Current pain and headache reports
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Cervical whiplash injuries are common and yet poorly understood. Several of these cases become chronic for unknown reasons and defy most forms of musculoskeletal therapy. Botulinum toxin has shown promise in selected cases in which soft tissue injury predominates. In conjunction with a good biomechanical assessment and appropriate physical rehabilitation techniques, this new approach to treatment may offer a way of treating the central and peripheral dysfunction that characterizes this condition.
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Fibromyalgia is a common disorder of diffuse musculoskeletal pain. Several rheumatic diseases can mimic fibromyalgia, and a clinician would not want to miss these diagnoses because of their potential long-term sequelae, such as progressive joint damage or life- or organ-threatening disease if they remain untreated. This paper discusses the typical clinical presentations of selected rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica, and osteoarthritis) then highlights the key features in history, laboratory testing, and radiographic imaging that aid the clinician in differentiating between fibromyalgia and these rheumatic diseases.
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Nonsteroidal anti-inflammatory drugs are the mainstay of migraine treatment for children and adolescents by most primary care physicians. Not all patients respond to these readily available agents. Triptans have been studied in children and adolescents, and there is reasonable evidence to support the use of these agents in these populations. ⋯ Agents such as antidepressants, anticonvulsants, and antihypertensives are commonly used in clinical practice. Safety issues are fairly well understood because of historical use and use for other conditions. Efficacy and optimal dosing have yet to be established for the treatment of migraine in children and adolescents in double-blind, randomized, placebo-controlled trials.
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In this article, we develop an approach to the headache patient based upon pattern of headache. Headache can be acute recurrent, acute, chronic progressive, and chronic nonprogressive. Within each pattern we go through the differential diagnosis, with a focus on secondary causes of headache. Although most patients presenting with headache will end up having migraine, we must be able to recognize the other causes when they present.
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Post-traumatic headache after craniocerebral trauma is not an uncommon occurrence in children and adolescents. It can occur after mild, moderate, or severe injury. ⋯ In time, the headache and accompanying symptoms gradually resolve over a period of 8 to 12 weeks. However, sometimes it may become chronic, requiring a multidimensional management approach including pharmacologic intervention, physical rehabilitation, and cognitive-behavioral therapy as used in the adult population.