Current pain and headache reports
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Lumbar radicular pain is a frequent medical pathology and represents a significant burden on society. The diagnosis of sciatica is largely clinical, in the setting of a combination of radicular pain and neurologic deficits (motor, reflexes, and/or sensation) or a positive straight leg raise test. Imaging is generally not necessary for sciatica, except in the presence of warning signs or in the setting of persisting or worsening pain. ⋯ The choice of a conservative treatment approach combined with simple analgesics in the initial stages seems to be reasonable. A detailed discussion with the patient is important to explain the fact that surgery may only be necessary in the event of pain persisting in excess of 3 months or because of the development or worsening of a neurologic deficit. More high quality studies are clearly required to assist the medical practitioner in knowing how best to treat this group of patients.
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Curr Pain Headache Rep · Oct 2014
ReviewSufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating?
Migraine is, to a great extent, a genetically determined disorder and once it has manifested itself, it generally continues for years if not for decades. While the migraine is active, headaches can seemingly occur spontaneously but are often reportedly precipitated by events or factors, known as migraine triggers, the interplay of which is the topic of this paper. Among migraine triggers, the menstrual cycle is an important one that probably accounts for much of the excess of migraine in women compared with men. ⋯ Having identified trigger-headache associations, it needs to be determined which triggers are causative in the individual, either singly or in combination with others. This requires running an experiment with the individual that involves behavioral intervention to change exposure to a given trigger and determine whether that improves migraine. The ubiquitous adoption of the smart phone as a personal-data entry device, along with the possibility of bringing the results of sophisticated statistical analysis into the hands of patients and physicians, may well provide us with an important set of tools that will finally allow the unravelling of the age-old migraine-trigger puzzle.
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Curr Pain Headache Rep · Oct 2014
ReviewPrimary stabbing headache in adults and pediatrics: a review.
Primary stabbing headache (PSH) is an under-recognized primary headache disorder, which often goes undiagnosed. It is mainly characterized by its ultrashort stabbing quality and can be easily overlooked both by patients and providers as it is often not severe enough to interfere significantly with daily life. However, PSH may be severe and require therapy, and it is important for providers to recognize this headache type, both in adult and pediatric populations, as well as to be able to distinguish it from secondary headache disorders. PSH also may be more common than previously thought.
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Curr Pain Headache Rep · Oct 2014
ReviewWhat turns on a migraine? A systematic review of migraine precipitating factors.
Migraine attacks rarely occur spontaneously in the absence of any possible precipitating factors. A systematic literature review of 25 publications revealed a consistent set of stimuli that have been identified as factors associated with the onset of a migraine attack. The weighted average of the "Top 10" trigger factors was determined. ⋯ Future efforts aimed at mitigating these precipitating factors have the potential to significantly improve migraine management. However, the current healthcare system is unlikely to be able to develop detailed personalized management plans. There is a need to develop a novel approach to the identification and management of multiple trigger factors in individual migraineurs.
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Migraine aura consists of fully reversible focal neurologic symptoms that may precede or coexist with headache in a significant minority of migraine patients. Typical aura symptoms include visual, sensory, and language disturbances. ⋯ Ongoing study suggests that susceptibility to migraine aura and CSD may be genetically mediated. CSD appears to be a potential target for future development of migraine-specific preventive therapies.