Current pain and headache reports
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The term ophthalmoplegic migraine (OM) was first coined by Charcot in 1890. This condition was included as a migraine variant in the first Headache Classification of the International Headache Society in 1988. Based on postcontrast enhancement seen on MRI in some patients who were diagnosed with OM, there was a suggestion that this could be an inflammatory/demyelinating disorder; therefore, it was moved out of the "migraine" group and repositioned as a "neuralgia" in the revised 2004 classification. ⋯ Based on a survey of literature on OM in the post-imaging era, this article highlights the fact that enhancement on magnetic resonance is not a sine qua non for the diagnosis of OM. Some diagnostic dilemmas are discussed, and a protocol is included for documentation of clinical findings in future case reports on a prospective basis. Hopefully, this will help in modification of the criteria, better understanding the etiology, correct diagnosis, and determining appropriate treatment for OM.
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Because of the inextricable link between the eyes and headaches, ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, eye pain and visual disturbances are often neurologic in origin. ⋯ Moreover, the frontal or retro-orbital pain of some primary ophthalmic conditions may be mistaken for a headache disorder, particularly if the ophthalmologic examination is normal. This article reviews common ocular conditions that are associated with head pain, and some secondary causes of headache with neuro--ophthalmic manifestations.
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Curr Pain Headache Rep · Aug 2008
ReviewAssessment and management of breakthrough pain in cancer patients: current approaches and emerging research.
Cancer pain is highly prevalent and often severe. Fortunately, most cancer pain can be readily managed, with up to 90% of patients responding well to standard interventions. However, breakthrough cancer pain-brief flares of severe pain superimposed on baseline pain-is common, difficult to manage, and often negatively impacts patients' quality of life. ⋯ However, because of its sudden onset and severity, oral opioids often fall short of providing adequate control. Research into novel approaches to pain management has identified several innovative strategies for this difficult cancer pain problem. We describe current approaches to assess, define, characterize, and treat breakthrough cancer pain, and summarize recent clinical research on novel agents, novel routes of drug delivery, and other advances in its management.
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Recent literature shows an interest in the relationship between psychiatric disorders and headache. This relationship is complex and multifaceted, with existing studies confirming high rates of comorbidity between psychiatric disorders (especially depression and anxiety) and migraine and tension-type headache, implicating comorbid psychiatric disorders as risk factors for headache progression and chronification, and underscoring the need for assessment and treatment of relevant disorders. A smaller amount of literature has focused on headache that presents exclusively during and secondary to a psychiatric disturbance; this phenomenon has been termed "headache attributed to psychiatric disorder." We review recent developments in the relationship between psychiatric conditions and headache, with a particular focus on headaches attributed to psychiatric disorders, and discuss needed areas for future research.
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This review discusses headaches secondary to disorders of homeostasis, formerly known as "headaches associated with metabolic or systemic diseases." They include the headaches attributed to 1) hypoxia and/or hypercapnia (high altitude, diving, sleep apnea); 2) dialysis; 3) arterial hypertension; 4) hypothyroidism; 5) fasting; and 6) cardiac cephalalgia. For each headache type, we discuss the clinical features and diagnosis, as well as therapeutic strategies.