Current pain and headache reports
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Curr Pain Headache Rep · Apr 2002
ReviewTrigeminal neuralgia and other neuropathic pain syndromes of the head and face.
Trigeminal neuralgia is the most common craniofacial pain syndrome of neuropathic origin. Although the diagnosis remains based exclusively on history and symptomatology, modern diagnostic techniques, particularly high-resolution magnetic resonance imaging, provides valuable new insight into the pathophysiology of these cases with additional implications for therapeutic strategies. ⋯ Rarely, neuralgias of other cranial nerves mimic trigeminal neuralgia. Finally, it is imperative to distinguish atypical facial pains from these neuropathic syndromes to avoid unsuccessful therapies.
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Butalbital compounds are of proven efficacy in the treatment of tension headache. Decades of experience have established their value in the treatment of other mild-to-moderate headaches. ⋯ The medications are cost-effective with only occasional and minor immediate adverse effects. Their overuse may cause the evolution of episodic primary headaches to chronic daily headaches; however, removal of these agents from the market would reduce the chronic daily headache in the general population by a small fraction of 1%.
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Curr Pain Headache Rep · Apr 2002
Do over-the-counter medications for migraine hinder the physician?
The availability of many over-the-counter drugs that were formerly prescription medications enable patients with migraine to self-medicate easily and delay entry into the appropriate medical management. The potential for adverse effects, drug interactions, and analgesic rebound headaches can often be complications that hinder treatment. Over-the-counter products force the patient to employ a less effective step-care approach as opposed to evidence-based guidelines.
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Curr Pain Headache Rep · Feb 2002
ReviewElectroconvulsive therapy in the management of chronic pain.
Electroconvulsive therapy (ECT) is used predominantly to treat major depressive illness but has also been used for chronic pain. ECT causes a variety of neurochemical and neurophysiologic effects, some of which may interact with the pathophysiologic mechanisms in complex pain states. An extensive literature on the use of ECT in pain patients identifies subgroups for whom ECT may result in substantial pain relief. In this article, we review the literature on the use of ECT in pain patients, suggest possible neurobiologic bases for the efficacy of ECT in such patients, and conclude with our recommendations for current clinical practice.
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Curr Pain Headache Rep · Feb 2002
ReviewWhat predicts evolution from episodic to chronic cluster headache?
Over the last few years, attention has increasingly been focused on the evolution of cluster headache over time. Predictive factors have been identified that are correlated with an increased risk of unfavorable evolution from the episodic form to the chronic form of cluster headache. Late onset, the presence of sporadic attacks, a high frequency of cluster periods, and short-lived duration of remission periods when the headache is still in its episodic form all correlate with a possible worsening of the clinical picture over time. The reasons for evolution of episodic cluster headache to chronic are still unknown, but some factors, such as head trauma and other lifestyle factors--eg, cigarette smoking and alcohol intake--have been suggested as having a negative influence on the course of cluster headache over time.