Current pain and headache reports
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Curr Pain Headache Rep · Jun 2008
ReviewMigraine prevention trials and optimized acute therapy: translating lessons learned into clinical practice.
Different classes of drugs, discovered by serendipity, have been used successfully for migraine prevention for more than 40 years. The progressive knowledge of migraine pathophysiology, brain hyperexcitability, and the specific neurotransmitter systems involved in pain perception has driven the attempts at targeting two crucial mechanisms: the restoration of nociceptive dysmodulation and the inhibition of cortical hyperexcitability. ⋯ With the clinical application of this updated information from clinical trials, migraine impact on productivity, quality of life, and suffering will certainly be diminished. We hope that these achievements will create a stable path of management to benefit our patients, without interruption, into the foreseeable future.
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Curr Pain Headache Rep · Jun 2008
ReviewOptimizing circadian cycles and behavioral insomnia treatment in migraine.
Sleep regulation may play a key role in headache management for individuals with migraine. At least among individuals with a predisposition to headache, episodes may be provoked by sleep deprivation or excess, as well as by sleep disorders. Chronobiological patterns have been identified in some forms of headache, including migraine. ⋯ Because sleep represents a potentially modifiable vulnerability to headache, practitioners may wish to consider strategies that restore sleep homeostasis. Behavioral strategies are effective for regulation of sleep and may be abbreviated for headache medical practice settings. This article discusses the nature and prevalence of sleep complaints in migraineurs, conceptualization, and behavioral management of insomnia in the headache practice setting.
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Peripheral neuropathies of identical etiology can be painful or painless. The reason for this difference in clinical presentation is as yet unknown; however, immune mediators, particularly cytokines, may play a role. Cytokines are proteins that are produced by immune and nonimmune cells and are categorized as pro- and anti-inflammatory. ⋯ A proinflammatory cytokine profile seems to be associated with pain in peripheral neuropathies of different etiologies and in other painful disorders such as the complex regional pain syndrome. Specifically, an imbalance between pro- and anti-inflammatory cytokines may contribute to pain generation. A better understanding of the underlying pathophysiology may open new opportunities for the treatment of pain.
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Curr Pain Headache Rep · Apr 2008
ReviewDoes direct-to-consumer advertising affect patients' choice of pain medications?
In the United States, direct-to-consumer advertising (DTCA) has grown rapidly to promote prescription medications, including analgesics. Few studies in the literature directly examine the association between DTCA and patients' choice of pain medications. This article discusses how DTCA affects such choice from a behavioral perspective, because DTCA-prompted behaviors are important indicators of DTCA's influence. ⋯ Patients who suffer from pain may seek more communication with their health care providers because they are cautious about the information quality of DTCA, mainly because of the recall of rofecoxib (Vioxx; Merck, Whitehouse Station, NJ). However, the availability and DTCA of over-the-counter analgesics complicate their treatment choice. Patients could use DTCA as a tool to launch health communication and make an informed treatment choice with the guidance of their health care providers.
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About 1% of all chronic cluster headache patients become intractable (iCCH; ie, they are refractory to adequate regimens of all established preventive drugs). Various lesional interventions have been attempted in these patients, none with lasting benefits. In recent years, nondestructive neurostimulation methods have raised new hope. ⋯ At this stage, it should be the preferred first-line invasive therapy for iCCH. Recent case reports mention efficacy of supraorbital and vagus nerve stimulation. Whether these neurostimulation methods have a place in the management of iCCH patients remains to be determined.