject of increased attention recently. It appears that the overall human and financial cost of headache is considerable. ⋯ This article gathers emerging data that give an estimate of some of the aspects of the burden imparted by tension-type headache on society. It also briefly considers some of the factors that could positively influence this challenge of modern medicine.
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Fibromyalgia is a common idiopathic pain condition often resulting in increased morbidity and disability in patients. The lack of peripheral abnormalities in this disease has led clinicians and researchers alike to question if this syndrome represents a valid entity. ⋯ In addition, neurobiological studies indicate that fibromyalgia patients have abnormalities within central brain structures that normally encode pain sensations in healthy pain-free controls. Future studies that focus on central neurobiological and/or genetic influences in fibromyalgia may bring insight into mechanisms of this problematic disease and ultimately result in improved treatments.
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Headache is common in childhood; recurrent headaches include both migraine and tension-type headache (TTH). Although much of the attention recently has been focused on migraine, TTH can also be problematic for children and needs further study. Standardized criteria have been developed and used for epidemiology and treatment studies, but they are yet to be validated for children. The pathophysiology, selective treatment, impact, and outcome of TTH in children need to be studied further.
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Although many Americans suffer from undertreated pain, the regulatory and legal environment for the use of opioids in pain relief is currently in a state of flux. The federal government's efforts to curb drug abuse have complicated the use of opioids for pain relief. ⋯ Despite a disturbing shift in regulatory authority over opioid analgesics away from health agencies and toward law enforcement agencies, recent state policies and guidelines from national medical organizations are playing an important role in promoting the use of opioids for pain treatment and helping to reduce practitioners' concerns over regulatory oversight. Current and future trends concerning the legal and regulatory aspects of chronic opioid treatment are discussed in this article.
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Giant cell, or temporal, arteritis is a vasculitis of the medium and large arteries that preferentially involves vessels originating from the arch of the aorta. Classically, this disease manifests in an older individual with new-onset persistent headache, an abnormal temporal artery on examination, and increased serum inflammatory markers. ⋯ However, the diagnostic gold standard is achieved by histologic confirmation by temporal artery biopsy. Prompt treatment with corticosteroids is essential in order to minimize the frequency of permanent sequelae such as visual loss and stroke.