Forecasting Migraine Attacks and the Utility of Identifying Triggers
AbstractPurpose of ReviewThis review synthesizes the utility of measuring migraine triggers for the purpose of forecasting future headache attacks. The nature of forecasting models, headache triggers as inputs to such models, and how these trigger exposures can be measured for forecasting are reviewed. A critical evaluation of the existing forecasting models in the context of their potential application for preemptive treatment is considered.Recent FindingsA substantial pool of candidate trigger factors could be considered in the creation of forecasting models. However, because mechanistic information about causal factors ...
Source: Current Pain and Headache Reports - July 16, 2018 Category: Neurology Source Type: research

Emerging Treatments in Episodic Migraine
AbstractPurpose of ReviewThe purpose of this review is to evaluate and describe recent and emerging treatment options for episodic migraine.Recent FindingsRecent advances have been made in better understanding the pathophysiology of migraine, which has led to further investigation of potential new pharmacologic and non-pharmacologic treatment options.SummaryA number of new medications are emerging for the acute and preventive treatment of migraine, including CGRP monoclonal antibodies, CGRP receptor antagonists, serotonin 5-HT1F agonists, and PACAP receptor monoclonal antibodies. Additionally, newer studies on existing non...
Source: Current Pain and Headache Reports - July 16, 2018 Category: Neurology Source Type: research

A Review of Recent Advances in Ultrasound, Placed in the Context of Pain Diagnosis and Treatment
AbstractUltrasound plays a significant role in the diagnosis and treatment of pain, with significant literature reaching back many years, especially with regard to diagnostic ultrasound and its use for guiding needle-based delivery of drugs. Advances in ultrasound over at least the last decade have opened up new areas of inquiry and potential clinical efficacy in the context of pain diagnosis and treatment. Here we offer an overview of the recent literature associated with ultrasound and pain in order to highlight some promising frontiers at the intersection of these two subjects. We focus first on peripheral application o...
Source: Current Pain and Headache Reports - July 10, 2018 Category: Neurology Source Type: research

Complexities of Perioperative Pain Management in Orthopedic Trauma
AbstractPurpose of ReviewThis review discusses both obvious and hidden barriers in trauma patient access to pain management specialists and provides some suggestions focusing on outcome optimization in the perioperative period.Recent FindingsOrthopedic trauma surgeons strive to provide patients the best possible perioperative pain management, while balancing against potential risks of opioid abuse and addiction. Surgeons often find they are ill-prepared to effectively manage postoperative pain in patients returning several months following trauma surgery, many times still dependent on opioids for pain control. Some individ...
Source: Current Pain and Headache Reports - July 10, 2018 Category: Neurology Source Type: research

Occipital Headaches and Neuroimaging in Children
AbstractPurpose of ReviewThe goal of this review is to outline the prevalence and significance of occipital headaches in children and how they relate to neuroimaging findings. We seek to evaluate the concern that occipital headaches in children are indicative of secondary headache pathology by reviewing the yield of neuroimaging in pediatric patients with occipital headache location.Recent FindingsOccipital headaches are a common presentation of primary headache disorders in children, seen in 7 –16% of children presenting for evaluation of headache and in up to 20% of children diagnosed with migraine in the emergency...
Source: Current Pain and Headache Reports - July 10, 2018 Category: Neurology Source Type: research

Headaches in Patients with Pituitary Tumors: a Clinical Conundrum
AbstractPurpose of ReviewPituitary tumors account for approximately 17% of all intracranial neoplasms, with the majority being pituitary adenomas. Often, these are found incidentally during a workup for headache; however, the relationship between symptom and pathology remains unclear. The purpose of this article is to review the most recent literature on the epidemiology, pathophysiology, and management of headaches in patients with pituitary tumors.Recent FindingsThe current literature is limited, with few prospective trials focusing on this question. With the exception of pituitary apoplexy, the relationship between head...
Source: Current Pain and Headache Reports - July 4, 2018 Category: Neurology Source Type: research

SUNCT and SUNA: an Update and Review
AbstractPurpose of ReviewThe purpose of this review is to provide an update on the clinical features, diagnosis, pathogenesis, epidemiology, and treatment of the rare primary headache disorders short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA). Together these entities are known as short-lasting unilateral neuralgiform headache attacks (SUNHA).Recent FindingsRecent case reports of secondary SUNCT and SUNA due to medullary infarcts support the theory that the trigeminohypothalamic pat...
Source: Current Pain and Headache Reports - June 21, 2018 Category: Neurology Source Type: research

