Current pain and headache reports
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The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. ⋯ Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. Treatment directed toward muscular factors include electromyography biofeedback, which has a documented effect in patients with TTH, as well as physiotherapy and muscle relaxation therapy, which are most likely effective. Future studies should aim to identify the source of peripheral nociception.
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Curr Pain Headache Rep · Dec 2011
Review Meta AnalysisComplementary and alternative medicine for rheumatoid arthritis and osteoarthritis: an overview of systematic reviews.
This review critically evaluates the literature on complementary and alternative medicine (CAM) as treatment options for rheumatoid arthritis and osteoarthritis. ⋯ Five systematic reviews met our inclusion criteria. They all arrived at cautious conclusions. Four reviews were of high quality and one was burdened with high risk of bias. The evidence to support the effectiveness of CAM as a treatment option for rheumatoid arthritis and osteoarthritis is ambiguous.
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Curr Pain Headache Rep · Oct 2011
Review Comparative StudyAre menstrual and nonmenstrual migraine attacks different?
Migraine is the second most common headache condition next to tension-type headache. Up to one fourth of all women have migraine, and 20% of them experience migraine without aura attack in at least two thirds of their menstrual cycles. ⋯ Future studies should be based on the general population. Collection of both prospective and retrospective data is warranted, and headache diagnosis base on interviews by physicians with interest in headache are more precise than lay interviews or questionnaires.
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Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Even though sleep recording is not part of the routine evaluation, polysomnography may disclose primary sleep disorders in patients with fibromyalgia, including obstructive sleep apnea and restless leg syndrome. In addition, genetic background and environmental susceptibility link fibromyalgia and further sleep disorders. ⋯ The effect of exercise is contradictory, but overweight or obese patients with fibromyalgia should be encouraged to lose weight. Regarding the approved antidepressants, amitriptyline proved to be superior to duloxetine and milnacipran for sleep disturbances. New perspectives remain on the narcolepsy drug sodium oxybate, which recently was approved for sleep management in fibromyalgia.
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Curr Pain Headache Rep · Oct 2011
ReviewTreatment of chronic migraine headache with onabotulinumtoxinA.
Chronic migraine headache remains an exceedingly difficult entity to manage. Treatment of chronic migraine headache with onabotulinumtoxinA has recently been shown to be effective in reducing the severity and frequency of chronic migraine headache, in the PREEMPT trials, a landmark achievement. However, the studies use a primarily fixed dose and site approach to treatment, allowing some individualized injections. However, the authors do not address the issue of myofascial trigger points as potential triggers of migraine that could be inactivated using onabotulinumtoxinA, despite several studies that support the role of myofascial trigger points in initiating some migraine headaches.