Current pain and headache reports
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Curr Pain Headache Rep · Jun 2007
Review Meta AnalysisControlled trials in pediatric migraine: crossover versus parallel group.
Studies on the treatment of migraine in children and adolescents are rare and difficult to design. In particular, the high placebo response makes it difficult to show efficacy of a verum drug. When analyzing all published trials in the acute drug treatment of migraine in children, crossover trials show lower placebo rates and higher therapeutic gain, compared with parallel group trials. This should be considered in the future design of acute drug trials in childhood migraine.
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Anatomic, functional, and neurochemical imaging studies have provided new investigative tools in the study of central pain. High-resolution imaging studies allow for precise determination of lesion location, whereas functional neuroimaging studies measure pathophysiologic consequences of injury to the central nervous system. Additionally, magnetic resonance spectroscopy evaluates lesion-induced neurochemical changes in specific brain regions that may be related to central pain. The small number of studies to date precludes definitive conclusions, but the recent findings provide information that either supports or refutes current hypotheses and can serve to generate new ideas.
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More than 20 million US women suffer with migraine, two thirds of whom experience menstrually related migraine. Estrogen plays an important role in triggering migraine, and given the numerous hormonal fluctuations throughout a woman's lifetime, there are many opportunities for a hormonal impact. Accurate diagnosis is key to initiating effective treatment, and when acute therapy fails, the unique predictability of menstrual migraine lends itself to preventative treatment.
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Curr Pain Headache Rep · Jun 2007
ReviewSpontaneous pain and brain activity in neuropathic pain: functional MRI and pharmacologic functional MRI studies.
Functional brain imaging studies in chronic neuropathic pain patients have lagged far behind equivalent studies in acute pain. In the past few years, this trend has begun to shift. This article discusses the novel approach of studying brain activity for spontaneous pain and its modulation by pharmacologic manipulation. We argue that the approach provides a solid methodology for studying clinical (especially neuropathic) pain and patient populations, and moreover, that the latest results using this approach imply that distinct clinical chronic pain conditions seem to involve specific brain circuitry, which is also distinct from the brain activity commonly observed in acute pain.
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A comprehensive review of the neurotologic manifestations of migraine is presented, focusing on the most recent publications regarding the epidemiology, clinical presentation, pathophysiology, diagnosis, and management of migraine-related vertigo (MV). A strong association exists between vertigo and migraine, with MV being the most common cause of spontaneous (nonpositional) episodic vertigo. Symptoms can be quite variable among patients and within individual patients over time, creating a diagnostic challenge. ⋯ Operational diagnostic criteria have been proposed but are not included in the most recent International Headache Society classification of migraine. Better elucidation of the neurologic linkages between the central vestibular pathways and migraine-related pathways and the discovery of ion channel defects underlying some causes of familial migraine, ataxia, and vertigo have furthered the understanding of MV pathophysiology. Treatment of MV currently parallels that of migraine headache, as proper studies of optimal MV management are just beginning.