Current pain and headache reports
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Curr Pain Headache Rep · Dec 2009
ReviewTension-type headache with medication overuse: pathophysiology and clinical implications.
Tension-type headache (TTH) is the most prevalent primary headache disorder. An important factor in the long-term prognosis of TTH is the overuse of acute medications used to treat headache. There are many reasons why patients with TTH overuse acute medications, including biobehavioral influences, dependency, and a lack of patient education. ⋯ A proper diagnosis is essential for the treatment of these patients. Treatment should include pathological considerations concerning TTH and MOH, which include peripheral and central mechanisms. Because TTH with MOH carries the worst prognosis, more clinical studies focusing on the complex interaction and treatments of TTH and MOH are needed.
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Joint hypermobility syndrome (JHS) was initially defined as the occurrence of musculoskeletal symptoms in the presence of joint laxity and hypermobility in otherwise healthy individuals. It is now perceived as a commonly overlooked, underdiagnosed, multifaceted, and multisystemic heritable disorder of connective tissue (HDCT), which shares many of the phenotypic features of other HDCTs such as Marfan syndrome and Ehlers-Danlos syndrome. ⋯ There is hardly a clinical specialty to be found that is not touched in one way or another by JHS. Over the past decade, it has become evident that of all the complications that may arise in JHS, chronic pain is arguably the most menacing and difficult to treat.
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Curr Pain Headache Rep · Dec 2009
ReviewPosttraumatic headache in combat soldiers and civilians: what factors influence the expression of tension-type versus migraine headache?
Traumatic brain injury (TBI) is highly prevalent in the United States and a common cause of posttraumatic headache (PTH) and disability. The criteria that define PTH include timelines and features that are not based on clearly established physiologic data and may result in the underrecognition and incorrect treatment of these headaches. ⋯ The fact that tension-type headache phenotypes are uncommon in military personnel with PTH suggests that there are features unique to the combat environment, which may predispose to the development of migraine. Further insight may also be obtained from soldiers with PTH with regard to the true pathophysiology and timelines of headache in the context of TBI.
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Tension-type headache is the most common headache type worldwide. Chronic tension-type headache (CTTH) affects 2% to 3% of patients, yet it represents the least talked about subtype of chronic daily headache. There is much debate in the headache community on whether CTTH exists as its own entity or is a milder form of chronic migraine (CM), because there are similarities and differences between the two headache forms. This article reviews CTTH, as well as the current pathophysiology and treatment, and discusses controversial issues in the diagnosis of CTTH and CM.
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With the aging of the baby boomer generation, the number of patients with osteoarthritis (OA) is expected to swell, posing treatment challenges. Viscosupplementation, in which hyaluronic acid (HA) is injected into the knee joint, has evolved into an important part of our current therapeutic regimen in addressing the patient with knee pain due to OA. Although suffering from lack of an "evidence-based" approach, and largely funded by industry, there is a growing body of outcome data demonstrating the efficacy of HA in decreasing pain and improving function in patients with knee OA, although no evidence indicates that HA is in any way chondroprotective. The clinical success of HA has led to the ongoing introduction of various forms of HA, although little data are available to justify one over the other.