Current pain and headache reports
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Methodology varies greatly in whiplash studies; therefore, results are not directly comparable. Headache seems to be present in 50% to more than 75% of cases in the acute stage, and in 20% to 30% of cases in the early chronic stage. Headache naturally occurs frequently (> 75% of the cases ) in patients who consult headache specialists due to protracted symptoms. ⋯ In one study, this type of headache was present in 8% at 6 weeks and 1% at 6 years. It was more rare than postwhiplash, unspecified headache. De novo postwhiplash headache may consist of cervicogenic headache and of noncervicogenic headache (probably in the acute phase).
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New daily persistent headache (NDPH) is frequently seen in young patients with chronic daily headache. NDPH begins with a sudden onset, often associated with an infection or other physical stress. This headache syndrome is difficult to treat and may persist for years. This review discusses the epidemiology, comorbid symptoms, evaluation, and treatment of this disorder.
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Chronic daily headache (CDH) is a fairly common but disabling disorder that disproportionately affects women and afflicts individuals across all stages of adulthood. It is a dynamic disorder, marked by relatively high rates of remission and incidence. ⋯ The purpose of this article is to understand the CDH classification; determine the prevalence and associated demographic profile of CDH as derived from population-based studies; outline identified risk factors for development or persistence of CDH; and understand which risk factors may be more amenable to intervention. Understanding the factors that put people at risk for developing CDH helps to inform possible clinical interventions and also determines which individuals may be most in need of preventive efforts.
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This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. ⋯ Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.
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Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. ⋯ Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).