Headache
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Neurostimulation as a treatment option for refractory neuropsychiatric disorders has been increasingly utilized in recent years. For patients with such refractory disorders who have often failed to respond to various medical interventions, deep brain stimulation (DBS) has emerged as a promising treatment modality. DBS is a reversible and adjustable form of brain stimulation (also known as functional neurosurgery) in which desired brain structures (or circuits) are given focal electric stimulation via electrodes that are implanted in the brain tissue during a surgical procedure. It has been utilized among various psychiatric and neurological illnesses, in particular headache disorders. This article reviews the most relevant data regarding DBS for psychiatric and primary headache disorders. ⋯ Current data support DBS as a promising treatment option for neuropsychiatric disorders that do not respond to conventional treatments; however, it is clear that more research and patient volume is needed to demonstrate its efficacy in treating these conditions. The use of functional imaging to understand the pathophysiology of these disorders has been crucial for the utilization of DBS.
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To describe patterns of psychosocial adjustment and psychological attributes in preadolescent children as a function of headache status in univariate and adjusted analyses. ⋯ Children with migraine are at an increased risk of having impairment in psychosocial adjustment, and the factors associated with this impairment have been mapped. Future studies should address the directionality of the association and putative mechanisms to explain it.
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Lacrimal neuralgia has only recently been described in 3 cases. None of them had an underlying lesion or any precipitating event, so they were considered primary. Here, we report a symptomatic case due to surgical trauma. ⋯ Lacrimal neuralgia may be due to local trauma. This new case not only reinforces the existence of a specific neuralgia of the lacrimal nerve, but also introduces a classification into primary and secondary forms based on the etiology.
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In patients with episodic migraine (EM), diffusion tensor imaging (DTI) revealed microstructural white matter alterations in various brain regions related to pain processing. Some of these changes were correlated with migraine duration and attack frequency, suggesting that migraine is a progressive disease with proceeding structural alterations of the brain. This study aimed to identify possible microstructural white matter alterations in patients with chronic migraine (CM) using DTI. We hypothesized that alterations in DTI are more pronounced in patients with CM compared with EM. ⋯ No microstructural white matter changes could be observed in middle-aged chronic and episodic migraineurs using DTI. CM does not seem to be a risk factor for progressive microstructural changes in DTI.
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Despite limited evidence from the literature surrounding safety or efficacy, butalbital-containing medicines (BCMs) have maintained their rank as "go-to" prescribed migraine and headache relief drugs in the United States, despite bans on these barbiturates in Germany and other European countries. Providers at the Pediatric Headache Program at Boston Children's Hospital recommend that clinicians prescribe triptan-based medications instead of BCMs, given the known negative side effects of BCMs on the general population, and the uncertain longitudinal trajectory of BCMs on developing brains.