Current pain and headache reports
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Cluster headache has long been considered a predominantly male disorder, with much of our knowledge based on studies of men. However, it has become increasingly more recognized in women. Although there are many similarities between men and women in the expression of the disorder, studies over the years have revealed gender differences. This article reviews epidemiologic, clinical, hormonal, and familial differences between male and female cluster patients, examines how they may affect treatment, and suggests studies that may give us a better understanding of the disorder.
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Classified as a trigeminal autonomic cephalalgia, cluster headache is characterized by recurrent short-lived excruciating pain attacks, which are concurrent with autonomic signs. These clinical features have led to the assumption that cluster headache's pathophysiology involves central nervous system structures, including the hypothalamus. ⋯ Using a variety of neuro-imaging techniques (functional , biochemical , and structural ) in patients with cluster headache, we are making improvements in our understanding of the role of the brain in this disorder. This article summarizes neuroimaging findings in cluster headache patients, describing neuronal changes that occur during attacks and remission, as well as during hypothalamic stimulation.
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Opioid analgesics are given to people with pain. These medications are highly effective for relieving pain and are generally considered to have little or no end-organ toxi-cities. ⋯ They are known to have central nervous systems effects and are now understood to impact the regulation of gonadotropic hormones. Providing meaningful informed consent requires disclosure about the risks associated with lowered gonadotropic hormone levels.
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The nosological boundaries between cluster headache and migraine are sometimes ill-defined. Although the two disorders are distinct clinical entities, patients sometimes present with clinical scenarios having characteristics of both headache types, but either do not fully meet International Classification of Headache Disorders, Second Edition diagnostic criteria for either disorder or have sufficient symptoms and signs to allow both diagnoses to be present. These occasions provide diagnostic challenges and include what is variously described as migraine-cluster, cyclical migraine, clustering episodes of migraine, cluster with aura, or atypical cluster without autonomic symptoms or severe pain. Patients with symptoms overlapping cluster headache and migraine likely reflect the inherent clinical variability in each of these two disorders, rather than distinct diagnostic entities in their own right.
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Curr Pain Headache Rep · Apr 2007
ReviewDoes thalidomide have an analgesic effect? Current status and future directions.
Dramatic relief of pain and life-altering changes in quality of life in some patients treated with immunomodulators such as thalidomide compel us to look more closely at unconventional mechanisms that may be involved in propagation of persistent pain. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, and IL-10 are the cytokines with the most evidence in pain modulation. TNF-alpha and IL-1beta seem to initiate neuropathic pain, IL-6 maintains such pain, and IL-10 inhibits this persistent pain. ⋯ Thalidomide may be an alternative for some patients with intractable pain. However, use of thalidomide is limited by its neurotoxic and teratogenic effects. Newer analogues may significantly improve the risk/benefit of using such immunomodulators.