Current pain and headache reports
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Sexual hormones influence complex brain function and pain perception. Many psychophysical studies attempted to establish pain perception changes across menstrual cycle in animal models and healthy women or those with chronic pain. ⋯ The few studies applying neurophysiological procedures to test pain-related changes during menstrual cycle suggested a fluctuation of central modulation of pain across phases, with a prevalence of excitatory versus inhibitory control in the premenstrual period, which may explain the cyclic worsening of many syndromes, such as migraine. Whatever is the relevance of menstrual cycle on individual painful symptoms, it should be accepted as one of the numerous factors influencing mechanisms of neuromodulation.
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Curr Pain Headache Rep · Oct 2011
Review Comparative StudyAre menstrual and nonmenstrual migraine attacks different?
Migraine is the second most common headache condition next to tension-type headache. Up to one fourth of all women have migraine, and 20% of them experience migraine without aura attack in at least two thirds of their menstrual cycles. ⋯ Future studies should be based on the general population. Collection of both prospective and retrospective data is warranted, and headache diagnosis base on interviews by physicians with interest in headache are more precise than lay interviews or questionnaires.
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Curr Pain Headache Rep · Oct 2011
ReviewTreatment of chronic migraine headache with onabotulinumtoxinA.
Chronic migraine headache remains an exceedingly difficult entity to manage. Treatment of chronic migraine headache with onabotulinumtoxinA has recently been shown to be effective in reducing the severity and frequency of chronic migraine headache, in the PREEMPT trials, a landmark achievement. However, the studies use a primarily fixed dose and site approach to treatment, allowing some individualized injections. However, the authors do not address the issue of myofascial trigger points as potential triggers of migraine that could be inactivated using onabotulinumtoxinA, despite several studies that support the role of myofascial trigger points in initiating some migraine headaches.
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Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Even though sleep recording is not part of the routine evaluation, polysomnography may disclose primary sleep disorders in patients with fibromyalgia, including obstructive sleep apnea and restless leg syndrome. In addition, genetic background and environmental susceptibility link fibromyalgia and further sleep disorders. ⋯ The effect of exercise is contradictory, but overweight or obese patients with fibromyalgia should be encouraged to lose weight. Regarding the approved antidepressants, amitriptyline proved to be superior to duloxetine and milnacipran for sleep disturbances. New perspectives remain on the narcolepsy drug sodium oxybate, which recently was approved for sleep management in fibromyalgia.
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Headache and endometriosis show some similarities in their clinical and epidemiological features that are probably due to the influence of female sexual hormones on both disorders. Epidemiological studies indicate that they are comorbid disorders. ⋯ A common link to the widespread use of estroprogestins may seem less probable. For physicians dealing with women with either of these disorders, awareness of the comorbidity may be helpful in the treatment of the patient.