Current pain and headache reports
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The connection between headache and the cervical spine has been a theme of debate for decades. Cervicogenic headache is a headache related to the cervical spine that often is misdiagnosed and treated inadequately because of confusing and varying terminology. In this article, we discuss our experience in diagnosing and treating cervicogenic headache.
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Curr Pain Headache Rep · Aug 2006
ReviewMigraine and intranasal contact point headache: is there any connection?
It has been suggested that contact point can trigger headache in individuals with migraine. In this article, we review the anatomy of the sinonasal cavity. ⋯ We close by presenting our personal casuistic in the surgical treatment of patients with contact point and refractory headaches. In migraineurs with contact point, surgery may improve the headaches.
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The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. ⋯ A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.
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Curr Pain Headache Rep · Jun 2006
ReviewUpdate on pharmacotherapy guidelines for the treatment of neuropathic pain.
Neuropathic pain is a common problem in our society affecting nearly 1.5% of the US population. There currently are five medications approved by the US Food and Drug Administration (FDA) for the treatment of neuropathic pain, which include gabapentin, pregabalin, duloxetine, 5% lidocaine patch, and carbamazepine. ⋯ All of these agents, both FDA-approved and off-label, have been recommended as first-line treatments for neuropathic pain. This article discusses these agents in detail as they relate to the treatment of neuropathic pain.
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Curr Pain Headache Rep · Jun 2006
ReviewDuloxetine for neuropathic pain based on recent clinical trials.
The treatment of neuropathic pain with antidepressants has a long history. Early studies were contradictory and were limited by small numbers of patients. ⋯ Recently, duloxetine, a dual-action reuptake inhibitor, has demonstrated significant efficacy in the management of diabetic peripheral neuropathic pain in three double-blind, placebo-controlled trials and was approved by the FDA for this indication. These studies are discussed in this article.