Current pain and headache reports
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The purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis. ⋯ The mainstays of endometriosis advances of both surgical and medical management continue to evolve. Experimental pharmaceuticals include Gestirone, and aromatase inhibitors have shown promise but are still under scrutiny. Surgical techniques include laparoscopic uterosacral nerve ablation/resection and presacral neurectomy. No studies have directly compared medical versus surgical management, and as such, no one treatment modality can be recommend as superior to the other. Patients may initially be given a medical diagnosis and treated with nonsteroidal anti-inflammatory drugs, neurolepitcs, OCP, GNRH agonists/antagonists, and Danazol. Assessing the success of these regimens has proved difficult. Surgical management relies on various methods including excision/ablation of the lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy.
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Curr Pain Headache Rep · Jul 2020
ReviewPediatric Migraine Phenomena and Variants: Don't Let Them Go Over Your Head.
Primary care providers, general pediatric neurologists, and other related subspecialty providers require a clear understanding of pediatric migraine with typical aura and its variants. ⋯ We highlight some of the genetic mutations known to contribute to specific types of migraine with aura, discuss the ophthalmologic phenomena of migraine and call attention to some of the earliest manifestations of migraine in children, many of which have correlates in adulthood. While the majority of headaches in children are migraine with or without aura or tension type, many migraine and aura variants exist. Early and accurate diagnosis of episodic syndromes associated with migraine, as defined by the 2018 ICHD-3 criteria, can help to reduce unnecessary imaging, referrals, cost and anxiety, thereby benefiting patients and their families.
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Curr Pain Headache Rep · Jul 2020
ReviewDiagnosis, Treatment, and Management of Dejerine-Roussy Syndrome: a Comprehensive Review.
Post-stroke pain represents a complex condition with few standardized diagnostic criteria. As such, the array of symptoms is often difficult to categorize and diagnose. Central post-stroke pain (CPSP), also known as Dejerine-Roussy syndrome, presents as painful paresthesia in any part of the body that is usually coupled with sensory abnormalities. ⋯ In patients who had experienced a cerebrovascular accident, CPSP typically affects the same areas of the body that are also impacted by the general motor and sensory deficits that result from stroke. Though it is generally debated, CPSP is thought to result from a lesion in any part of the central nervous system. Pain usually presents in the range of 3-6 months after the occurrence of stroke, manifesting contralaterally to the lesion, and most commonly involving the upper extremities. For the most accurate diagnosis of CPSP, a thorough history and clinical examination should be supplemented with imaging. Infarcted areas of the brain can be visualized using either CT or MRI. First-line treatment of CPSP is pharmacologic and consists of a three-drug regimen. Despite this, CPSP is often refractory to medical management producing only modest pain reduction in a limited subset of patients. Adverse effects associated with pharmacologic management of CPSP and frequent recalcitrance to treatment have driven alternative minimally invasive methods of pain control which include transcranial stimulation, deep brain stimulation, and neuromodulation. The aim of this review is to provide a comprehensive update to recent advances in the understanding of the treatment and management of CPSP.
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In this review, we examine reported cases of cephalgia alopecia including the initial case report from 2006. The goal is to review the clinical description, pathophysiology, diagnosis, and treatment of cephalgia alopecia. ⋯ The pathophysiology of the headache and hair loss in cephalgia alopecia is believed to be related to neuroregulation of skin and nerve. It is hypothesized that the headache causes recurrent activation of trigeminal and upper cervical branches that innervate the hair cells. The repetitive activation of C fibers results in depletion of substance P and calcitonin gene-related peptide (CGRP), which leads to loss of hair growth promotion and disruption of immune system regulation. A case report suggests that cephalgia alopecia and nummular headache with trophic changes may represent a spectrum of disease involving head pain and cutaneous changes. Cephalgia alopecia is a rare headache disorder described as recurrent burning, stabbing head, and neck pain that is followed by hair loss in the corresponding region of the scalp. The mainstay treatment for both pain and hair loss is OnabotulinumtoxinA (onabotA). A patient's clinical history and response to onabotA treatment is used to make the diagnosis. Future research is needed to examine the hypothesized disease continuum of head pain and cutaneous changes. It will also be beneficial to assess if the grid-like onabotA technique used in nummular headache is effective in cephalgia alopecia. In addition, further studies are needed to assess the proposed pathophysiology.
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Our objective is to describe the various neurologic manifestations of Behcet's syndrome with special attention to headache syndromes. ⋯ Most recent studies have focused on data collection to better characterize the relatively rare disorder of neuro-Behcets (NBD). In patients with Behcet's disease (BD) who are experiencing headache, most are primary headache disorders, specifically tension type or migraines. Worsening headache can, however, be a sign of increased Behcets disease activity. Behcet's disease is a chronic, systemic, inflammatory disorder of unknown etiology. The prevalence of BD is most notable in countries along the ancient Silk Road, particularly the Middle East. BD occasionally has neurologic manifestations, further categorized into parenchymal and non-parenchymal syndromes. Headache is the most frequently reported neurological symptom of BD. Primary headaches are the most common headache type among patients with BD with comorbid headache disorders with debate regarding whether migraine or tension-type headache is most prevalent. Of the secondary causes of headache in BD, cerebral venous thrombosis is the most common.