Current pain and headache reports
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Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. ⋯ Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).
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New daily persistent headache (NDPH) is frequently seen in young patients with chronic daily headache. NDPH begins with a sudden onset, often associated with an infection or other physical stress. This headache syndrome is difficult to treat and may persist for years. This review discusses the epidemiology, comorbid symptoms, evaluation, and treatment of this disorder.
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Curr Pain Headache Rep · Feb 2009
ReviewSpinal cord stimulation for the treatment of angina and peripheral vascular disease.
Spinal cord stimulation has been shown to be an effective and well-established treatment for failed back surgery syndrome, complex regional pain syndrome, and other neuropathic pain states. Recent advances in this therapy have led to its use in enhancing blood flow and reducing ischemic pain patterns. ⋯ This article examines the selection of patients, application of the therapy, outcomes, and future uses of stimulation for patients afflicted with these diseases. This article also examines possible study protocols to further examine the overall outcome of these therapies.
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Curr Pain Headache Rep · Feb 2009
ReviewChronic migraine: current pathophysiologic concepts as targets for treatment.
Chronic daily headache (CDH) affects approximately 4% of the population and exerts a significant degree of disability on its sufferers. Chronic migraine (CM) is a subset of CDH that represents migraine without aura occurring on 15 or more days per month for at least 3 months. Although numerous risk factors are associated with the development of CM, the pathophysiology governing its genesis is largely unknown. The role of neurotransmitters, such as glutamate, as well as disruptions of antinociceptive systems and structures, are implicated in CM and are supported by the fact that treatments targeting these abnormalities are effective.
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At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures critical in the pathophysiology of migraine. ⋯ Triptans have been shown to be effective as both an abortive and short-term preventive treatment, and estradiol has been shown to be an effective short-term preventive treatment. Ergotamines, combinations of drugs such as sumatriptan-naproxen sodium, and rizatriptan with dexamethasone show promise in the treatment of MM.