Current pain and headache reports
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Curr Pain Headache Rep · Dec 2008
ReviewFibromyalgia: should the treatment paradigm be monotherapy or combination pharmacotherapy?
Fibromyalgia (FM) is a disorder characterized by chronic widespread pain, tenderness, and associated symptoms such as fatigue, sleep disturbance, mood disorder, and cognitive dysfunction. Research on the pathophysiology of FM has focused on dysregulation of sensory processing in the central nervous system, as well as genetic and sociobiologic background factors. Abnormalities include excessive pronociceptive input and deficiency of modulatory signaling via noradrenergic and serotonergic pathways. ⋯ Although there has been little assessment of combination therapy in FM, this review outlines the basis for rational treatment using this approach (in order to most effectively treat multiple symptom domains). Controlled monotherapy trials of medications currently being approved for FM demonstrate significant effect on pain, patient global impression of change, and function. Trials are currently being developed to assess the potential additive or synergistic effects of combined central pharmacotherapy and to assess the safety and tolerability of this approach.
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Curr Pain Headache Rep · Dec 2008
ReviewComplementary and alternative approaches to the treatment of tension-type headache.
Although pharmacotherapy with NSAIDs and tricyclic antidepressants comprises the traditional treatment of tension-type headaches (TTHs), the use of other therapeutic approaches in combination with medications can increase the success of treatment. Patients with comorbid mood disorders and unremitting headaches may particularly benefit from some nonpharmacologic approaches. This review focuses on complementary and alternative approaches to TTH treatment, including psychological therapies, acupuncture, and physical treatments.
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Curr Pain Headache Rep · Dec 2008
Review Comparative StudyPerimenstrual migraines: are they different from migraines in general?
Differences between menstrually related migraine (MRM) and non-MRM are subtle. Preconception that population-based trials do not show differences, but that clinic-based trials showed severe, longer, and clinically refractory menstrual migraines, turns out to be simplistic. This review examines studies comparing and contrasting MRM and non-MRM. ⋯ A significant subset of MRM patients has poorer response to acute medication. Overall, it appears that MRM is more severe than non-MRM when considering population- and clinic-based studies, with slightly but clinically meaningfully worse intensity, duration, disability, prodrome, nausea, and response to acute medications. Clinicians must have compassion and skill to manage patients with MRM.
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Curr Pain Headache Rep · Dec 2008
Review Comparative StudyTension-type headache and migraine: two points on a continuum?
The question of whether tension-type headache (TTH) and migraine represent two points on a continuum has been debated for decades. Skeptics of the continuum model support their view by noting that the characteristics of these two headaches and the demographics of the individuals who suffer from them are undeniably distinct. ⋯ TTH and migraine may exhibit similar associated features (even within the constraints of diagnostic criteria), respond effectively to similar medications, share similar demographics among certain age groups, and may each have genetic influences. These findings suggest that TTH and migraine may be more intimately related than would be suggested by their diagnostic criteria.
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Curr Pain Headache Rep · Dec 2008
ReviewPragmatic consideration of recent randomized, placebo-controlled clinical trials for treatment of fibromyalgia.
A flurry of recent randomized, placebo-controlled trials assessing dissimilar pharmacotherapeutic treatment options for fibromyalgia (FM) have been presented in the past few years. This review evaluates these trials in light of recent pathophysiological concepts germane to FM, including mood disorders, autonomic dysregulation, altered sleep stage architecture, and the diagnostic tender point controversy. Studies with gabapentin, pregabalin, duloxetine, milnacipran, sodium oxybate, and pramipexole for treatment of FM are discussed.