Current pain and headache reports
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Menstrual-related migraine (MRM) affects the majority of female migraineurs, with menstrual-associated attacks reported to be more disabling, longer lasting, and less responsive to traditional treatments than nonmenstrual attacks. Emerging evidence suggests that minimizing or eliminating monthly declines in estrogen concentration may be effective in preventing MRM. This article gives a practical overview of current hormonal options, both contraceptive and noncontraceptive. Our intent is to help the reader better understand the differences in currently available formulations and how some of these agents may be utilized as hormonal preventives of MRM.
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Fibromyalgia (FM) and migraine are common chronic disorders that predominantly affect women. The prevalence of headache in patients with FM is high (35%-88%), with migraine being the most frequent type. ⋯ We also discuss the participation of hypothalamic and brainstem centers of pain control, the putative role played by neurotransmitters or neuromodulators on central sensitization, and changes in their levels in the cerebrospinal fluid. Understanding their mechanisms will help to establish new treatment strategies for treating these disabling brain disorders.
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Curr Pain Headache Rep · Oct 2009
ReviewBrain manifestation and modulation of pain from myofascial trigger points.
The brain plays a prominent role in the generation and modulation of pain. It contains powerful endogenous pain modulatory systems that can be engaged in a beneficial way by therapeutical intervention. In contrast, pain chronification is associated with maladaptive structural and functional changes that may shift the balance of the modulatory systems. ⋯ Recent neuroimaging data suggest that hyperalgesia from MTrPs is processed in similar regions as hyperalgesia from other pain conditions. However, abnormal hippocampal hypoactivity suggests that dysfunctional stress responses may play an important role in the generation and maintenance of hyperalgesia from MTrPs. Other data suggest that short-term pain relief obtained with intramuscular electrostimulation within an MTrP is partially due to descending pain inhibitory mechanisms.
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Curr Pain Headache Rep · Oct 2009
ReviewNew techniques for the quantification of fibromyalgia and myofascial pain.
Myofascial pain and fibromyalgia share a number of common features: the patient is uncomfortable; abnormalities can be detected on physical examination; and there is a lack of an objective means to either quantify or visualize their core features. This has undoubtedly contributed to a slowed acceptance of their importance by the medical community. ⋯ Although progress may be somewhat slower in fibromyalgia, in which attention appears to focus on pain sensitivity and functional brain imaging, a number of approaches now seem promising in their ability to quantify the physical and biochemical characteristics of the taut bands and trigger points of myofascial pain. This review focuses on myofascial pain with an emphasis on the growing capability of MRI, microanalytic techniques, and ultrasonography to assess, quantitate, and even visualize the characteristics of these stigmatic lesions.
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Some studies suggest that platelet activation and aggregation are associated with migraine, likely secondary to changes occurring during the acute attack. Evidence also suggests that platelet clots can lodge in small cerebral vessels, and that the resultant ischemia and inflammation can induce cortical spreading depression with aura-like symptoms and pulsatile headache. ⋯ When associated with other factors, such as oral contraceptive use, there may be an increased tendency for thrombus formation, secondary migraine with aura, transient ischemic attacks, and stroke. Identifying those migraineurs at highest risk of developing endothelial dysfunction and platelet disorders may allow for preventive strategies to avoid the cerebral consequences.