Current pain and headache reports
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Misdiagnosis of cluster headache is common in clinical practice and can lead to significant morbidity. The International Headache Society has published diagnostic criteria that are generally straightforward and useful, but careful understanding of these criteria and how to handle exceptions is necessary. The primary diagnostic points involve severity, length, and frequency of individual headache attacks, as well as the presence of ipsilateral autonomic features. Such additional features as time cycling of headache clusters, physical characteristics of patients, and response to treatment may prove useful in individual cases, but must not be relied on too much.
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Curr Pain Headache Rep · Feb 2002
ReviewHow could the validity of the DSM-IV pain disorder be improved in reference to the concept that it is supposed to identify?
This article examines the dilemmas inherent in psychiatry's attempts to incorporate pain disorders into the standard psychiatric nomenclature. Each succeeding Diagnostic and Statistical Manual has broadened the concept of pain disorders, and, gradually, the diagnosis has become increasingly removed from the original idea of "psychogenic pain." The advantage of this broadening has been the increased use of the diagnosis in clinical settings. ⋯ After examining this problem, the article looks at some alternative models, and offers some generalizations regarding the dimensions of the pain experience. The article ends by tentatively offering some suggestions for future approaches to pain diagnoses in psychiatry.
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This last decade has seen remarkable progress made toward unraveling the mystery of primary headache disorders like migraine and cluster. The vascular theory has been superseded by recognition that neurovascular phenomena seem to be the permissive and triggering factors in migraine and cluster headache. ⋯ Prior to these imaging techniques it was impossible to study the primary headache disorders because these had no structural basis. There is now an increasing body of evidence that the brain is involved primarily in cluster and migraine and that vessel dilatation is an epiphenomenon.
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Curr Pain Headache Rep · Feb 2002
ReviewThe significance of the concept of obsessive-compulsive spectrum disorder to the treatment of chronic nonmalignant pain.
The concept of an obsessive-compulsive spectrum of disorders has become useful. This article reviews what has been learned about these conditions (especially in the last few years), and how this information may be helpful to clinicians and researchers who work with patients with chronic nonmalignant pain.
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With an increased knowledge of neural anatomy and technologic improvement, radiofrequency ablation (RFA) became an often-used technique for the pain control over an extended time period. Today, RFA is used safely for spinal pains of facet or discogenic origin, sympathetically maintained pain, and other pains of neural origin.