Syncope and Headache
AbstractPurpose of ReviewWe review the literature on co-occurrence of syncope and headache and share clinical experience.Recent FindingsHeadache in relation to syncope has been the subject of recent interest.SummaryOrthostatic intolerance has an expanding spectrum with three well-defined entities: orthostatic hypotension (OH), neurally mediated hypotension (NMH), and postural tachycardia syndrome (PoTS). Syncope occurs in patients with OH as well as in patients with episodically occurring NMH. Headache of OH is called coat-hanger ache (CHA) because it affects the neck and shoulders in a coat-hanger pattern. It can serve as...
Source: Current Pain and Headache Reports - June 15, 2018 Category: Neurology Source Type: research

Clinical Presentation and Management of Headache in Pituitary Tumors
This article provides an overview of headache in the setting of pituitary adenoma. The purpose of this article is to educate providers on the association, possible pathophysiology, and the clinical presentation of headache in pituitary tumor.Recent FindingsRecent prospective evaluations indicate that risk factors for development of headache in the setting of pituitary adenoma include highly proliferative tumors, cavernous sinus invasion, and personal or family history of headache. Migraine-like headaches are the predominant presentation. Unilateral headaches are often ipsilateral to the side of cavernous sinus invasion.Sum...
Source: Current Pain and Headache Reports - June 15, 2018 Category: Neurology Source Type: research

Virtual Reality as a Clinical Tool for Pain Management
AbstractPurpose of ReviewTo evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.Recent FindingsRecent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses.SummaryCurrent management techniques for acute and chronic pain, such as opioids...
Source: Current Pain and Headache Reports - June 15, 2018 Category: Neurology Source Type: research

Relapsing Painful Ophthalmoplegic Neuropathy: No longer a “Migraine,” but Still a Headache
AbstractPurpose of ReviewRecurrent painful ophthalmoplegic neuropathy (RPON), formerly known as ophthalmoplegic migraine, is an uncommon disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache. This review discusses the clinical presentation, current understanding of the pathophysiology, key differential diagnoses, and evaluation and treatment of RPON.Recent FindingsThe literature is limited due to the rarity of the disorder. Recent case reports and series continue to suggest the age of first attack is most often during childhood or adolescence as well as a female predominanc...
Source: Current Pain and Headache Reports - June 14, 2018 Category: Neurology Source Type: research

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Co-morbid Pain and Depressive Symptoms
AbstractPurposeReview recent meta-analyses and clinical trials investigating the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) for concurrent pain and depressive symptoms.Recent FindingsRecent meta-analyses have included both pain and depression outcomes in fibromyalgia and chronic pain. Randomized controlled trials have also been conducted in post-herpetic neuralgia, trauma-related headache, and neuropathic pain with attention to both pain and depressive symptoms. In general, studies have demonstrated reduction in pain in patients with fibromyalgia as an add-on treatment, post-herpetic neuralgia, ...
Source: Current Pain and Headache Reports - June 14, 2018 Category: Neurology Source Type: research

Chiari Headache
AbstractPurpose of ReviewChiari malformations (CM) are a group of neuroanatomical pathologies resulting from overcrowding of the hindbrain. The purpose of this review is to characterize Chiari headache (CH) and describe diagnosis and treatment of the condition.Recent FindingsRecent research has helped solidify the criteria for diagnosis of CH. Imaging studies have expanded our understanding of the morphological features producing them and helped to better characterize the pathophysiology. Additionally, identifying this unusual headache disorder accurately has helped with specific treatment options.SummaryCH is a disabling ...
Source: Current Pain and Headache Reports - June 14, 2018 Category: Neurology Source Type: research

Perioperative Management of Patients with Addiction to Opioid and Non-opioid Medications
AbstractPurpose of ReviewWith the rise of the opioid epidemic, anesthesiologists will find themselves faced with opioid-addicted patients more frequently. Addiction to opioids may also occur concurrently with abuse of other non-opioid medications. Our review article seeks to outline an armamentarium of pain management strategies in the perioperative period for these patients with addiction to opioid and non-opioid medications.Recent FindingsStatistics from the CDC demonstrate a shocking increase in opioid prescription rates and opioid-related deaths. Furthermore, opioid-addicted patients have notoriously undertreated pain ...
Source: Current Pain and Headache Reports - June 14, 2018 Category: Neurology Source Type: research

