Current pain and headache reports
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Although migraines are the most common cause of headaches in children, it is important to be cognizant of other, secondary causes of headaches. Secondary headaches are caused by an underlying etiology that may be systemic (medical) or due to a problem inherent in the central nervous system. ⋯ In some situations, early identification and appropriate treatment of these underlying conditions can result in complete headache resolution. This article discusses these secondary causes of headaches due to primary brain etiologies, focusing on aspects of the history that should lead a neurologist to order neuroimaging or electroencephalographic studies for these children.
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Headache can be caused by primary entities (as in migraine or tension-type headache) or the pain may result from secondary causes, such as brain tumors, idiopathic intracranial hypertension, chronic meningitis, hydrocephalus, drug intoxications, paranasal sinus disease, or acute febrile illnesses (eg, influenza). To determine the nature of a child's headache, the evaluation begins with a thorough medical history, followed by methodic physical examination with measurement of vital signs and complete neurologic examination. ⋯ Clues to the presence and identification of secondary causes of headache are uncovered through this systematic process of history and physical examination. The performance of ancillary diagnostic testing rests upon information or concerns revealed during the history and physical examination.
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Fibromyalgia syndrome (FMS) is now understood as a chronic pain syndrome, and recent evidence indicates it is not a pure psychosomatic disorder. We review the current knowledge in FMS pain pathways, focusing on the central system sensitization phenomenon and the abnormalities in the inhibitory pain systems. ⋯ These features include the nerve growth factor actions and failure of the endocannabinoid system. In addition, we review new immunological aspects of FMS, both in their humoral (autoantibodies, antipolymer antibodies) and cytokine (interleukin-2) aspects.
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Curr Pain Headache Rep · Oct 2008
ReviewNeuromodulators for the treatment of headache disorders and fibromyalgia.
Migraine and fibromyalgia are prevalent and disabling disorders with few preventive medications approved by the US Food and Drug Administration (FDA). Neuromodulators (or antiepileptic drugs; AEDs) are often effective in the treatment of these conditions. ⋯ For fibromyalgia, pregabalin has recently been approved in the United States. We review the use of AEDs in the preventive treatment of these highly prevalent disorders.
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Curr Pain Headache Rep · Oct 2008
ReviewThe impact of latent trigger points on regional muscle function.
To date, most investigation of latent myofascial trigger points (LTrPs) has occurred in pain populations. Many have thought that LTrPs are clinically relevant as -potential precursors to developing active myofascial trigger points and spontaneous pain. ⋯ Fatigue and neurophysiologic studies provide evidence as to the pathways via which group III and IV afferents can alter activity of the motoneuron pool and therefore affect muscle activation and performance. This article offers suggestions as to the mechanisms via which LTrP-related pathophysiology may explain the clinical examination findings associated with LTrP-containing and functionally related muscles.