Current pain and headache reports
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Curr Pain Headache Rep · Aug 2004
Review Case ReportsThe role of the outpatient clinic nurse in monitoring opioid therapy.
Outpatient clinical nurses specialize in patient care in a particular area of nursing practice. Typically, the registered nurse also holds a professional certification in that specialty or subspecialty. The only nursing certification related to pain and symptom management is the Hospice and Palliative Care certification. ⋯ A nurse is one of the first contacts in the health care system that the patient encounters. Nurses must possess unique qualifications and be able to deal compassionately with a demanding and sometimes hostile group of patients. How the patients are accepted into a pain medicine practice and managed is discussed in this article.
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Vestibular symptoms such as vertigo and dizziness are quite common in migraine. There is no specific category in the new International Headache Society Classification for vestibular migraine. However, given the symptomatology often described, it would fit best under basilar-type migraine, even though by definition monosymptomatic attacks with rotational vertigo for a few seconds to minutes do not strictly fit the criteria. Vestibular migraine must be regarded as a migraine equivalent because it is a prominent symptom in many migraineurs.
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Topical analgesics exert their analgesic benefit locally and without significant systemic absorption. The mechanism of the topical analgesic is unique to the specific medication. ⋯ Topical analgesics have been studied in an increasing number of painful clinical conditions; the results of many of these studies are summarized in this review. Recent data suggest that at least one topical analgesic, although applied peripherally, may result in central nervous system alterations of pain processing.
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Curr Pain Headache Rep · Aug 2004
Review Case ReportsPainful ophthalmoplegia: overview with a focus on Tolosa-Hunt syndrome.
Painful ophthalmoplegia is an important presenting complaint to emergency departments, ophthalmologists, and neurologists. The etiological differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies including vascular (eg, aneurysm, carotid dissection, carotid-cavernous fistula), neoplasms (eg, primary intracranial tumors, local or distant metastases), inflammatory conditions (eg, orbital pseudotumor, sarcoidosis, Tolosa-Hunt syndrome), infectious etiologies (eg, fungal, mycobacterial), and other conditions (eg, microvascular infarcts secondary to diabetes, ophthalmoplegic migraine, giant cell arteritis). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that if left untreated, can be associated with significant morbidity or mortality. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids, but should be diagnoses of exclusion.
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Colloid cysts of the third ventricle are rare intracranial tumors, accounting for 0.5% of intracranial tumors. Colloid cysts represent 2% of gliomas, are more common in men than women, and usually are diagnosed between the third and fifth decades of life. The primary presenting complaint of this disorder is headache. ⋯ Colloid cysts of the third ventricle are diagnosed by computed tomography or magnetic resonance imaging and treatment is surgical. This rare type of headache disorder is significant because it is associated with sudden death. Recognition of the unusual features of colloid cyst headache may result in decreased mortality in this disorder.