Headache Attributed to Airplane Travel: A Review of Literature
AbstractPurpose of ReviewHeadaches due to airplane travel are rare but documented in the literature. We aim to provide a review of diagnostic criteria and treatment for this condition.Recent FindingsSeveral cases of this syndrome have been reported since it was first described in 2004. Airplane headache is classified as unilateral, stabbing, orbito-frontal pain, lasting under 30  min, and occurs during ascent or descent of a plane. Patients with this condition can develop anxiety and fear of flying given the intensity and severity of the pain. The pathophysiology of this syndrome is unknown, but theories include suspe...
Source: Current Pain and Headache Reports - June 14, 2018 Category: Neurology Source Type: research

The Challenges of Cervicogenic Headache
AbstractPurpose of ReviewThe purpose of this manuscript is to illuminate the diagnostic challenges in patients who present with both headache and neck pain.Recent FindingsThe differential diagnosis for headache and neck pain includes many conditions. Furthermore, cervical musculoskeletal abnormalities including head forward posture and myofascial trigger points may play an overlapping role in many of these conditions.SummaryMultiple headache disorders may be present within the same patient. A multidisciplinary team approach addressing all components of the headache may lead to better outcomes for these patients. (Source: C...
Source: Current Pain and Headache Reports - June 13, 2018 Category: Neurology Source Type: research

Labeling Morphine Milligram Equivalents on Opioid Packaging: a Potential Patient Safety Intervention
AbstractPurpose of ReviewGiven that the primary cause of overdose death in the USA is related to prescribed opioids, one potential strategy to improve awareness and decrease morbidity and/or mortality could include improved labeling. Specific patient populations which significantly struggle with adverse outcomes related to opioid abuse are seen in palliative care, chronic pain, and acute pain treatment settings.Recent FindingsAn unexplored option for improving the healthcare quality and safety for patients currently prescribed opioids would be to require pharmaceutical companies to provide a morphine milligram equivalent (...
Source: Current Pain and Headache Reports - May 31, 2018 Category: Neurology Source Type: research

Motor Cortex Stimulation for Deafferentation Pain
AbstractPurpose of ReviewSince the early 1990s, motor cortex stimulation (MCS) has been a unique treatment modality for patients with drug-resistant deafferentation pain. While underpowered studies and case reports have limited definitive, data-driven analysis of MCS in the past, recent research has brought new clarity to the MCS literature and has helped identify appropriate indications for MCS and its long-term efficacy.Recent FindingsIn this review, new research in MCS, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) are analyzed and compared with historical landma...
Source: Current Pain and Headache Reports - May 23, 2018 Category: Neurology Source Type: research

Animal Models of Chronic Migraine
AbstractPurpose of ReviewChronic migraine (CM) is a recalcitrant subtype of migraine which causes high degrees of disability, poor treatment responses, and frequent recurrences in sufferers. However, the pathophysiological mechanisms underlying the development and chronification of migraine attacks remain incompletely understood. A validated animal model could help to decipher the pathogenic mechanism of the disease, facilitating the development of possible therapeutic strategies for CM. In this review, we aimed to summarize current animal models of CM and discuss the validity of these models.Recent FindingsSeveral methods...
Source: Current Pain and Headache Reports - May 19, 2018 Category: Neurology Source Type: research

Pain, Headache, and Other Non-motor Symptoms in Myasthenia Gravis
AbstractPurpose of ReviewMyasthenia gravis (MG) is traditionally conceptualized as a disease with purely motor manifestations. This paper reviews the supporting evidence and pathophysiology of non-motor symptoms in MG, including pain, headache, special sense and autonomic dysfunction, sleep disturbance, and cognitive and psychosocial issues.Recent FindingsWork in this area has been limited. Recent studies have identified bodily pain and headache as common complaints in patients with MG. A growing literature also suggests that there may be an association of MG and sleep disturbance (both obstructive sleep apnea and sleep cy...
Source: Current Pain and Headache Reports - May 3, 2018 Category: Neurology Source Type: research

