Current pain and headache reports
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This review evaluates and explains our current understanding of a rare subtype of migraine, typical aura without headache, also known as migraine aura without headache or acephalgic migraine. ⋯ Typical aura without headache is a known entity within the spectrum of migraine. Its pathophysiology is suggested to be similar to classic migraines, with cortical spreading depression leading to aura formation but without an associated headache. No clinical trials have been performed to evaluate treatment options, but case reports suggest that most patients will respond to the traditional treatments for migraine with aura. Bilateral greater occipital nerve blocks may be helpful in aborting migraine with prolonged aura. Transcranial magnetic stimulation has shown efficacy in aborting attacks of migraine with aura but has not been specifically tested in isolated aura. Typical aura without headache occurs exclusively in 4% patients with migraine, and may take place at some point in 38% of patients with migraine with aura. Typical aura without headache commonly presents with visual aura without headache, brainstem aura without headache, and can also develop later in life, known as late-onset migraine accompaniment.
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Curr Pain Headache Rep · Sep 2018
ReviewThe Pivotal Role of Pediatric Psychology in Chronic Pain: Opportunities for Informing and Promoting New Research and Intervention in a Shifting Healthcare Landscape.
In the context of new efforts to formulate more comprehensive diagnostic and treatment processes for chronic pain conditions, this review aims to provide an overview of some of the most salient developments in the diagnosis and clinical treatment of pediatric chronic pain and to delineate the current and future role of clinical pediatric psychologists in these efforts. ⋯ The acceptance and promotion of the multidisciplinary approach to pediatric pain management has had an especially significant impact on the field of pediatric psychology. Though chronic pain was historically conceptualized as a biomedical problem, psychology is increasingly viewed as a routine, integral, and component part of treatment. With this evolving biopsychosocial paradigm, pediatric psychology is poised to help shape the development of this field, contributing to emerging conceptual and diagnostic frameworks via consultation, research, clinical care, and education. This review discusses the role of pediatric psychologists as collaborators in emerging diagnostic and assessment frameworks, leaders in pain-related research, drivers of clinical care, and educators for providers, patients, and the lay public. With increased opportunities to enhance the conceptualization and treatment of pediatric pain, pediatric psychologists have an important role to play in reducing the prevalence and persistence of pediatric pain.
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Curr Pain Headache Rep · Sep 2018
ReviewFactors Associated with Sport-Related Post-concussion Headache and Opportunities for Treatment.
The purpose of this review is to (1) describe factors both pre- and post-injury that are associated with post-concussion headache, (2) describe the influence of post-concussion headache on recovery following concussion, and (3) provide potential post-concussion treatment options that may reduce the burden of headache, as well as other symptoms to facilitate recovery. ⋯ Various factors may be associated with post-concussion headache presentation. These may include pre-injury or historical factors such as sex, family and self-history of headache and migraine, concussion history, and mood disorders. In addition, post-injury presentation factors for consideration may include injury mechanism, symptom clusters, cervicogenic dysfunction, and post-concussion physiologic dysfunction. Despite this complex interplay of factors, many treatment options may improve headache symptoms and recovery post-concussion including rehabilitation programs focusing on deficits such as visual-vestibular dysfunction, sub-symptom threshold exercise, and potential pharmacological interventions. Concussion is a complex injury that results in a variety of sequelae with headache being one of the most common. Understanding factors related to post-concussion headache presentation and the available options for treatment may improve patient care and outcomes post-concussion.
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Curr Pain Headache Rep · Aug 2018
ReviewThe Evolution of Surgical Enhanced Recovery Pathways: a Review.
Enhanced recovery pathways are a well-defined perioperative health care program utilizing evidence-based interventions in a protocol-like manner designed to standardize techniques including drug selection and dosing to improve results and to reduce overall costs including facilitating earlier discharge from hospitals after surgery. ⋯ A PubMed and World Wide Web search was performed with the following key words: enhanced recovery, surgical enhanced recovery, recovery pathways, and enhanced recovery pathways surgery. This introduction to enhanced recovery pathways reflects its 20-year history, worldwide appeal, and ever growing presence in our practices. Many clinical teams have not, as of yet, incorporated enhanced recovery pathway principles to their practices and therefore, continued evolution should include increasing outreach and formalized guidelines in the future.
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Curr Pain Headache Rep · Aug 2018
ReviewIs Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients.
The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses. ⋯ All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates. The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the "worst" patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of "whatever is likely to be perceived to provide some relief", despite these drugs that are perceived as "more powerful", are often indicated as second- or third-line medications.