The Clinical journal of pain
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An inpatient headache treatment unit provides a special environment for those patients whose headaches have failed to respond to outpatient therapy. Outpatient therapy may be precluded for a variety of treatment issues, including detoxification, initiation of copharmacy prophylactic medical therapy, and intravenous treatment for intractable chronic cluster headache and status migrainous headache. These complex medical treatments are viewed as some of the most valuable therapies by the patients and, at least in part, significantly decrease both headache indexes utilized in this survey. ⋯ Treatment failures may be due to variations in the etiology of chronic muscle contraction headache and posttraumatic headache. Denial of psychological factors in headache may also contribute to treatment failure. Habituation to analgesics and ergots may decrease patient response as compared with those not dependent.
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A number of classifications of headache have appeared in medical and professional journals. In addition to these formal diagnostic classifications, a number of articles have addressed the relationship of sexual functioning to headache etiology, course, and prevalence. To this end, many headache specialists have developed a classification for what are termed "sexual headaches." To date, these sexual headaches have been limited to migraine and muscle contraction (tension) headache patterns. We present, for the first time, two case studies documenting the role of sexual activity in both etiology and course of cluster headache.
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Tyramine sulfoconjugation following an oral tyramine load was determined in 30 patients suffering from migraine and 14 controls not regularly suffering from headache. Reduced tyramine sulfoconjugation was found in those patients with a history of major depressive disorder compared with controls. When the patients with a history of major depression were removed from the analysis, no differences were found between diet-sensitive and non-diet sensitive migraine patients and controls.