Stem Cell Therapy for Osteonecrosis of the Femoral Head: Current Trends and Comprehensive Review
AbstractPurpose of ReviewOsteonecrosis of the femoral head (ONFH) is a common and frequently occurring disease. It is caused by interruption of blood supply with different etiologies. ONFH leads to degeneration and necrosis of the subchondral bone of the femoral head and eventually collapse of the femoral head. ONFH has a high disability rate, seriously affecting the quality of living of patients, and often involves middle-aged and younger people.Recent FindingsIn recent years, the technology and understanding of stem cells and regenerative medicine have been developing rapidly. Numerous studies have reported successful re...
Source: Current Pain and Headache Reports - May 3, 2018 Category: Neurology Source Type: research

Atypical Facial and Head Pain in Childhood and Adolescence
AbstractPurpose of ReviewThis review will consider forms of atypical facial and head pain in children and adolescents. A brief and general overview of typical head and facial pains and treatments will be offered. Moreover, atypical head and face pain will be discussed with treatment options.Recent FindingsThe most recent literature including case reports will be evaluated; possible pathophysiological mechanisms, resulting disabilities, and family and social impact will be discussed.SummaryGeneral indications for pharmacological treatment will be reviewed, when needed in more disabling cases. Also, non-pharmacological treat...
Source: Current Pain and Headache Reports - May 3, 2018 Category: Neurology Source Type: research

Post-operative Weaning of Opioids After Ambulatory Surgery: the Importance of Physician Stewardship
AbstractPurpose of ReviewWe performed a systematic review to elucidate the current guidelines on weaning patients from opioids in the post-operative ambulatory surgery setting, and how pain management intraoperatively can impact this process.DesignThe review highlights the most up-to-date research from clinical trials, patient reports, and retrospective studies regarding both the current guidelines and weaning of opioid analgesia in ambulatory surgery setting.Recent FindingsA striking paucity of convincing evidence exists on ambulatory postoperative pain management discontinuation or weaning of pain medications. However, r...
Source: Current Pain and Headache Reports - May 3, 2018 Category: Neurology Source Type: research

Obesity and Migraine in Childhood
AbstractPurpose of ReviewThe purpose of this work was to review the current literature on the epidemiology and pathophysiology of pediatric obesity and migraine, underlying pathogenic mechanisms that may explain the association between the two disorders, and the effects of treatment.Recent FindingsIn children and adolescents, the bulk of the available data support an association between obesity and headache disorders in general, though a small number of studies contradict these findings. Relative to the adult population, however, few studies have focused specifically on migraine, and no wide-ranging meta-analyses have been...
Source: Current Pain and Headache Reports - May 3, 2018 Category: Neurology Source Type: research

CGRP Monoclonal Antibodies for the Preventative Treatment of Migraine
AbstractPurpose of ReviewCGRP is a key neuropeptide in migraine pathophysiology. The blockade of the CGRP pathway at the side of the CGRP receptor of the CGRP peptide leads to the interruption of trigeminal nerve system-mediated headache syndromes such as migraine. Monoclonal antibodies (mAbs) targeting the CGRP pathway have been developed and are currently under investigation for episodic (EM) and chronic migraine (CM) prevention. Here, we report data from these clinical trials.Recent FindingsPlacebo-controlled, randomized double-blind phase studies of CGRP mAbs in episodic and chronic migraine have shown that the specifi...
Source: Current Pain and Headache Reports - April 6, 2018 Category: Neurology Source Type: research

New Advances in Acute Postoperative Pain Management
This article highlights some of the promising new advances and approaches in postoperative pain management.Recent FindingsOver the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

The Evidence for the Role of Nutraceuticals in the Management of Pediatric Migraine: a Review
AbstractPurpose of ReviewNutraceuticals are a form of complementary and alternative medicine that is commonly used by children and adolescents with migraine. In this review, observational studies, randomized controlled trials, systematic reviews, and meta-analyses on the efficacy and safety of single compound nutraceuticals for the management of migraine in children and adolescents were identified through a literature search of MEDLINE, Embase, and EBM Reviews —Cochrane Central Register of Controlled Trials.Recent FindingsTwenty-one studies were reviewed, of which 11 were observational studies, 7 were randomized cont...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

Is Migraine Primarily a Metaboloendocrine Disorder?
AbstractPurpose of the ReviewThe goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.Recent FindingsRecently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a sig...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

