The Clinical journal of pain
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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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Recent research advances indicate that specialized neural pathways are involved in the encoding of pain sensations and that these pathways are sensitive to changes in stimulus features, such as intensity, quality, duration, and location. It has also been established that there are three major families of opioid peptides in the brain: the enkephalins, the dynorphins, and the endorphins. In addition to these opioid peptides, other neurochemicals such as serotonin and norepinephrine play a role in the modulation of signals related to tissue damage. ⋯ Opioid drugs are administered into the membranes surrounding the spinal cord to provide long-lasting pain relief. Peripherally acting opioid drugs may represent a new functional class of analgesics devoid of the undesirable side effects of centrally acting opioids. Tricyclic antidepressant drugs are used in the treatment of neuropathic pain, based on their effects on noradrenergic and serotoninergic pathways in the central nervous system.
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A significant percentage of chronic headache sufferers use excessive quantities of substances for relief. Drug dependency is frequent in these patients. Patients have an impaired lifestyle, sustain organ system damage, may suffer a withdrawal syndrome, and continue to have headaches. ⋯ The mechanism of substance abuse may be related to repeated use of substances that reinforce behavior and stimulate brain reward systems. Treatment includes comprehensive diagnostic workup, withdrawal of the agent, and use of headache preventives. beta-Adrenergic blockers, tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and nonsteroidal anti-inflammatory agents may be of value. Behavior modification and dietary counseling are also helpful.
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Healing or successful intervention usually leads to the resolution of pain. However, in some patients biologic or psychologic symptoms associated with pain persist despite treatment or apparent healing. In cases in which the etiology is not known, persistent pain is categorized as a clinical syndrome known as "chronic pain." Organic, psychologic, and socioenvironmental factors contribute to the development of chronic pain. ⋯ Before successful management can begin, the major etiologic factors and sequelae of the chronic pain syndrome must be understood. Antidepressants, neuroleptics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and hydroxyzine have been proven effective in the treatment of pain syndromes. The treatment of patients who present with chronic pain must be individualized based on a comprehensive understanding of the factors underlying the chronic pain syndrome of each patient.
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Muscle contraction headache is the most common headache afflicting mankind. Acute muscle contraction headache usually presents no problem in treatment and is a self-limited condition. Chronic muscle contraction headache presents a very difficult treatment problem. ⋯ The pathophysiology of muscle contraction headache is unknown. There is much controversy as to whether muscle contraction is the primary cause of this condition or whether muscle contraction is merely another component of this syndrome. The extensive research now going on in the field of chronic pain should help clarify the issue.