Current pain and headache reports
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Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves. ⋯ Physical therapy and preventive medication with antiepileptics and tricyclic antidepressants are often effective treatments for occipital neuralgia. Refractory cases may require intervention with pulsed radiofrequency or occipital nerve stimulation.
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Cluster headache is a rare primary headache disorder and the most common trigeminal-autonomic cephalalgia. Even though it has been extensively studied, its pathophysiology remains nebulous. Over the last two decades, cerebral imaging has increasingly been used to aid the investigation of pain and headache disorders. ⋯ More recent works demonstrate structural changes across multiple structures related to pain processing, sensory integration, and emotional evaluation. These changes do not seem to be static, but rather appear to be dynamic in nature as they change over the course of the disease. This was interpreted as a reflection of the plasticity of the human brain and should guide future thoughts towards a more complex pathophysiological model involving a maladaptive pain modulatory network.
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Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation. Its expansion has become possible due to both technological and clinical advances in pain medicine. The first implantable systems were surgically placed. ⋯ The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds.
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Curr Pain Headache Rep · Apr 2014
ReviewLumbar sympathetic treatment in the management of lower limb pain.
The sympathetic system has been a target for interventional treatment since the early half of the 20th century. One area targeted for treatment has been the lumbar sympathetics for lower limb pain. Physicians have treated various neuropathic and ischemic conditions employing the use of sympathetic procedures as a mode of treatment, yet the studies strongly supporting the utility of the procedure have been lacking. ⋯ Many studies have reported positive results with blockade and neurolysis, but review of the literature reveals poor strength quality and small sample population. These reports should be viewed as building blocks for more robust investigation. Interpretation of the results should be performed with caution, and translation into common practice implemented on a case by case basis.
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Paroxysmal hemicrania (PH) is an underreported and underdiagnosed primary headache disorder. It usually begins in the third or fourth decade of life. The recent observations indicate that it is equally prevalent in both males and females. ⋯ The hallmark of PH is the absolute cessation of the headache with indomethacin. However, a range of drugs may show partial to complete relief in certain groups of patients. Neuromodulatory procedures, such as greater occipital nerve blockade, blockade of sphenopalatine ganglion and neurostimulation of the posterior hypothalamus, are reserved for refractory PH.