Current pain and headache reports
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The therapy for tension-type headache remains insufficient, and recent advances have been scarce. Although tricyclic antidepressants are at the forefront of treatment advances, upcoming agents tentatively modifying central sensitization are promising. ⋯ This article reviews current treatments, emphasizing newer approaches. Much remains to be achieved.
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Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated in clinical practice. The similarities and differences between migraine and TTH may impose diagnostic challenges as well as management difficulties. ⋯ The continuum concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology, pathophysiology, and management of these two most prevalent headaches.
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Pathologies currently defined as temporomandibular disorders may be different in nature. Temporomandibular joint (TMJ) disorders and craniofacial and cervical myogenous pain (MP) are distinct pathologies but may be superimposed and share some etiologic factors. ⋯ Psychiatric comorbidity (depression and/or anxiety disorder) is less frequent in sheer TMJ disorders, compared with MP and TTH. A screening for the presence of an underlying psychiatric disorder should be part of the clinical evaluation in patients suffering from headache and facial pain.
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Chronic neck pain is a common patient complaint. Despite its frequency as a clinical problem, there are few evidence-based studies that document efficacy of therapies for neck pain. The treatment of this symptom is based primarily on clinical experience. ⋯ Local injections of anesthetics with or without soluble corticosteroid preparations offer additional pain relief. The purpose of these agents is to diminish pain to facilitate normal neck movement. Surgical therapy with cervical spine fusion is indicated for the rare patient with intractable neck pain resistant to all nonsurgical therapies.
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The association between tension-type headache and cognitive ability was assessed among 971 members of a longitudinal birth cohort study. Primary headache status was determined at age 32 years according to 2004 International Headache Society criteria, frequent childhood headaches were identified from parent report from ages 7 to 13 years, and data relating to cognitive and academic performance from ages 3 to 32 years were analyzed. ⋯ Instead, a consistent relation was found between childhood headache (regardless of headache diagnosis in adulthood) and lower scores on most cognitive measures from age 3 years through adolescence (verbal and performance IQ, receptive language, and reading scores). The data indicate that cognitive performance deficits in childhood headache sufferers can probably be attributed to factors stemming from utero or early childhood.