Current pain and headache reports
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Headache is a common presenting complaint in the pediatric emergency department. Although the majority of headaches are benign in nature, headache may be secondary to more serious pathology, such as tumor, meningitis, hemorrhage, or brain abscess. A systematic history will elicit the temporal pattern of the headache, guiding the development of an appropriate differential diagnosis. Thorough physical and neurologic examinations will disclose the objective signs that dictate the need for further diagnostic testing.
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Chronic daily headache (CDH) is increasingly recognized as a problem in pediatrics and tertiary pediatric headache care. It is estimated that up to 4% of the adult population has CDH. Many of these are chronic migraine (CM). ⋯ In children, most CDH appears to have migraine features, although it may not completely meet the ICHD-II criteria for migraine or CM. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the secondary headaches or headaches directly attributed to a secondary cause. Treatment and management involve a multidisciplinary approach, including acute therapy for when the headache severity increases (while avoiding medication overuse), preventative therapy to reduce the frequency and impact of the CDH, and biobehavioral therapy to assist with long-term outcome.
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Migraine in the pediatric population remains substantially underdiagnosed and undertreated. The recently revised International Classification of Headache Disorders is a step in the right direction to improve our diagnostic accuracy. This article reviews the practical diagnostic issues related to migraine in the pediatric population.
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Curr Pain Headache Rep · Oct 2006
ReviewPhysical therapy and other nonpharmacologic approaches to fibromyalgia management.
Fibromyalgia is a vague and changing syndrome that comprises many symptoms. Due to the confounding nature of fibromyalgia syndrome, there has been much debate about which interventions and therapies should be considered as viable treatment options. ⋯ Several studies have shown promise, with initial improvement in symptoms, but in many cases, these improvements were not lasting or the patients were then unable to continue/replicate the program on their own. In this article, some of the more recently published findings regarding the efficacy of exercise are explored, specifically physical therapy and other nonpharmacologic interventions, for managing fibromyalgia syndrome.
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Myofascial pain syndrome (MPS) is caused by myofascial trigger points (MTrPs) located within taut bands of skeletal muscle fibers. Treating the underlying etiologic lesion responsible for MTrP activation is the most important strategy in MPS therapy. If the underlying pathology is not given the appropriate treatment, the MTrP cannot be completely and permanently inactivated. ⋯ When treating the active MTrPs or their underlying pathology, conservative treatment should be given before aggressive therapy. Effective MTrP therapies include manual therapies, physical therapy modalities, dry needling, or MTrP injection. It is also important to eliminate any perpetuating factors and provide adequate education and home programs to patients so that recurrent or chronic pain can be avoided.