Current pain and headache reports
-
Voluntary muscle is the largest human organ system. The musculotendinous contractual unit sustains posture against gravity and movement against inertia. However, when exposed to single or recurrent episodes of biomechanical overloading, muscle injury may occur. ⋯ Techniques for evaluation of the muscular components of a pain syndrome involve palpation, strength testing, range of motion, and assessment of muscle endplay. Management of acute injuries may necessitate imaging and surgery consultation for lacerations or hemorrhage. Treatment of acute syndromes consists of cryotherapy and reduced activity, whereas chronic syndromes may require multiple therapeutic approaches, applied together or sequentially.
-
Tension-type headache (TTH) is the most prevalent form of headache. Although it is not the most severe form of headache, it has a significant impact on society. In spite of this, little is known about its pathophysiology. ⋯ Whether there is an overlap in the continuum between TTH and migraine is controversial. Abortive and prophylactic treatments are discussed and wellness and adjunct therapy are also emphasized. Lastly, special attention is paid to the doctor-patient relationship in patients with difficult headaches.
-
Curr Pain Headache Rep · Oct 2001
ReviewClassification, epidemiology, and natural history of myofascial pain syndrome.
Myofascial pain syndrome is a disease of muscle that produces local and referred pain. It is characterized by a motor abnormality (a taut or hard band within the muscle) and by sensory abnormalities (tenderness and referred pain). ⋯ When it becomes chronic, it tends to generalize, but it does not change to fibromyalgia. It is a treatable condition that can respond well to manual and injection techniques, but requires attention to postural, ergonomic, and structural factors, and toxic or metabolic factors that impair muscle function.
-
This article discusses the neurophysiology of myofascial pain syndrome. The local twitch response is a characteristic finding of this condition; it is activated by snapping palpation, pressure, or needle insertion at the trigger point. It is manifested by a burst of activity in the muscle band that contains the activated trigger point. ⋯ While this theory may explain the effects of alpha-adrenergic antagonists at the trigger point, it does not fully explain the electromyographic (EMG) findings recorded at the trigger point. The second theory is that trigger points represent hyperactive end-plate regions, as the EMG activity recorded at trigger points resembles that described at the end-plate region. Other theories that either deny the existence of myofascial pain syndrome or believe it represents a focal dystonia are also discussed.
-
For years clinicians and researchers have debated the nosology of headache generally and of "migraine" versus "tension-type headache" in particular, an exhaustive process that arguably has done little to improve patient management and clinical outcome. New research data now indicate that the migraine versus tension-type distinction indeed may possess some clinical use, because patients with migraine or "mixed" headache syndromes may respond differently to a specific therapeutic intervention than patients with "pure" tension-type headache. This variable response to treatment intervention would seem to imply that similarly distinctive biologies are generating the respective headache syndromes, but to date we have insufficient evidence to support that conclusion.