Current pain and headache reports
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Curr Pain Headache Rep · Dec 2003
ReviewCurrent and potential future drug therapies for tension-type headache.
Tension-type headache is a common primary headache with tremendous socioeconomic impact. Establishment of an accurate diagnosis is important before initiation of any pharmacologic therapy. Simple analgesics and nonsteroidal anti-inflammatory drugs are the mainstays of treatment of episodic tension-type headache. ⋯ Progress in basic neuroscience has emphasized the importance of nitric oxide inhibition and N-methyl-D-aspartate and alpha-amino-3-hydroxy-5-methylisoxasole-4-propionic acid receptor antagonism in the treatment of chronic pain. It has been demonstrated that inhibition of nitric oxide is effective in chronic tension-type headache. These interesting data indicate that more specific and effective treatment possibilities will emerge in the future.
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The aim of this review is to present research that has a bearing on the pathogenesis of hypersensitivity in muscle pain syndromes. Allodynia and hyperalgesia in these syndromes can be segmental or generalized and temporary or permanent. Hypersensitivity in muscle pain conditions in the clinic is best diagnosed by determining the pressure pain threshold. ⋯ Pathogenetic mechanisms for allodynia and hyperalgesia can be identified at several levels of the nociceptive system, from the nociceptors in the muscle to the cortex. Central sensitization of nociceptive neurons in the dorsal horn and a disturbed balance between inhibitory and facilitatory impulses in the descending tracts from the brain stem to the dorsal horn are the main mechanisms for pain hypersensitivity. Changes in function, biochemical make-up, and synaptic connections in the nociceptive neurons in the dorsal horn are considered to be caused by neuronal plasticity.
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Curr Pain Headache Rep · Dec 2003
ReviewDiagnosis, epidemiology, and impact of tension-type headache.
Although tension-type headache is the most prevalent headache and affects 78% of the general population, the substantial societal and individual burden associated with this primary headache has been overlooked. In contrast to migraine headache, there has been limited focus on tension-type headache. Most patients with the chronic form of tension-type headache, which affects 3% of the population, are left virtually without any specific treatment. ⋯ Daily or near daily headaches also constitute a major diagnostic and therapeutic problem and distinguishing chronic tension-type headache from migraine headache and from medication-induced headache is a substantial diagnostic challenge because management strategies are completely different. Considerable benefits for the society can be gained by specific strategies leading to reductions in the amount of sickness absence and impaired working abilities. The burden on the affected patients' and their families' quality of life also may be improved by a general acceptance of the disorder and by the development of a specific treatment strategy.
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Curr Pain Headache Rep · Dec 2003
ReviewCentral and peripheral sensitization in tension-type headache.
Recent studies on tension-type headache indicate that the nociceptive input to the central nervous system may be increased as a result of activation or sensitization of peripheral sensory afferents. Moreover, pain perception studies and pharmacologic studies strongly suggest that the central nervous system is sensitized in patients with chronic tension-type headache. ⋯ Studies have demonstrated that treatment with drugs that counteract sensitization has an analgesic effect on tension-type headache. Targeting this mode of action seems to be a promising way of improving the treatment for this prevalent disorder.
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Curr Pain Headache Rep · Dec 2003
ReviewInduction and assessment of muscle pain, referred pain, and muscular hyperalgesia.
Muscle pain can be induced and assessed experimentally by a variety of methods. Ischemic and exercise-induced muscle pain are typical endogenous pain models; external stimulation with mechanical, electrical, and chemical modalities constitute the exogenous models. These models are a good basis to study the muscle sensitivity, muscle pain responses under normal and pathophysiologic conditions, and drug efficacy on specific muscle pain mechanisms. ⋯ The experimental test paradigm must include different stimulation modalities (multimodal) to obtain sufficiently advanced and differentiated information about the human nociceptive system under normal and pathophysiologic conditions because the different stimuli activate different receptors, pathways, and mechanisms. This may be a useful approach in future mechanism-based classification and treatment of muscle pain. Similarly, the multimodal approach is important in clinical studies to provide evidence for which specific muscle pain modalities and mechanisms are affected and how they are modulated by pharmacologic approaches.