Current pain and headache reports
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Curr Pain Headache Rep · Jun 2020
Review Retracted PublicationGut Microbiome Dysbiosis and Depression: a Comprehensive Review.
The human gut microbiome is involved in a bi-directional communication pathway with the central nervous system (CNS), termed the microbiota-gut-brain axis. The microbiota-gut-brain axis is believed to mediate or modulate various central processes through the vagus nerve. The microbiota-gut-brain axis is involved with the production of microbial metabolites and immune mediators which trigger changes in neurotransmission, neuroinflammation, and behavior. Little is understood about the utilization of microbiome manipulation to treat disease. ⋯ Though studies exploring the role of the microbiome in various disease processes have shown promise, mechanisms remain unclear and evidence-based treatments for most illnesses have not yet been developed. The animal studies reviewed in the present investigation include an array of basic science studies that clarify mechanisms by which the microbiome may affect mental health. More evidence is needed, particularly as it relates to translating this work to humans. The studies presented in this review demonstrate encouraging results in the treatment of depression. Limitations include small sample sizes and heterogeneous methodology. The exact mechanism by which the gut microbiota causes or alters neuropsychiatric disease states is not fully understood. In this review, we focus on recent studies investigating the relationship between gut microbiome dysbiosis and the pathogenesis of depression.
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Curr Pain Headache Rep · May 2020
ReviewHeadache in the Older Population: Causes, Diagnoses, and Treatments.
Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients. ⋯ Diagnosis and management of headaches in those > 65 years are discussed. Migraine and tension-type headaches are rarely new onset in this age group and should be a diagnosis of exclusion. In older individuals, migraine is more likely to be bilateral with less sensory sensitivities. Migraine aura may present without headache; careful assessment is needed to exclude stroke. Other primary headaches discussed include cough, hypnic, and other headaches. Secondary causes discussed include giant cell arteritis, trigeminal post-herpetic neuropathy, sleep apnea, cardiac cephalgia, cervicogenic pain, vascular etiologies, medications, and burning-mouth syndrome. In older individuals, primary headaches are diagnoses of exclusion, and treatment is affected by comorbidities and polypharmacy. Secondary headaches are a major consideration requiring appropriate workup. Many treatments can safely be offered regardless of age.
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Intracranial dermoid cysts are benign, rare mass-occupying lesions of the central nervous system arising from the neuroectodermal cell lines. While rupture of intracranial dermoid cysts is rare, it can present with a variety of clinical manifestations. To explore the headache manifestations among patients with ruptured intracranial dermoid cysts. To our knowledge, limited studies focusing on headache due to the intracranial dermoid cysts rupture have been published to date. A literature review was done through PubMed/Medline. Articles within the past 10 years were reviewed. Articles in languages other than English were excluded. ⋯ Rupture of intracranial dermoid cysts could have various manifestations including headache, seizure, and meningitis. Depending on the location of the cyst, headache secondary to the rupture of the intracranial dermoid cysts could present in different ways. A detailed systematic literature review of headache presentations due to intracranial dermoid cysts rupture is provided.
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The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. ⋯ Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.
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Curr Pain Headache Rep · May 2020
ReviewAcupuncture for Migraine: a Review of the Data and Clinical Insights.
The purpose of this review is to discuss the current evidence for acupuncture in migraine and to provide insight into which patients may benefit most from acupuncture. ⋯ Multiple studies support acupuncture as a validated modality for the prevention of episodic migraine. While small studies on acupuncture for the prevention of chronic migraine are encouraging, evidence for its benefit is limited. Likewise, the existing studies on acupuncture for acute migraine treatment are insufficient. Acupuncture is commonly used to treat migraine and has gained popularity as a validated non-pharmaceutical option. Although the specific mechanisms of acupuncture are not clearly understood, there is evidence for its effectiveness in treating migraine. Results of acupuncture studies are quite variable and depend on multiple factors, including frequency, duration, and consistency of treatments, as well as acupoint selection. A better understanding of the flaws inherent in acupuncture research will help guide the development of future studies.