Current pain and headache reports
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An integrated palliative care plan with goals of therapy that change throughout a child's illness will reflect an individualized, child-centered, and family-centered approach to care. This care plan will act as a foundation to assist and guide all providers, from the primary pediatrician to the subspecialty surgeon, in providing interventions that will most benefit a child and add life to the child's years.
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Ophthalmoplegic migraine is a rare condition, previously thought to represent a variant of migraine. Recent observations regarding its usual clinical presentation and common magnetic resonance imaging findings have given rise to speculation that this illness is more likely to represent an inflammatory cranial neuropathy. The recent revision of the International Headache Classification has reclassified ophthalmoplegic migraine from a subtype of migraine to the category of neuralgia. ⋯ Differential diagnosis is rather large, although most other possible causes of ophthalmoplegia and headache have distinctive presentations or can be excluded with fairly straightforward diagnostic testing. Optimal prophylactic and acute treatment is still unclear, but migraine prophylactic medications such as b blockers and calcium channel blockers have been proposed. Steroids have been used with mixed results.
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Curr Pain Headache Rep · Aug 2004
ReviewAssessing aberrant drug-taking behaviors in the patient with chronic pain.
Tremendous progress has been made in the study and treatment of pain in the past two decades. The growing problem of prescription drug abuse has forced the field to take a new look at opioid prescribing and to seek balance between its risks and benefits. Every pain clinician must become better acquainted with the principles of addiction medicine as they apply to pain management. The assessment of aberrant behaviors in patients with chronic pain is one key aspect of mastering these principles.
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Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.
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The numbers of older people, particularly those older than 85 years of age, are increasing rapidly. Aging and chronic conditions contribute to the limitation in response to stress or insults in the elderly and impact assessment and management of pain. ⋯ Physiological alteration in body composition and renal and hepatic function alter distribution and elimination of medications and metabolites. Non-medical treatments also may be effective in managing pain and should be considered for older patients.