Der Schmerz
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A completely new classification system for headache disorders, cranial neuralgias and facial pain has been prepared by a headache classification committee working within the International Headache Society (IHS). The committee is made up of an international body of experts, who spent almost 3 years on the preparation of the classification, publishing it in 1988 (Cephalalgia 8 Suppl 7ratio1ff., 1988). The German translation appeared a year later (Nervenheilkunde 8ratio161-203, 1989). ⋯ The advantages and the problems encountered are discussed. On balance, the new IHS classification is proving to be a very useful basis for the diagnosis of painful conditions affecting the head and face. It is indispensable for a modern headache clinic.
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Myofascial pain syndromes, fibromyalgia, and articular dysfunctions may all be contributing to our patients' ubiquitous musculoskeletal pain problems that generally are poorly understood and poorly managed. Thepectoralis minor myofascial pain syndrome, for example, results from trigger points (TrPs) activated by stress overload of the muscle. ⋯ Snapping palpation at the TrP elicits a local twitch response (LTR). The increased muscle tension of a pectoralis minor syndrome commonly entraps the lower trunk of the brachial plexus, producing symptoms of a cervical radiculopathy.
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In parallel with the development of the various electrophysiological methods now available, the clinical syndrome of migraine has been repeatedly analyzed with the aid of these tools, in attempts to track its course with reference to electrophysiological parameters. A survey of the international literature reveals the following EEG findings. (1) In patients with different forms of headache without structural lesions the distribution of normal and abnormal EEG recordings during headachefree intervals resembles that seen among healthy subjects. (2) In common migraine, nonfocal and nonspecific abnormalities are reflected in up to 65% of all EEG recordings during the migraine-free interval. (3) Focal EEG abnormalities during a migraine attack are relatively rare, generally occurring only during migraines with transient focal neurological disturbances. (4) It is very rare for there to be permanent focal changes that are apparent during both pain-free intervals and migraine attacks. In the presence of such changes very careful diagnosis is necessary to exclude symptomatic lesions. (5) In up to 53% of migraineurs a few minutes' hyperventilation leads to generalized slow, wide-amplitude, sometimes episodic waves in the EEG. Similar changes also occur in healthy subjects, but are less common, less intense and of shorter duration. (6) There is a statistically significant correlation between the occurrence of a migraine and EEG activation by photic stimulation at frequencies over 20 Hz. (7) No unequivocal results obtained in large series of patients with train mapping are yet available.