Current pain and headache reports
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Curr Pain Headache Rep · Dec 2008
ReviewThe treatment of psoriatic arthritis and inflammatory spondylitis.
NSAIDs still remain the initial therapeutic modality for psoriatic arthritis and inflammatory spondylitis. Disease-modifying antirheumatic drugs have only been proven to be useful in peripheral arthritis, without efficacy in axial inflammatory spondylitis. In recent years, the introduction of tumor necrosis alpha inhibitors into clinical practice has produced a substantial impact in both peripheral and axial disease, with improvement in pain, function, and quality of life. Factors such as cost-effectiveness and safety will need to be better characterized over time.
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Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. ⋯ Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.
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Gout is currently the most common form of inflammatory arthritis in men. The overall incidence of gout has increased rapidly in the past 20 years. Clinicians in all fields are likely to experience a patient with acute gout in their career. ⋯ Fortunately, these diseases can be readily treated and long-term sequelae can be prevented. Recent advances in understanding the role of the innate immune system in acute gout have provided new treatment options. This article addresses the epidemiology, inflammatory pathophysiology, pain management techniques (including recent advances), and treatment of the underlying disease itself.
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Although migraines are the most common cause of headaches in children, it is important to be cognizant of other, secondary causes of headaches. Secondary headaches are caused by an underlying etiology that may be systemic (medical) or due to a problem inherent in the central nervous system. ⋯ In some situations, early identification and appropriate treatment of these underlying conditions can result in complete headache resolution. This article discusses these secondary causes of headaches due to primary brain etiologies, focusing on aspects of the history that should lead a neurologist to order neuroimaging or electroencephalographic studies for these children.
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Headache can be caused by primary entities (as in migraine or tension-type headache) or the pain may result from secondary causes, such as brain tumors, idiopathic intracranial hypertension, chronic meningitis, hydrocephalus, drug intoxications, paranasal sinus disease, or acute febrile illnesses (eg, influenza). To determine the nature of a child's headache, the evaluation begins with a thorough medical history, followed by methodic physical examination with measurement of vital signs and complete neurologic examination. ⋯ Clues to the presence and identification of secondary causes of headache are uncovered through this systematic process of history and physical examination. The performance of ancillary diagnostic testing rests upon information or concerns revealed during the history and physical examination.