Current pain and headache reports
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The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. ⋯ A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.
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Curr Pain Headache Rep · Jun 2006
ReviewUpdate on pharmacotherapy guidelines for the treatment of neuropathic pain.
Neuropathic pain is a common problem in our society affecting nearly 1.5% of the US population. There currently are five medications approved by the US Food and Drug Administration (FDA) for the treatment of neuropathic pain, which include gabapentin, pregabalin, duloxetine, 5% lidocaine patch, and carbamazepine. ⋯ All of these agents, both FDA-approved and off-label, have been recommended as first-line treatments for neuropathic pain. This article discusses these agents in detail as they relate to the treatment of neuropathic pain.
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Curr Pain Headache Rep · Jun 2006
ReviewDuloxetine for neuropathic pain based on recent clinical trials.
The treatment of neuropathic pain with antidepressants has a long history. Early studies were contradictory and were limited by small numbers of patients. ⋯ Recently, duloxetine, a dual-action reuptake inhibitor, has demonstrated significant efficacy in the management of diabetic peripheral neuropathic pain in three double-blind, placebo-controlled trials and was approved by the FDA for this indication. These studies are discussed in this article.
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Although the influence of age on the prevalence of migraine is well known, the clinical characterization of migraine across the lifespan remains poorly studied. Limited evidence suggests that migraine attacks get shorter and less typical with advancing age. Similar results were found for transformed migraine at different ages. ⋯ We then discuss the epidemiology and profile of transformed migraine across the lifespan. Clarifying the influence of age on migraine is of importance for clinical diagnosis and treatment. It also may contain clues to evolving disease biology.
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The paradigm of early treatment of the migraine attack at mild pain intensity has become one alternative to circumventing the problem of compromised oral absorption of symptomatic drugs due to migraine-induced gastrointestinal dysmotility. Early treatment also has been proposed to be advantageous because most migraineurs could be less responsive to delayed treatment, owing to the development of central sensitization of the trigeminal pain transmission. Ranking the underlying principles, it seems that the improved response to an oral triptan formulation at mild migraine symptom intensity has more to do with less impaired gastrointestinal absorption in the early stage of the attack than decreasing the time and preventing chances for central sensitization and development of cutaneous allodynia. ⋯ Individually tailored use of the available triptan formulations will increase, without any doubt, the within-migraineur consistency of response. It also will reduce the overall proportion of migraine attacks or migraineurs not responding to triptan treatment. Notwithstanding, the recommendation of early treatment during the migraine attack when the pain is mild remains valid.