Current pain and headache reports
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Back pain is one of the most common patient complaints brought forth to physicians. Mechanical back pain accounts for 97% of cases, arising from spinal structures such as bone, ligaments, discs, joints, nerves, and meninges. Acute back pain in the absence of progressive neurologic deficits and other underlying nonmechanical causes may be treated conservatively, with specific emphasis on maintaining activity levels and function. ⋯ Common causes of mechanical back pain include spinal stenosis, herniated discs, zygapophysial joint pain, discogenic pain, vertebral fractures, sacroiliac joint pain, and myofascial pain. A wide variety of treatments are available, with different treatments specifically targeted toward different causes. A balanced approach, which takes into account patient psychosocial factors and incorporates multidisciplinary care, increases the likelihood of success from back pain interventions.
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Curr Pain Headache Rep · Dec 2008
Review Comparative StudyTension-type headache and migraine: two points on a continuum?
The question of whether tension-type headache (TTH) and migraine represent two points on a continuum has been debated for decades. Skeptics of the continuum model support their view by noting that the characteristics of these two headaches and the demographics of the individuals who suffer from them are undeniably distinct. ⋯ TTH and migraine may exhibit similar associated features (even within the constraints of diagnostic criteria), respond effectively to similar medications, share similar demographics among certain age groups, and may each have genetic influences. These findings suggest that TTH and migraine may be more intimately related than would be suggested by their diagnostic criteria.
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Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. ⋯ Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.
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Curr Pain Headache Rep · Dec 2008
ReviewAdvances in the pharmacologic treatment of tension-type headache.
Tension-type headache (TTH) is the most prevalent form of primary headache in the general population. We discuss advances in the treatment of TTH. ⋯ For preventive treatment, amitriptyline is the best-studied drug, but nortriptyline, mirtazapine, tizanidine, the selective serotonin reuptake inhibitors, and other medications can be used. We close by discussing potential future therapies, including calcitonin gene-related peptide receptor antagonism, as well as substance P and the nitric oxide pathways.
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The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important to differentiate TTH from other headaches, including primary and secondary headaches. Significant overlap in the diagnostic criteria makes it difficult to differentiate TTH from other headache disorders and, in particular, migraine. A controversy exists about whether TTH and migraine represent a continuum of the same pathophysiological process.