Current pain and headache reports
-
Curr Pain Headache Rep · Oct 2007
ReviewSensitization, glutamate, and the link between migraine and fibromyalgia.
Recent advances have shed insight on the pathophysiologic mechanisms of fibromyalgia and migraine, especially in the chronic form. A growing body of evidence supports the involvement of peripheral and central sensitization disturbances of pain-related processes underlying both disorders. ⋯ These findings have implications for future therapies directed against glutamate receptors (in particular, N-methyl-D-aspartate receptors). Limited clinical experience in this regard, although promising, does not exclude additional mechanisms contributing to the maintenance of pain, which can be the target of therapeutic approaches in both disorders.
-
Curr Pain Headache Rep · Oct 2007
ReviewThe role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck.
Neck and head pain syndromes are common problems seen in clinical practice. Pain features of commonly designated idiopathic neck pain and some primary headaches (ie, tension-type headache or migraine) fit the descriptions of referred pain originating in muscle trigger points (TrPs). This article discusses the scientific evidence supporting the role of muscle TrPs in chronic musculo-skeletal disorders of the neck and head. ⋯ Referred pain elicited by active TrPs mimics the pain areas observed during head pain attacks in these primary headaches. Based on available data, it seems that the pain profile of neck and head syndromes may be provoked referred pain from TrPs in the posterior cervical, head, and shoulder muscles. Additional studies are needed to delineate more information on the relation between muscle TrPs and musculoskeletal pain syndromes of the head and neck.
-
Migraine headache occurs frequently in children and adolescents but is often not recognized. This underdiagnosis or misdiagnosis results in inappropriate and potentially ineffective treatments. ⋯ The standardized criteria that have been developed to assist with the recognition and accurate diagnoses have recently been revised (the International Classification of Headache Disorders II). These criteria provide the scientific basis for the study of headache, including the determination of the incidence and prevalence of pediatric migraine.
-
Post-traumatic headaches as well as post-traumatic syndrome can occur in patients after mild, moderate, or severe traumatic brain injury. Most of the patients' symptoms clear within the first 3 to 6 months; however, there are no precise criteria for predicting the clinical outcome. The diagnostic criteria for post-traumatic headaches were defined by the International Headache Society in 2004 and are helpful for classification. ⋯ There is a small group of people who do not respond and have long-term problems. These patients may benefit from a combination of pharmacologic, nonpharmacologic, and neuropsychiatric treatment. Long-term studies are needed to help clarify the history of these patients.
-
Curr Pain Headache Rep · Oct 2007
ReviewMyofascial dysfunction associated with chronic pelvic floor pain: management strategies.
Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature. Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral management, medications, physical therapy, trigger point injections, neuromodulation, botulinum toxin injection, and other lesser known treatment modalities, are discussed in detail in this article.