Current pain and headache reports
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Thunderclap headache refers to an excruciating headache of instantaneous onset. It occurs as suddenly and unexpectedly as a "clap of thunder." Patients with thunderclap headache may have normal neurologic examination results and normal computed tomographic brain scans, even if they have serious underlying pathology. This has created confusion regarding nosology and the nature and extent of the diagnostic evaluation, which this article discusses.
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Treatment for patients who are dying from cancer and are suffering with physiologic and existential symptoms is an important and valuable skill for health care providers. However, the treatment for suffering at the end of life and the use of sedation for comfort often are misunderstood. The following is a discussion of the clinical skills and ethical considerations that health care providers should have when treating terminal patients with cancer.
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The overuse of acute medications in patients who are headache-prone poses a great challenge to headache management. Medication overuse-induced headache represents one of the most common iatrogenic disorders. ⋯ The recent development of acute headache medications, especially the triptans, has provided increased migraine relief; however, the incidence of triptan-overuse headache has also increased. Awareness of medication overuse-induced headache and familiarity with the diagnosis and the treatment of this disorder are important to physicians who treat patients with headache.
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Cancer pain is a significant problem despite the advent of the World Health Organization's cancer pain guidelines, the US government's cancer pain guidelines, and the Joint Commission's mandate for hospital pain evaluation and treatment. Ninety percent of patients with cancer pain can be effectively treated with oral conservative medications. The remaining 10% need more invasive treatments to control their pain. This article reviews current methods of controlling cancer pain using intrathecal catheters, nerve blocks, and neurosurgical procedures.