Current pain and headache reports
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Curr Pain Headache Rep · Dec 2002
ReviewPsychiatric comorbidity of chronic daily headache: impact, treatment, outcome, and future studies.
Patients with chronic daily headache have high frequencies of psychiatric comorbidity or psychologic distress in clinic-based studies. The presence of psychologic distress contributes to poor quality of life in patients with chronic daily headache. ⋯ A systematic investigation of psychiatric comorbidity is emphasized in patients with chronic daily headache and aims at a more comprehensive clinical management. Large-scale, longitudinal surveys and clinical trials specifically for psychiatric comorbidity of chronic daily headache are warranted to answer whether a syndromic relationship exists between different chronic daily headache subtypes and different psychiatric disorders, and to provide evidence-based treatment options for this large group of patients.
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Curr Pain Headache Rep · Dec 2002
ReviewCognitive-behavioral issues in the treatment and management of chronic daily headache.
Chronic daily headache is a heterogeneous group of daily or near-daily headaches that afflicts close to 5% of the general population and accounts for close to 35% to 40% of patients at headache centers. First-line drug or cognitive-behavioral therapies administered alone have minimal impact on reducing the frequency or severity of headaches. ⋯ Cognitive-behavioral therapies focus on preventing mild pain from becoming disabling pain, improving headache-related disability, affective distress, and quality of life, and reducing overreliance on medication. For cognitive-behavioral therapies to be effective, it is important to address complicating factors, including medication overuse, psychiatric comorbidity, stress and poor coping, and sleep disturbance.
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Headache and sleep disturbance are common health complaints. Both complaints often co-exist in the same patient, leading some to suspect a causal relationship or common underlying pathology. However, the empirical literature in this area is limited. ⋯ There is no accepted model for understanding the link between headache and sleep disturbance. This paper reviews the available literature concerning comorbid headache and sleep disturbance and offers some preliminary suggestions based on the available literature to guide their evaluation and management. Information specific to the relationship between sleep disturbance and chronic daily headache, where available, is highlighted.
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Curr Pain Headache Rep · Dec 2002
ReviewProphylaxis for chronic daily headache and chronic migraine with neuronal stabilizing agents.
Approaches to acute and prophylactic migraine and headache treatment are evolving as our understanding of some of the underlying pathophysiology improves. This article focuses on the emerging use of medications originally introduced for the treatment of seizures (anticonvulsants) as primary therapy for eradicating or reducing migraine and chronic daily headaches. A more accurate term for their pharmacologic mechanisms, if they are used to treat headaches and pain disorders, is neuromodulating or neuronal stabilizing agents. This term refers to their many cellular actions to reduce pain transmission supraspinally, in the spinal cord, and in the brainstem.
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Curr Pain Headache Rep · Dec 2002
ReviewDrug infusions for the diagnosis and treatment of chronic pain.
Diagnostic infusion therapy has several advantages over other routes of drug administration in the management of chronic pain. Although systemic side effects may occur, the procedure is relatively noninvasive and is generally well tolerated by patients. ⋯ This article reviews the scientific and clinical background behind the major classes of drugs used in diagnostic infusion testing, namely local anesthetics, opioids, and a-adrenergic blockers. Clinical application of these agents in the management of chronic pain also is outlined.