Current pain and headache reports
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Curr Pain Headache Rep · Dec 2008
ReviewAdvances in the pharmacologic treatment of tension-type headache.
Tension-type headache (TTH) is the most prevalent form of primary headache in the general population. We discuss advances in the treatment of TTH. ⋯ For preventive treatment, amitriptyline is the best-studied drug, but nortriptyline, mirtazapine, tizanidine, the selective serotonin reuptake inhibitors, and other medications can be used. We close by discussing potential future therapies, including calcitonin gene-related peptide receptor antagonism, as well as substance P and the nitric oxide pathways.
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Back pain is one of the most common patient complaints brought forth to physicians. Mechanical back pain accounts for 97% of cases, arising from spinal structures such as bone, ligaments, discs, joints, nerves, and meninges. Acute back pain in the absence of progressive neurologic deficits and other underlying nonmechanical causes may be treated conservatively, with specific emphasis on maintaining activity levels and function. ⋯ Common causes of mechanical back pain include spinal stenosis, herniated discs, zygapophysial joint pain, discogenic pain, vertebral fractures, sacroiliac joint pain, and myofascial pain. A wide variety of treatments are available, with different treatments specifically targeted toward different causes. A balanced approach, which takes into account patient psychosocial factors and incorporates multidisciplinary care, increases the likelihood of success from back pain interventions.
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Curr Pain Headache Rep · Dec 2008
ReviewPsychological issues in the evaluation and treatment of tension-type headache.
Tension-type headache (TTH) is a common disease that is usually minimally impairing. However, more chronic TTH can be associated with significant disability and psychological comorbidity. ⋯ Special populations, including pediatric patients, pregnant patients, and geriatric patients, may especially benefit from psychological interventions. Further work needs to be done in researching the effects of psychological treatments and making them available to a wider population.
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The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important to differentiate TTH from other headaches, including primary and secondary headaches. Significant overlap in the diagnostic criteria makes it difficult to differentiate TTH from other headache disorders and, in particular, migraine. A controversy exists about whether TTH and migraine represent a continuum of the same pathophysiological process.
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The risk of migraine is increased among women during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation. For some women with menstrual migraine, headaches that occur at this time are more severe, of longer duration, and more disabling. Although it is recognized that menstrual migraine requires specific management, there remain a number of unmet needs. ⋯ Failure to diagnose menstrual migraine will lead to suboptimal management. Accurate diagnosis is insufficient unless it results in effective treatment strategies. Although effective and specific treatments for menstrual migraine have been developed, there is a need to define individual timing and duration of perimenstrual prophylaxis.