Current pain and headache reports
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Curr Pain Headache Rep · Oct 2009
ReviewBrain manifestation and modulation of pain from myofascial trigger points.
The brain plays a prominent role in the generation and modulation of pain. It contains powerful endogenous pain modulatory systems that can be engaged in a beneficial way by therapeutical intervention. In contrast, pain chronification is associated with maladaptive structural and functional changes that may shift the balance of the modulatory systems. ⋯ Recent neuroimaging data suggest that hyperalgesia from MTrPs is processed in similar regions as hyperalgesia from other pain conditions. However, abnormal hippocampal hypoactivity suggests that dysfunctional stress responses may play an important role in the generation and maintenance of hyperalgesia from MTrPs. Other data suggest that short-term pain relief obtained with intramuscular electrostimulation within an MTrP is partially due to descending pain inhibitory mechanisms.
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Some studies suggest that platelet activation and aggregation are associated with migraine, likely secondary to changes occurring during the acute attack. Evidence also suggests that platelet clots can lodge in small cerebral vessels, and that the resultant ischemia and inflammation can induce cortical spreading depression with aura-like symptoms and pulsatile headache. ⋯ When associated with other factors, such as oral contraceptive use, there may be an increased tendency for thrombus formation, secondary migraine with aura, transient ischemic attacks, and stroke. Identifying those migraineurs at highest risk of developing endothelial dysfunction and platelet disorders may allow for preventive strategies to avoid the cerebral consequences.
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Curr Pain Headache Rep · Oct 2009
ReviewThe associations between migraine, unipolar psychiatric comorbidities, and stress-related disorders and the role of estrogen.
Migraine is a common and often disabling neurovascular disorder. It has been linked with several psychiatric disorders, such as depression and anxiety, and to stress-related disorders, such as abuse and posttraumatic stress disorder (PTSD). Epidemiological data have consistently shown a higher prevalence of migraine, depression, anxiety, abuse, and PTSD in women as compared with men. ⋯ This article offers an in-depth review of several studies linking psychiatric disorders and stress-related disorders with migraine. We also discuss the role of estrogen in the pathophysiologic overlap between these disorders. Finally, we briefly touch on where future research may be headed, in light of these data.
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Curr Pain Headache Rep · Oct 2009
ReviewMedication use in the treatment of migraine during pregnancy and lactation.
Migraine is very common in women of reproductive age. With peak prevalence of migraine occurring during childbearing years, many women with migraine may knowingly or unknowingly use medication during pregnancy. Although migraine tends to improve during pregnancy, many women may still experience moderate to severe disabling headache and need pharmacologic treatment for the pain, nausea, and vomiting. ⋯ Acute and preventive treatment of migraine during pregnancy and lactation is discussed, with an emphasis on safety to the fetus and nursing infant. Safety and recommended use of medication during pregnancy may be different when use is considered during breastfeeding. A goal of treatment is to balance potential risk of treatment to the fetus and nursing infant with significant relief and return to normal function of the mother.
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Perimenopause marks a time of change in a woman's hormonal environment, which is apparent from the resultant irregular periods and vasomotor symptoms. These symptoms can start in the early 40s and continue through to the early 50s. Migraine is also affected by hormonal fluctuations, particularly the natural decline in estrogen in the late luteal phase of the menstrual cycle. ⋯ Despite the increased prevalence of headache and migraine in women in their 40s, migraine is underdiagnosed in this population. In women attending with symptoms suggestive of perimenopause, it is important to ask about headache symptoms. Once diagnosed, a number of strategies can be used to manage both perimenopausal migraine and menopausal symptoms effectively, with the potential to reduce the associated morbidity.