Current pain and headache reports
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Serotonin (5-hydroxtryptamine, 5-HT) is an important molecule in pain processing and modulation. Whether 5-HT has an analgesic or hyperalgesic action depends on the cell type and type of receptor it acts on. ⋯ Furthermore, genetic alterations in the 5-HT system may influence the susceptibility to migraine. In the central nervous system, 5-HT is involved in descending inhibition, but facilitatory serotonergic pathways may be functionally more important.
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For decades, glucocorticoid therapy has been a well-recognized abortive treatment for cluster headaches. However, the role of steroid hormones, including both glucocorticoids and sex steroids, in the pathophysiology and therapy of cluster headaches has been a topic of much debate and speculation. Current research now points to the importance of cortisol and testosterone in the pathogenesis of cluster headaches, and they appear to be linked mechanistically to another hormone, melatonin. ⋯ Accumulated evidence suggests sympathetic dysfunction--embodied in the Horner sign so commonly seen in the cluster headache--as a necessary ingredient in the inception of the cluster headache. Sympathetic dysfunction now is thought to be associated with the hypercortisolism, hypotestosteronism, and lower-than-normal melatonin levels in the active cluster patient. Future research may hold the key to a fuller explanation of the complex interaction of hormonal systems in the cluster headache.
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Post-traumatic cluster headache (CH) is a very rare occurrence. Only one such case has been verified in the literature thus far. ⋯ Head trauma may damage extra- or intracranial peripheral or central nervous structures, hence predisposing to the future development of CH. However, there also is the possibility that previous head injuries may be more frequent among CH patients because of their lifestyle, which may leave them more exposed to the risk of traumatic events.
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Cluster headache is a rare but debilitating recurrent headache disorder. It is most common in middle-aged and older men, a group with a high prevalence of cardiovascular disease. This article reviews available information regarding the association of cluster headache and the heart in three selected areas: 1) the known effects of cluster headache on cardiovascular parameters such as heart rate and rhythm and blood pressure; 2) the prevalence of cardiac risk factors in subjects with cluster headache; and 3) the connection between patent foramen ovale and cluster headache. ⋯ There also is evidence that disturbances of autonomic function or certain structural cardiac anomalies may be more common in cluster headache sufferers. In addition, a number of important treatment options for cluster headache have effects on cardiovascular function that must be considered in planning therapy. The implications of these findings for clinical practice are discussed.
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Opioid analgesics are effective for treating many pain conditions. Opioid analgesic tolerance is a pharmacologic phenomenon that could affect the clinical use of opioid analgesics. ⋯ Thus, exposure to opioids could lead to two seemingly unrelated cellular processes (ie, the development of opioid tolerance and opioid-induced pain sensitivity). Their converging effects may be part of the mechanisms leading to the reduced opioid analgesic efficacy in chronic opioid therapy.