Current pain and headache reports
-
Curr Pain Headache Rep · Apr 2002
ReviewTrigeminal neuralgia and other neuropathic pain syndromes of the head and face.
Trigeminal neuralgia is the most common craniofacial pain syndrome of neuropathic origin. Although the diagnosis remains based exclusively on history and symptomatology, modern diagnostic techniques, particularly high-resolution magnetic resonance imaging, provides valuable new insight into the pathophysiology of these cases with additional implications for therapeutic strategies. ⋯ Rarely, neuralgias of other cranial nerves mimic trigeminal neuralgia. Finally, it is imperative to distinguish atypical facial pains from these neuropathic syndromes to avoid unsuccessful therapies.
-
The triptans have provided a major advance in the treatment of the pain and disability associated with migraine headache. With seven triptans in use or in clinical development, the clinician is faced with the decision of which triptan to prescribe to the patient with migraine. Although the triptans are pharmacologically similar, they each have unique attributes. This article focuses on the pharmacologic differences between triptans with regard to their pharmacokinetics and drug interactions, and provides some helpful tips on how to optimize migraine treatment with the triptans.
-
Fibromyalgia (FM) is characterized by abnormal pain sensitivity in response to diverse stimuli as well as persistent widespread pain and other symptoms such as fatigue and sleep disturbance. Progress has been made in identifying factors that contribute to the etiopathogenesis of abnormal pain sensitivity, but there is no single model of pathophysiology or treatment of FM that has gained wide acceptance among health care professionals. ⋯ This model posits that interactions of exogenous (e.g., environmental stressors) and endogenous (e.g., neuroendocrine dysfunction) abnormalities in genetically predisposed individuals lead to a final common pathway, i.e., alterations in central nervous system function and neuropeptide production that underlie central sensitization and abnormal pain sensitivity. This model also suggests that efforts to develop and evaluate treatments for FM should focus on interventions with direct or indirect effects on central functions that influence pain sensitivity.
-
Butalbital compounds are of proven efficacy in the treatment of tension headache. Decades of experience have established their value in the treatment of other mild-to-moderate headaches. ⋯ The medications are cost-effective with only occasional and minor immediate adverse effects. Their overuse may cause the evolution of episodic primary headaches to chronic daily headaches; however, removal of these agents from the market would reduce the chronic daily headache in the general population by a small fraction of 1%.
-
Curr Pain Headache Rep · Apr 2002
Review Comparative StudyDo over-the-counter medications help the physician manage migraine headache?
The use of over-the-counter-medication in migraine treatment is commonplace. They are often used in addition to physician-prescribed medications and may be used without the full knowledge of the physician. Although considerable evidence suggests their efficacy in migraine treatment, they are rarely used to maximal levels of efficacy and safety. A review of the evidence for these treatments is important for cost effective, well-tolerated, and specific treatment of migraine headache.