Current pain and headache reports
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Curr Pain Headache Rep · Jan 2015
ReviewTic versus TAC: differentiating the neuralgias (trigeminal neuralgia) from the cephalalgias (SUNCT and SUNA).
Trigeminal neuralgia, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA) are classified as distinct disorders in the International Classification of Headache Disorders 3 beta (ICHD-3 beta). SUNCT and SUNA are primary headache disorders included among the trigeminal autonomic cephalalgias. ⋯ The reported overlap among these conditions has called into question whether they should be considered distinct entities or rather a continuum of the same disorder. This review explores the known overlap and how other features not included in the ICHD-3 beta criteria may better differentiate the "Tics" (trigeminal neuralgia) from the "TACs" (SUNCT and SUNA).
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Curr Pain Headache Rep · Jan 2015
Review Historical ArticleHistory and present state of targeted intrathecal drug delivery.
Nearly 50 years ago, the seminal experiments of Melzack and Wall, culminating in the gate control theory, coupled with the discovery of endogenous opioid receptors, helped shape modern understandings of pain and provided interventionalists a potent therapeutic gateway to neuraxial analgesia. This paper emphasizes the historical antecedents, present state, and emerging future of the neuromodulatory technique of targeted intrathecal drug delivery (TIDD) for chronic pain. The strengths of TIDD are its customizability, reversibility, programmability, and low risk profile. Its benefits are evidenced by improved pain relief and quality of life and reduced demand for health-care resources.
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Curr Pain Headache Rep · Jan 2015
ReviewDiagnose and adios: practical tips for the ongoing evaluation and care of TAC patients taking indomethacin.
Paroxysmal hemicrania and hemicrania continua are primary headache disorders characterized by unilateral attacks of severe pain around the orbit with associated autonomic features. They are unique in their absolute response to indomethacin. ⋯ For patients who do not tolerate indomethacin, or wish to come off medication, there remain few options. This article will discuss the diagnosis of paroxysmal hemicrania and hemicrania continua and the ongoing management of patients on indomethacin, as well as options for patients who do not tolerate or need to come off indomethacin.
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Curr Pain Headache Rep · Jan 2015
ReviewIntrathecal baclofen: effects on spasticity, pain, and consciousness in disorders of consciousness and locked-in syndrome.
Disorders of consciousness (DOCs) include coma, vegetative state (VS), and minimally conscious state (MCS). Coma is characterized by impaired wakefulness and consciousness, while VS and MCS are defined by lacking or discontinuous consciousness despite recovered wakefulness. Conversely, locked-in syndrome (LIS) is characterized by quadriplegia and lower cranial nerve paralysis with preserved consciousness. ⋯ The precise mechanism underlying this recovery has not yet been elucidated. It has been hypothesized that ITB may act by reducing the overload of dysfunctional sensory stimuli reaching the injured brain or by stabilizing the imbalanced circadian rhythms. Although the current indication of ITB is the management of severe spasticity, its potential use in speeding the recovery of consciousness merits further investigation.
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Tension-type headache (TTH) is the most common type of primary headaches, and its chronic form, chronic tension-type headache (CTTH), is affecting 0.5 to 4.8 % of the worldwide population. Although the mechanism underlying CTTH remains unclear, the role of central versus peripheral mechanisms has always been discussed while explaining the pathogenesis of CTTH. ⋯ Compared with pharmacological treatments, non-pharmacological treatments have been popular as alternative interventions for CTTH in recent years. This review summaries the update knowledge on CTTH and discusses the most interested questions regarding pathogenesis and therapeutic strategies of CTTH.