Current pain and headache reports
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Menstrual migraine is commonly encountered in women who are experiencing attacks of migraine without aura. It remains controversial whether attacks of menstrually associated migraine are more severe and have a longer duration than non-menstrually associated attacks. The pathogenesis of menstrual migraine is not understood completely, but it may be related to estrogen withdrawal or prostaglandin release. ⋯ They can be administered short-term during the perimenstrual time period or continuously throughout the menstrual cycle. Short-term prophylactics should be tried first because menstrual migraines generally last for 1 to 4 days only. Continuous prophylactics may be considered in those with attacks refractory to short-term therapies.
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Curr Pain Headache Rep · Jun 2004
ReviewPharmacokinetic studies in migraine: what questions should physicians ask?
Migraine is a benign self-limiting condition for which the objective of treatment is to maximize the patient's quality of life by reducing the frequency of attacks and attenuating the pain and suffering of an individual attack as quickly and safely as possible. Evaluating the efficacy of antimigraine treatments, particularly those for the management of the acute attack, is relatively easy because acute symptomatic benefit is the criterion of success. ⋯ Given that the clinical response to antimigraine therapies relatively is readily assessed by history, the role of more sophisticated investigations such as pharmacokinetic studies may not be immediately clear. This paper aims to provide clinicians with a guide to interpretation of such studies.
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Curr Pain Headache Rep · Jun 2004
ReviewAnti-inflammatory agents for the treatment of musculoskeletal pain and arthritis.
Pain produced by musculoskeletal disorders commonly misconceived as having mechanical etiology often is caused by inflammatory mechanisms. Simple analgesics (ie, those that lack anti-inflammatory action) often are used to treat musculoskeletal pain when an anti-inflammatory analgesic may be more effective for the painful condition. This review addresses the anti-inflammatory agents available for the symptomatic management of common inflammatory musculoskeletal conditions including osteoarthritis, rheumatoid arthritis, and low back pain.
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Curr Pain Headache Rep · Jun 2004
ReviewNew and emerging pharmacological targets for neuropathic pain.
Increasing knowledge of the molecular consequences of nerve injury and the availability of genome databases has greatly increased the range of potential targets for the pharmacological management of neuropathic pain. Controlling neuronal sensitization and the associated alterations in gene expression, protein modification, and neuronal excitability is the key to managing neuropathic pain. Control of neuronal sensitization can occur through inhibition of nerve injury-associated production of cytokines, activation of glial cells, modulation of potassium channel subtypes, mitogen-activated protein kinases, the ubiquitin-proteasome system, or the protection and amplification of spinal cord dorsal horn inhibitory systems. These new and already established targets promise unparalleled opportunities for the prevention, management, and resolution of persistent pain states following nerve injury.
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Hemiplegic migraine may be familial or sporadic. Both forms share a similar spectrum of clinical presentations and genetic heterogeneity. ⋯ Sporadic cases are more difficult to diagnose and often require several investigations to rule out more ominous possibilities. Therapeutic options are limited, but future genetic research may elucidate pathophysiologic mechanisms that may, in turn, yield more specific treatments.