Current pain and headache reports
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Trigeminal autonomic cephalalgias (TACs) are primary headache syndromes that share some clinical features such as a trigeminal distribution of the pain and accompanying ipsilateral autonomic symptoms. By definition, no underlying structural lesion for the phenotype is found. There are, however, many descriptions in the literature of patients with structural lesions causing symptoms that are indistinguishable from those of idiopathic TACs. ⋯ We confirm that symptomatic TACs can have typical phenotypes. It is of crucial importance to identify symptomatic TACs, as the underlying cause will influence treatment and outcome. Our update focuses on when a structural lesion should be sought.
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Muscle nociception is mainly characterized by local tenderness and referred pain. The neurophysiological basis of muscle pain supports a role of sensitization mechanisms. From a clinical viewpoint, muscle pain is represented by the presence of myofascial trigger points (TrPs). ⋯ In fact, sensitization of nociceptive pain pathways in the central nervous system due to prolonged nociceptive stimuli from TrPs seems to be responsible for the conversion of episodic to chronic TTH. In other headaches, TrPs may be able to stimulate the trigeminal nucleus caudalis and hence triggering a migraine or cluster headache attack. Proper treatment directed towards TrP inactivation has documented positive effects in individuals with these headaches; however, longitudinal studies are needed to further determine the role of TrPs in head pain.
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Deep brain stimulation (DBS) is a commonly performed procedure and has been used for the treatment of chronic pain since the early 1970s. A review of the literature was performed utilizing the PubMed database evaluating the use of DBS in the treatment of various pain syndromes. Literature over the last 30 years was included with a focus on those articles in the last 10 years dealing with pain conditions with the highest success as well as the targets utilized for treatment. ⋯ Cephaligias have promising results, with cluster headaches carrying the best success rates. DBS plays a role in the treatment of chronic pain conditions. Although considered investigational in the USA, it carries promising success rates in a recalcitrant patient population.
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Curr Pain Headache Rep · Jul 2015
ReviewSupratrochlear and Supraorbital Nerve Stimulation for Chronic Headache: a Review.
Chronic daily headache accounts for a significant socioeconomic burden due to decreased productivity, work absenteeism, multiple office and ER visits, and hospital admissions for pain control. Associated comorbidities add to this cost. ⋯ It is in this setting of the urgent demand for better pain control and to assimilate chronic headache sufferers back into society that a variety of neuromodulatory approaches have been emerging. This review aims to familiarize the reader with current literature regarding supraorbital and supratrochlear nerve stimulation for chronic headache, point out the advantages of this approach, address unanswered questions about this subject, and highlight future directions.
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Curr Pain Headache Rep · Jun 2015
ReviewNeuroimaging and the clinical manifestations of Chiari Malformation Type I (CMI).
Chiari malformation type I (CMI) involves the caudal displacement of the cerebellar tonsils through the foramen magnum with resultant brainstem compression in some individuals. Due to pathophysiologic changes, secondary conditions may arise, such as syringohydromyelia (SH) and scoliosis. ⋯ Although the true etiology of this complex condition remains speculative, the advent of neuroimaging has allowed for clarification of the enigmatic relationship between cerebrospinal fluid (CSF) dynamics, neuroanatomical compression, and clinical symptoms. Recent advancements in magnetic resonance imaging (MRI) such as diffusion tensor imaging (DTI) and CSF flow studies show promise in clarifying the underlying fluid dynamics in CMI patients and can aid in the prognosis and diagnosis of this complex disorder.