Current pain and headache reports
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There now is one realized and several attractive targets for the treatment of acute attacks of migraine that will follow and augment the use of serotonin 5-HT1B/1D receptor agonists, the triptans. Calcitonin gene-related peptide (CGRP) receptor blockade recently has been shown to be an effective acute antimigraine strategy; therefore, blockade of CGRP release by inhibition of trigeminal nerves would seem a logical approach. A number of targets are reviewed in this article including serotonin 5-HT1F and 5-HT1D receptors, adenosine A1 receptors, nociceptin, vanilloid TRPV1 receptors, and anandamide CB1 receptors. Development of one or more such compound offers the exciting prospect of new non-vasoconstrictor treatments for migraine and cluster headache.
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Local anesthetic blocks have been used in a variety of ways in the management of headache. Some practitioners use blocks of the supraorbital and greater occipital nerves as a form of treatment. Although the effect of each block is limited in duration, a series of injections appears to provide sustained relief. ⋯ On the other hand, blocks can be used to diagnose cervical sources of headaches. When performed under controlled conditions, such blocks can identify cervical sources of pain in a substantial proportion of patients with headache after whiplash. Positive blocks also predict good outcome from radiofrequency neurotomy of the nerve blocked.
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There has been a dramatic increase in our understanding of fibromyalgia throughout the past 14 years since the publication of the 1990 American College of Rheumatology classification criteria. Before 1990, and for most of the 20th century, fibromyalgia was considered to be predominantly a muscle disorder; now the critical abnormality is described as "central sensitization." However, central sensitization has to have an initial genesis and nociceptive stimuli from painful foci in muscle are increasingly recognized as being relevant to the development of fibromyalgia. ⋯ However, some clues are emerging from the role of diverse stimuli in activating glial cells and the role of disordered cytokine networks. Some predictions about future developments in fibromyalgia are ventured based on the current state of knowledge.
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Curr Pain Headache Rep · Oct 2004
ReviewRole of neuroimaging in our understanding of the pathogenesis of primary headaches.
This article reviews new advances in neuroimaging of primary headaches. Imaging of the brain is reaching a new stage of maturity as the basic neural systems that participate in the pathogenesis of headaches are identified. Given the rapid advances in functional neuroimaging, it is no surprise that recent studies have supported the neurovascular theory of migraine and cluster headache. It is clear that functional neuroimaging will continue to be of paramount importance and ultimately may serve as the bridge between molecular and clinical domains in the field of headache research.
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Chronic nonodontogenic toothache has been reported in the literature since the 1700s. This problem has followed a similar scenario since those first reports. The patient typically is misdiagnosed and then subjected to multiple unnecessary procedures, ultimately resulting in tooth extractions because of dentists and physicians being unaware of the existence of atypical odontalgia and other types of intraoral neuropathic pain that are treatable without sacrificing the teeth. This paper reviews the medications and procedures used to treat nonodontogenic toothache.