Expert review of neurotherapeutics
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Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. ⋯ Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache.
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Expert Rev Neurother · Mar 2012
ReviewPrevalence, clinical features and potential therapies for fibromyalgia in primary headaches.
Fibromyalgia (FM) syndrome is predominantly related to generation and persistence of central sensitization, which is an aggravating factor for chronic headaches. This review aims to examine the last 11 years of studies on FM and primary headache comorbidity, focusing on prevalence, clinical features and treatments. ⋯ The effects of headache-preventive drugs on factors favoring FM comorbidity were poorly evaluated. Nonpharmacological approaches such as transcranial magnetic stimulation may be an option for treatment of chronic migraine associated with FM.
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Expert Rev Neurother · Feb 2012
Randomized Controlled Trial Multicenter StudyEfficacy and tolerability of combined dipyrone, isometheptene and caffeine in the treatment of mild-to-moderate primary headache episodes.
The efficacy and tolerability of a combination of dipyrone 600 mg, isometheptene 60 mg and caffeine 60 mg for the acute treatment of mild-to-moderate episodic primary headaches were evaluated against paracetamol 1000 mg and placebo. A total of 84 adult patients with two to six primary headache episodes (mild or moderate severity) per month were enrolled in this prospective, multicenter, randomized, two-period crossover study. Patients had a mean of 4.4 headache episodes/month (mean duration: 13 h; mean severity: 50.5 mm; assessed by visual analog scale (VAS). ⋯ Fewer patients required rescue medication after receiving combination therapy (18.4%), compared with paracetamol (37.7%; p = 0.008) or placebo (43.8%; p = 0.0007). Adverse events were infrequent and mild. We conclude that, despite failing to meet the primary outcome, the combination of dipyrone, isometheptene and caffeine is effective for the acute treatment of mild-to-moderate primary headache episodes, with excellent tolerability.
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Expert Rev Neurother · Feb 2012
ReviewConstraint-induced movement therapy: from history to plasticity.
Constraint-induced movement therapy (CIMT) is a rehabilitative strategy applied primarily to the post-stroke population to increase the functional use of the neurologically weaker upper extremity through massed practice, while restraining the lesser involved upper extremity. Although recent Cochrane reviews have reported success with CIMT, this therapeutic technique is difficult to deliver because it requires proper allocation of resources by both clinicians and patients. ⋯ Therefore, understanding the possible neuropredictors of recovery can help target the appropriate populations. This special report briefly presents the history of CIMT and its underpinnings in the psychology literature; however, the focus is on brain plasticity with an emphasis on the importance of the type and location of stroke and how this factor might influence outcomes following CIMT.
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Expert Rev Neurother · Feb 2012
Current acute stroke trials and their potential impact on the therapeutic time window.
Several trials in acute stroke are underway or have been completed recently. Among the latter, ECASS 3 was a milestone regarding the extension of the rigid 3-h time window out to 4.5 h for intravenous thrombolysis with recombinant tissue plasminogen activator. ⋯ Other pharmaceutical strategies include neuroprotection, and restoration, biophysical approaches, such as near infrared laser therapy, hemodynamic augmentation, and sphenopalatine ganglion stimulation. This perspective will cover the recently completed and currently recruiting acute stroke trials with respect to their potential role in expanding the therapeutic time window for acute ischemic stroke.