Current pain and headache reports
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Headache is a common presenting complaint in the pediatric emergency department. Although the majority of headaches are benign in nature, headache may be secondary to more serious pathology, such as tumor, meningitis, hemorrhage, or brain abscess. A systematic history will elicit the temporal pattern of the headache, guiding the development of an appropriate differential diagnosis. Thorough physical and neurologic examinations will disclose the objective signs that dictate the need for further diagnostic testing.
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Cervical whiplash injuries are common and yet poorly understood. Several of these cases become chronic for unknown reasons and defy most forms of musculoskeletal therapy. Botulinum toxin has shown promise in selected cases in which soft tissue injury predominates. In conjunction with a good biomechanical assessment and appropriate physical rehabilitation techniques, this new approach to treatment may offer a way of treating the central and peripheral dysfunction that characterizes this condition.
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Curr Pain Headache Rep · Oct 2006
ReviewPhysical therapy and other nonpharmacologic approaches to fibromyalgia management.
Fibromyalgia is a vague and changing syndrome that comprises many symptoms. Due to the confounding nature of fibromyalgia syndrome, there has been much debate about which interventions and therapies should be considered as viable treatment options. ⋯ Several studies have shown promise, with initial improvement in symptoms, but in many cases, these improvements were not lasting or the patients were then unable to continue/replicate the program on their own. In this article, some of the more recently published findings regarding the efficacy of exercise are explored, specifically physical therapy and other nonpharmacologic interventions, for managing fibromyalgia syndrome.
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Myofascial pain syndrome (MPS) is caused by myofascial trigger points (MTrPs) located within taut bands of skeletal muscle fibers. Treating the underlying etiologic lesion responsible for MTrP activation is the most important strategy in MPS therapy. If the underlying pathology is not given the appropriate treatment, the MTrP cannot be completely and permanently inactivated. ⋯ When treating the active MTrPs or their underlying pathology, conservative treatment should be given before aggressive therapy. Effective MTrP therapies include manual therapies, physical therapy modalities, dry needling, or MTrP injection. It is also important to eliminate any perpetuating factors and provide adequate education and home programs to patients so that recurrent or chronic pain can be avoided.
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Post-traumatic headache after craniocerebral trauma is not an uncommon occurrence in children and adolescents. It can occur after mild, moderate, or severe injury. ⋯ In time, the headache and accompanying symptoms gradually resolve over a period of 8 to 12 weeks. However, sometimes it may become chronic, requiring a multidimensional management approach including pharmacologic intervention, physical rehabilitation, and cognitive-behavioral therapy as used in the adult population.