Current pain and headache reports
-
Misdiagnosis of cluster headache is common in clinical practice and can lead to significant morbidity. The International Headache Society has published diagnostic criteria that are generally straightforward and useful, but careful understanding of these criteria and how to handle exceptions is necessary. The primary diagnostic points involve severity, length, and frequency of individual headache attacks, as well as the presence of ipsilateral autonomic features. Such additional features as time cycling of headache clusters, physical characteristics of patients, and response to treatment may prove useful in individual cases, but must not be relied on too much.
-
Curr Pain Headache Rep · Feb 2002
ReviewThe significance of the concept of obsessive-compulsive spectrum disorder to the treatment of chronic nonmalignant pain.
The concept of an obsessive-compulsive spectrum of disorders has become useful. This article reviews what has been learned about these conditions (especially in the last few years), and how this information may be helpful to clinicians and researchers who work with patients with chronic nonmalignant pain.
-
Curr Pain Headache Rep · Feb 2002
ReviewInterventional treatment for cluster headache: a review of the options.
There is no more severe pain than that sustained by a cluster headache sufferer. Surgical treatment of cluster headache should only be considered after a patient has exhausted all medical options or when a patient's medical history precludes the use of typical cluster abortive and preventive medications. ⋯ To understand the rationale behind the surgical treatment strategies for cluster, one must have a general understanding of the anatomy of cluster pathogenesis. The most frequently used surgical techniques for cluster are directed toward the sensory trigeminal nerve and the cranial parasympathetic system.
-
With an increased knowledge of neural anatomy and technologic improvement, radiofrequency ablation (RFA) became an often-used technique for the pain control over an extended time period. Today, RFA is used safely for spinal pains of facet or discogenic origin, sympathetically maintained pain, and other pains of neural origin.
-
Daily or near-daily headache is a widespread problem in clinical practice. The general term of chronic daily headache (CDH) encompasses those primary headaches presenting more than 15 days per month and lasting more than 4 hours per day. CDH includes transformed migraine (TM), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). ⋯ Regarding the prevalence of CDH subtypes, NDPH is rare (0.1%), whereas the prevalence of TM (1.5% to 2%) and CTTH (2.5% to 3%) is clearly higher. In contrast to data from specialized clinics, only around a quarter of CDH subjects in the general population overuse analgesics; the prevalence of CDH subjects with analgesic overuse being 1.1% to 1.9% of the general population. Most of these patients with analgesic overuse are TM patients.