Current pain and headache reports
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Cluster headache is a well-characterized, strictly unilateral headache with cranial autonomic features and can be classified as episodic or chronic. Cluster attacks reliably are short-lived, often have a clockwise regularity, and can occur daily for weeks or months during an active cluster period. Pharmacologic treatment for this disorder can be divided into abortive and prophylactic agents. ⋯ There has been increased interest in the use of anticonvulsants for pain syndromes such as primary headache disorders. This includes topiramate use for cluster prophylaxis; a number of open-label studies have had encouraging results. This article provides an overview of topiramate and the open-label studies of this agent in the prevention of cluster headache.
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Curr Pain Headache Rep · Apr 2003
ReviewThe relevance of health anxiety to chronic pain: research findings and recommendations for assessment and treatment.
Health anxiety is a dimensional construct that is characterized by extreme concern about one's health at one end of the continuum and lack of concern about health on the other. Research evidence is consistent with the notion that high levels of health anxiety among patients with pain represent a poor prognostic indicator. Moreover, the experience of chronic pain can serve to increase health anxiety levels. This article concludes with a series of practical recommendations to assist practitioners in the assessment and management of patients with health anxiety.
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Patients with chronic pain frequently experience a complex and convoluted journey through the health care system that often is unrewarding for all involved. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound. There often is no direct correlation between objective impairment and a patient's request for disability status. ⋯ Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. Patients with chronic pain syndrome who have not had psychosocial treatment may not be at maximum medical improvement. The purpose of this paper is to help the readership identify types of psychiatric, psychologic, and psychosocial issues that can coexist in patients with chronic pain who are applying for disability, and to help treating physicians avoid contributing to iatrogenic pain and disability by performing needless and potentially harmful procedures on patients who may be better served with an emphasis on psychiatric or psychologic care.
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Research suggests that violence has entered the medical setting to a remarkable degree, causing medical professionals to be at the highest risk for becoming the victims of assaults and violent acts. This article reviews general theories of aggression and research on these theories, and uses them to assess risk factors in patients with chronic pain. ⋯ However, it may decrease the risk in others paradoxically. The research available underscores the need for evaluating patients with pain for the risk of violent or aggressive behavior; specific recommendations are made in this regard.
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Cluster headache is rare, occurring in less than 1% of the population. Studies suggest that, in addition to the pain and associated autonomic disturbances recognized to be characteristic of the syndrome, patients also may experience nausea, photophobia, behavioral agitation, or restlessness. A decreasing male:female ratio also has been noted, perhaps attributable to lifestyle trends adopted by more women that were previously associated with men, such as tobacco use, alcohol consumption, and working outside of the home. ⋯ The emerging understanding of the genetics of cluster headache increasingly suggests a genetic component, with familial transmission now recognized to be more common than previously appreciated. Head trauma, coronary artery disease, and migraine appear to be present in more patients with cluster headache than can be explained by chance alone. Ethnic and racial differences in prevalence are less well understood.