Evidence-Based Non-Pharmacological Therapies for Fibromyalgia
AbstractPurpose of ReviewFibromyalgia (FM) is the second most common rheumatologic pain disorder after osteoarthritis with a multisystem presentation. While the treatment of FM in a clinical setting incorporates both pharmacologic and non-pharmacologic modalities, the present investigation reviews evolving literature on cognitive behavioral and complementary medical therapies. The recent medical literature on FM was reviewed between 2012 and 2017 via MEDLINE and the Cochrane Central Registry of Controlled Trials, with an emphasis on randomized controlled trials, meta-analyses, and evidence-based treatment guidelines.Recent...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

America ’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis
AbstractPurpose of ReviewIn the USA, there has been a sharp increase in heroin, prescription opiate, and illicitly manufactured fentanyl abuse with overdoses tripling since the 1990s. Several states have been deemed as “high-burden” abuse states where there is a greater proportion of synthetic opiate use. During the same period that prescription limitations were initially implemented throughout the country, the fentanyl epidemic started nationwide.Recent FindingsIn the setting of data demonstrating an almost fourfold increase in overdose deaths from 1999 to 2008, states began restricting access to Food and Drug...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

Global Supply and Demand of Opioids for Pain Management
AbstractPurpose of ReviewThe goal of this review is to evaluate the global supply and demand of opioids used for pain management and discuss how it relates to the utilization of opioids around the world. The purpose of the review is also to determine the factors that contribute to inappropriate pain management.Recent FindingsThe total global production of opium for opioid manufacturing is enough to supply the growing global demands. However, licit opioids are only consumed by 20% of the world population. Most people throughout the world had no access to opioid analgesics for pain relief in case of need. Opioid misuse and a...
Source: Current Pain and Headache Reports - April 4, 2018 Category: Neurology Source Type: research

Novel Pharmacological Nonopioid Therapies in Chronic Pain
AbstractPurpose of ReviewOpioid use and abuse has led to a worldwide opioid epidemic. And while opioids are clinically useful when appropriately indicated, they are associated with a wide range of dangerous side effects and whether they are effective at treating or eliminating chronic pain is controversial. There has long been a need for the development of nonopioid alternative treatments for patients that live in pain, and until recently, only a few effective treatments were available. Today, there are a wide range of nonopioid treatments available including NSAIDs, acetaminophen, corticosteroids, nerve blocks, SSRIs, neu...
Source: Current Pain and Headache Reports - April 3, 2018 Category: Neurology Source Type: research

Recommendations for Substance Abuse and Pain Control in Patients with Chronic Pain
AbstractPurpose of ReviewIn the present investigation, current literature on the relationship between substance abuse and pain is evaluated in order to improve clinical management and its implications on the increasingly challenging chronic pain and substance abuse epidemic. The relationship between substance abuse and chronic pain are evaluated, and this review provides recommendations on the management of this special patient population.Recent FindingsCurrently, there are limited guidelines for prescribing opioids and other analgesics in the chronic pain population. As this field of practice continues to evolve, it is es...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke
AbstractPurpose of ReviewCerebral hyperperfusion syndrome (CHS) is a rare but significant complication after carotid revascularization and is increasingly recognized after acute stroke treatments. In this review, we discuss the epidemiology and pathophysiology of CHS, clinical presentation including ipsilateral headache, seizures, and focal neurological deficits, and radiographic presentation. We propose preventive therapies with emphasis on acute stroke post-thrombectomy hyperperfusion.Recent FindingsCHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke. Pr...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

The Role of Endothelin in the Pathophysiology of Migraine —a Systematic Review
AbstractPurpose of ReviewVasoactive peptides play a key role in the attack-initiating cascade of migraine. Recent studies have highlighted a potentially important role for endothelin-1, a potent vasoconstrictor peptide, in migraine pathophysiology. Here, we review the current data on endothelin ’s involvement in migraine.Recent FindingsWe identified 23 articles. Nine studies reported on endothelin-1 plasma concentrations in patients with migraine, eight studies investigated relevant genetic associations, five studies investigated endothelin-1 and spreading depression in animals, and one randomized controlled clinical...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Treatment of the Patient with Refractory Headache
AbstractPurpose of ReviewTo review recent studies outlining the management of refractory primary headache patients, including emerging therapies such as neuromodulation. This includes both noninvasive and invasive neuromodulation techniques. Recent studies on the management of medication overuse headache were also reviewed.Recent FindingsThere is no consensus as yet on the definitions of refractory chronic migraine and chronic cluster headache although there is broad agreement on some aspects of these terms. The importance of identifying medication overuse headache and dealing effectively with it has been highlighted in se...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Novel Interventional Nonopioid Therapies in Headache Management
AbstractPurpose of ReviewHeadaches encompass a broad-based category of a symptom of pain in the region of the head or neck. For those patients who unfortunately do not obtain relief from conservative treatment, interventional techniques have been developed and are continuing to be refined in an attempt to treat this subset of patients with the goal of return of daily activities. This investigation reviews various categories of headaches, their pathophysiology, and types of interventional treatments currently available.Recent FindingsInjection of botulinum toxin has been shown to increase the number of headache free days fo...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

