Current pain and headache reports
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Nerve injury increases the spinal cord expression and/or activity of voltage- and ligand-gated ion channels, peptide receptors, and neuroimmune factors, which then drive dorsal horn neuron hyperexcitability. The intensity and duration of this central sensitization is determined by the net activity of local excitatory and inhibitory neurotransmitter systems, together with ongoing/evoked primary afferent activity and descending supraspinal control. ⋯ Excessive downregulation or defective compensatory upregulation of these systems may contribute to the maintenance of neuropathic pain. An increasing number of pharmacotherapeutic strategies for neuropathic pain are emerging that mimic and enhance inhibitory neurotransmission in the dorsal horn.
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Curr Pain Headache Rep · Jun 2009
ReviewBehavioral medicine for migraine and medication overuse headache.
Primary headaches, including migraine and medication overuse headache (MOH), can be conceptualized as biobehavioral disorders based on the interaction of biological, psychological, and environmental factors. This article reviews empirically supported and efficacious behavioral approaches to the treatment and management of headaches in general, with an emphasis on migraine and MOH from a biopsychosocial perspective. ⋯ Information regarding psychological comorbidities and risk factors for progression of migraine and the development of MOH is also reviewed. Strategies are provided for enhancing adherence and motivation, as well as facilitating medical communication.
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Initially described more than 40 years ago, basilar-type migraine has posed diagnostic and therapeutic dilemmas for medical practitioners. Defined by the coexistence of migraine headache with neurological symptoms emanating from either the brainstem or simultaneously from both cerebral hemispheres, basilar-type migraine has been categorized as "atypical" or "complicated" and has been considered more akin to hemiplegic migraine than to migraine with typical aura. Despite the absence of any data convicting basilar-type migraine as a vasospastic condition, the use of triptans in such patients has been considered prohibited. This review focuses on the diagnosis, clinical presentation, available genetic information, and treatment considerations in patients with basilar-type migraine.
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Curr Pain Headache Rep · Jun 2009
ReviewNewest aspects on the association between migraine and cardiovascular disease: the role of modifying factors.
Migraine has been established as a risk factor for ische-mic stroke. Further evidence suggests that migraine is also associated with other ischemic vascular events, including myocardial infarction and cardiovascular death. However, these associations appear to be limited to the subgroup of patients with migraine with aura (MA). ⋯ These include vascular risk factors, migraine attack frequency, and genetic variants. In addition, there appear to be differential effects with regard to ischemic stroke and myocardial infarction. These new findings await confirmation in independent patient populations and are currently not sufficient to argue for a change in diagnostic testing or treatment.
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Curr Pain Headache Rep · Jun 2009
ReviewRole of skin biopsy in the diagnosis of peripheral neuropathic pain.
Evaluation of epidermal nerve fiber density (ENFD) allows objective, pathologic, and minimally invasive assessment of small myelinated and unmyelinated cutaneous axons. In addition to providing diagnostic confirmation of neuropathies affecting these "small fibers," this procedure has advanced clinical care by dramatically increasing awareness of the role of small myelinated and unmyelinated axons in disorders of peripheral nerve and in neuropathic pain. This review highlights the technical aspects of skin biopsy for ENFD determination, the role of skin biopsy in the diagnosis of small-fiber neuropathy and ganglionopathy, and the diagnostic approach to the patient with peripheral neuropathic pain.