Current pain and headache reports
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Curr Pain Headache Rep · Jun 2008
ReviewPutative mechanisms of the relationship between obesity and migraine progression.
Studies suggest that obesity is associated with migraine progression from an episodic into a chronic form. We discuss putative mechanisms to justify this relationship. Several of the inflammatory mediators that are increased in obese individuals are important in migraine pathophysiology, including interleukins and calcitonin gene-related peptide. ⋯ Substances that are important in metabolic control are nociceptive at certain levels. Hypothalamic dysfunction in the orexin pathways seems to be a risk factor for both conditions. In addition, we discuss the importance of metabolic syndrome and autonomic dysfunction in modulating the obesity/migraine progression relationship.
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Curr Pain Headache Rep · Jun 2008
ReviewPathophysiology and treatment of painful diabetic neuropathy.
Diabetes is the most common cause of peripheral neuropathy, and painful diabetic neuropathy (PDN) affects approximately 30% of diabetic patients with neuropathy. It is extremely distressing for the patient and poses significant management difficulties because no treatment provides total relief, and side effects of therapy are a major limiting factor for titrating therapy. Understanding the pathogenesis of diabetic neuropathy may lead to the development of new treatments to prevent nerve damage, and a better understanding of the mechanisms that modulate pain may lead to more effective relief of painful symptoms. We provide an update on the pathogenesis, diagnosis, and treatment of PDN.
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Curr Pain Headache Rep · Jun 2008
ReviewAnxiety disorders and migraine intractability and progression.
Comorbid psychopathology has been implicated as a risk factor for the chronification and progression of migraine. Although past research has focused principally on depression and migraine, recent research consistently has confirmed that a disproportionate number of migraineurs suffer from one or more comorbid anxiety disorders. Moreover, this research has implicated anxiety disorders as factors potentially associated with migraine intractability and progression; growing evidence suggests that anxiety disorders may be even more prognostically significant than depression. This article summarizes these recent developments, considers mechanisms underlying this comorbidity, discusses strategies for assessing and managing comorbid anxiety, and notes directions for future clinical and empiric work.
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Weight gain is a common side effect of drugs used for headache prevention. Weight gain can adversely affect patient health, exacerbate comorbid metabolic disorders, and encourage noncompliance. ⋯ The practicing physician needs accurate information about important side effects, including weight gain, when selecting appropriate pharmacologic regimens. This article discusses the potential effects the more common headache medications have on weight.
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Curr Pain Headache Rep · Jun 2008
ReviewEvolving understandings about complex regional pain syndrome and its treatment.
Complex regional pain syndrome (CRPS) is still a puzzling disease. Although pathophysiologic understanding has improved, not every aspect of this challenging neuropathic pain syndrome has been explored. Typical symptoms of CRPS are sensory, motor, and autonomic dysfunctions. ⋯ Treatment usually requires a multidisciplinary approach, including medical and nonmedical therapies. The common therapeutic aim is to maintain or restore normal function of the affected extremity. Beyond highlighting pathophysiologic concepts, this article describes recent therapeutic approaches.