Current pain and headache reports
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Curr Pain Headache Rep · Nov 2021
Review Case ReportsIndomethacin-Induced Headache: Causing the Problem You Are Trying to Solve.
Indomethacin is an important medication in the headache medicine toolbox given its utility for both of the diagnosis and treatment of several primary headache disorders. Despite its prevalence in earlier rheumatologic studies, the possibility of drug-induced headache is a not commonly discussed in headache literature. ⋯ Herein, we describe a case of drug-induced headache after indomethacin trial for the treatment of an undifferentiated trigeminal autonomic cephalgia. Recognition of indomethacin-induced headache has important implications for patient education and interpreting the response to indomethacin when used both as a therapeutic and as a diagnostic tool.
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Curr Pain Headache Rep · Nov 2021
ReviewCo-Occurring Trauma and Non-Suicidal Self-Injury Among People With Chronic Pain: A Systematic Review.
Trauma and posttraumatic stress are common among individuals with chronic pain and contribute to increased morbidity and impairment. Individuals with trauma and chronic pain may be prone to non-suicidal self-injury, a relatively common yet risky self-regulatory behavior. There is a dearth of research on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). We conducted a systematic review of the extant literature. ⋯ Five quantitative and eight case reports were identified. Only one quantitative study reported specifically on NSSI. Self-harm rates varied across studies, though appeared elevated among patients with chronic pain. Childhood trauma was linked to this co-occurrence. Causal links between trauma, NSSI, and pain are proposed, highlighting the need for a comprehensive theoretical model. We recommend assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.
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Neuromodulation devices have become an attractive alternative to traditional pharmacotherapy for migraine, especially for patients intolerant to medication or who prefer non-pharmacological options. In the past decades, many studies demonstrated the efficacy of neuromodulation devices in patients with episodic migraine (EM). However, the benefit of these devices on chronic migraine (CM), which is typically more debilitating and refractory than EM, remains not well studied. ⋯ We reviewed the literature within the last five years on using FDA-cleared and investigational devices for CM. There were eight randomized controlled trials and 15 open-label observational studies on ten neuromodulation devices. Neuromodulation is promising for use in CM, although efficacy varies among devices or individuals. Noninvasive devices are usually considered safe with minimal adverse events. However, stimulation protocol and methodology differ between studies. More well-designed studies adhering to the guideline may facilitate FDA clearance and better insurance coverage.
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Curr Pain Headache Rep · Nov 2021
ReviewHeadache as a Symptom of COVID-19: Narrative Review of 1-Year Research.
Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. ⋯ The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.