Current pain and headache reports
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Curr Pain Headache Rep · Sep 2014
ReviewTreatment of cervicogenic headache with cervical epidural steroid injection.
Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc, cervical myofascial trigger points, as well as the cervical spinal nerves. ⋯ And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition.
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Sports- and exercise-related headaches are not unusual. Despite their frequent occurrence in this context, there are little epidemiologic data concerning sports-related headache. ⋯ The nonspecific nature of headaches provides unique challenges to clinicians encountering this complaint. It is, therefore, imperative that physicians treating athletes are able to distinguish the various headache types and presentations often seen in this population.
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Medication overuse is not uncommon among children and adolescents with primary headache disorders. Medication overuse in adults is associated with increased headache frequency and reduced effectiveness of acute and preventive medications. ⋯ This review summarizes what is known about predicting the response to medication withdrawal. Strategies for managing children and adolescents with medication overuse are also offered.
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Deep brain stimulation (DBS) and motor cortex stimulation (MCS) are established surgical modalities that have been successfully used over the last several decades for treatment of numerous chronic pain disorders. Most often, these approaches are reserved for severe, disabling, and medically refractory syndromes after less invasive approaches have been tried and have failed. ⋯ Based on the worldwide published experience, it appears that additional data is needed to obtain regulatory approval for both MCS and DBS for the treatment of pain. Following approval, further clinical research will shape the ability to initiate, implement, and update comprehensive patient and procedure selection paradigms.
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Curr Pain Headache Rep · Jul 2014
ReviewRole of sphenopalatine ganglion stimulation in cluster headache.
Cluster headache attacks are characterized by extreme unilateral pain mostly in the first trigeminal branch and an ipsilateral activation of the cranial parasympathetic system, pointing to a relevant role of the cranial parasympathetic system in the pathophysiology, and therapy of cluster headache. Based on animal experiments and several interventions of the sphenopalatine ganglion (such as an aesthetic or alcoholic blocks and radiofrequency ablation) in cluster headache patients, stimulation of the sphenopalatine ganglion (SPGS) as the major efferent peripheral parasympathetic structure was established with an encouraging abortive effect on acute attacks and a frequency reduction over time. In this review, the clinical data and potentially underlying pathophysiological concepts of SPGS are discussed in detail, which in brief point to a relevant role of the parasympathetic system both in the induction and termination of attacks.