Current pain and headache reports
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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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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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This article discusses what is known of and written regarding the possible association of cluster headache and head trauma. There is additional discussion of conditions other than direct head trauma that are also seen in association with cluster headache. These conditions bring into question the concept of primary versus secondary cluster headache and raise the possible need to expand the category of secondary cluster headache. With increasing knowledge of the pathophysiology of cluster headache, the potentially causative role of head trauma in the development of cluster headache may become better defined.
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Curr Pain Headache Rep · Apr 2007
ReviewDoes aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects.
Aerobic exercise can cause an acute improvement in mood as well as a reduction in the perception of pain from a painful stimulus. Regular exercise training also may offer some protection from depression, is clinically useful in treating certain psychiatric and chronic pain conditions, and may allow for an enhancement of the acute improvements in mood from a single exercise session. The utility of aerobic exercise training for improving mood disturbances and pain perception among patients with chronic pain requires further investigation.