Current pain and headache reports
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Curr Pain Headache Rep · Dec 2016
ReviewChallenges to Treatment of Chronic Pain and Addiction During the "Opioid Crisis".
Health care in the USA faces a double challenge, the crisis of chronic pain and the crisis of opioid misuse and overdose. Patients have been prescribed opioids at high doses with unclear indications for long periods of time, putting them at high risk for morbidity and mortality. A significant proportion of these patients have comorbid psychiatric or substance use disorders complicating their pain conditions. The challenges to treating these patients adequately are discussed, along with potential solutions to these issues at the level of the individual provider, healthcare systems, and society.
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Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. ⋯ Given the high risk of neurological compromise or death and the propensity of these injuries to occur in younger individuals, early diagnosis of carotid and vertebral artery dissections is critical. Although angiography remains the criterion standard for diagnosis, advances in noninvasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis. This article examines the current imaging modalities used to diagnose this under-recognized entity.
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Curr Pain Headache Rep · Dec 2016
ReviewHow Well Does the ICHD 3 (Beta) Help in Real-Life Migraine Diagnosis and Management?
Classification has played a major role in the diagnosis of primary headache conditions including migraine with and without aura. With many updates and changes, the International Classification of Headache Disorders (ICHD)-3 beta is currently considered as the gold standard for classification of migraine and other headaches. ⋯ The ICHD-3 beta version represents the state of the art in migraine diagnosis but is expected to evolve as biological knowledge advances. Future research should focus on identification of biologically homogeneous subgroups of migraine based on genes and biomarkers.
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The goal of this review is to provide an actualized overview on vestibular migraine in childhood and adolescence, with focus on the epidemiology and clinical presentation as well as its treatment. ⋯ Vertigo spells in childhood can evolve into other periodic syndromes and/or migraine types and persist even into adulthood. Vestibular migraine (VM) and benign paroxysmal vertigo are the most common causes of vertigo in children and adolescents. The diagnostic criteria for VM are dizziness and vertigo, headache, phonophobia and photophobia, and visual aura. The prevention of attacks is the treatment for children and adolescents with VM, as is recommended for migraine with or without aura. Thus, non-pharmacological measures are the first-line option; when these measures fail or daily activities are notably affected, drugs are administrated. Psychological assessment and cognitive behavioral therapy are also important therapeutic measures in this patient group. There is still insufficient research on VM in children and adolescents; future studies on clinical presentation, evolvement, and specific treatment are necessary.
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Curr Pain Headache Rep · Dec 2016
ReviewPsychological and Behavioral Issues in the Management of Migraine in Children and Adolescents.
It is sometimes assumed that children and adolescents with migraine have a psychiatric or behavioral comorbidity, a belief that can be stigmatizing. This review will examine the recent literature addressing this area to determine if pediatric and adolescent migraineurs are at increased risk for psychiatric comorbidity and to discuss management strategies. ⋯ A large systematic review of pediatric and adolescent studies concluded anxiety and depression were not associated with onset of recurrent headaches. Children with increasing migraine frequency have reduced school attendance. Pediatric migraineurs have mildly lower quality of life (QOL) scores than healthy peers but not abnormally low. Finally, children with higher migraine frequency as well as migraineurs with aura were more likely to report suicidal ideation. Migraine is a primary neurologic disorder. Migraine and psychiatric disorders may be comorbid; however, at this time, it can be difficult to clearly delineate some migraine features from psychiatric diagnoses with the current screening tools available. The majority of pediatric migraineurs do not have behavioral comorbidities; however, when such comorbidities occur, they should be addressed and appropriately managed. We need more accurate ways of delineating psychiatric and behavioral comorbidities from the migraine phenotype.