Current pain and headache reports
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Curr Pain Headache Rep · Apr 2007
ReviewCluster headache: a review of online resources for patients and clinicians.
Technology has revolutionized the ability of both patients and physicians to find and retrieve medical information. In particular, the Internet has become an increasingly important source of information for patients and physicians in all medical fields, including headache. Although these resources may be readily available, it is not certain that those who would benefit most from these websites are aware of their existence or how to differentiate if the website is reputable. This article briefly reviews how patients and physicians can differentiate which sites provide legitimate and reputable information and then focuses on where to find online information on cluster headache.
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Curr Pain Headache Rep · Apr 2007
ReviewThe relationship between cytokines and pain/depression: a review and current status.
Cytokines are small protein molecules secreted in response to immune stimuli. Recent research has outlined important roles for proinflammatory cytokines in the cascade of normal physiologic responses to environmental stresses, encompassing so-called sickness behavior that is thought to be an adaptive response to infection and other illnesses. ⋯ This article reviews evidence that may enhance our understanding of how pathologic symptoms, such as mood disorders and neuropathic pain, may emerge from proinflammatory cytokine activation. Possible conceptualizations of these illnesses and potential treatment implications are explored.
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Curr Pain Headache Rep · Apr 2007
ReviewIs there genetic polymorphism evidence for individual human sensitivity to opiates?
Opiate analgesics have been widely used for severe acute pain and chronic cancer-related pain. Individual differences in the effectiveness of opiates and their side effects limit the clinical benefits and increase risks of drug abuse. Genetic factors might affect variations of opiate sensitivity. ⋯ There are more than 100 polymorphisms identified in the human MOP (OPRM1) gene. These polymorphisms might be correlated with OPRM1 mRNA stability and opiate sensitivity, including opiate analgesia, tolerance, and dependence. More precise studies on the relationship between gene polymorphisms and opiate sensitivity will enable realization of personalized pain treatment by predicting opiate sensitivity and requirement for each patient.
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Curr Pain Headache Rep · Apr 2007
Case ReportsCluster headache treatment dilemmas: the experts respond.
When conventional treatment approaches to cluster headache are unsuccessful, expert recommendations are relevant but may not be easily accessible to treating clinicians. We conducted a study of expert recommendations in response to standardized vignettes. Ten expert headache clinicians were asked what treatment they would recommend for a hypothetical 55-year-old male cluster headache patient in the following five situations: 1) known coronary artery disease with response only to sumatriptan; 2) strictly unilateral headaches unresponsive to preventive treatment; 3) effective abortive treatment not covered by insurance; 4) patient request to obtain methysergide from Canada; and 5) headaches responsive only to steroid treatment.
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Curr Pain Headache Rep · Feb 2007
ReviewIs Chiari type I malformation a reason for chronic daily headache.
This article briefly reviews the spectrum of headaches associated with Chiari type I malformation and specifically analyzes current data on the possibility of this malformation as an etiology for some cases of chronic daily headache (CDH). Chiari type I malformation is definitely associated with cough headache and not with primary episodic headaches, with the rare exception of basilar migraine-like cases. ⋯ An MRI study would be justified only in patients showing either a Valsalva-aggravating component or cervicogenic features. Hydrocephalus and low intracranial pressure syndrome should be ruled out in patients showing tonsillar herniation in an MRI study and consulting due to daily headache.