A Review of Current Treatment Options for Coccygodynia
AbstractPurpose of ReviewCoccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. For patients who do not respond to conservative therapies, there are further interventions available. This includes local injection of local anesthetics and steroids, neurolysis of sacral nerve roots, caudal epidural block, pulse radiofrequency (PRF), intra-rectal massage and manipulation, ganglion impar block, levator ani massage and stretching, coccyx manipulation, and coccygectomy. The purpo...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Cyclic Vomiting Syndrome in Children
AbstractPurpose of ReviewCyclic vomiting syndrome (CVS) is a misrecognized and probably underdiagnosed episodic syndrome associated with migraine, occurring preferentially in childhood. Attacks are stereotyped for each individual, with predictable periodicity. This review summarizes recent clinical and paraclinical observations in this syndrome, and current approaches in explorations and therapeutics.Recent FindingsClinical phenotype during prodromal, vomiting, and recovery phases contains visceral and neuropsychological symptoms, but also cranial and systemic symptoms. Some clinical arguments as circadian or circannual pe...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Spinal Cord Stimulation, MILD Procedure, and Regenerative Medicine, Novel Interventional Nonopioid Therapies in Chronic Pain
AbstractPurpose of ReviewChronic pain is a highly prevalent condition affecting millions of individuals.Recent FindingsIn recent years, newer treatments have emerged that are changing the way clinicians treat pain pathogenesis, including novel nonopioid strategies. In this regard, spinal cord stimulation, the MILD procedure, and regenerative medicine have shown promise. This review summarizes recent literature on these three emerging treatment strategies.SummaryThe results of this review suggest that under certain conditions, spinal cord stimulation, the MILD procedure, and regenerative medicine can be effective treatment ...
Source: Current Pain and Headache Reports - March 19, 2018 Category: Neurology Source Type: research

Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment
AbstractPurpose of ReviewThe complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.Recent FindingsThere are a bro...
Source: Current Pain and Headache Reports - March 14, 2018 Category: Neurology Source Type: research

Correction to: Treatment Strategies for the Opioid-Dependent Patient
AbstractThe original version of this article contains an error in the gender listing of the first author in the Conflict of Interest statement. (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - March 6, 2018 Category: Neurology Source Type: research

The Opioid Crisis: a Comprehensive Overview
AbstractPurpose of ReviewThe opioid crisis most likely is the most profound public health crisis our nation has faced. In 2015 alone, 52,000 people died of drug overdoses, with over 30,000 of those people dying from opioid drugs. A recent community forum led by the Cleveland Clinic contrasted this yearly death rate with the loss of 58,000 American lives in 4  years of the Vietnam War. The present review describes the origins of this opioid epidemic and provides context for our present circumstances.Recent FindingsAlarmingly, the overwhelming majority of opioid abusers begin their addiction with prescription medication...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Pain States, the Opioid Epidemic, and the Role of Radiologists
AbstractPurpose of ReviewThe prevalence of chronic pain and prescription opioid abuse has resulted in epidemic problems for patients and clinicians. The consequences are taking a heavy toll on patients, physicians, and society. Specific to radiology, a significant need exists for best practice assessment and treatment approaches for pain management, as patients with chronic pain often undergo radiological tests of unclear clinical relevance.Recent FindingsThe USA is amid an opioid-prescribing epidemic and resultant overdose public health emergency. A variety of reasons, which are examined in this manuscript, have contribut...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Systematic Review of Radiofrequency Ablation and Pulsed Radiofrequency for Management of Cervicogenic Headaches
AbstractPurpose of ReviewCervicogenic headache (CHA) is a secondary headache which has a source in the upper cervical spine. Many traditional analgesic choices lack good efficacy in managing the associated pain. As a result, in management of CHA, radiofrequency ablation (RFA) or pulse radiofrequency (PRF) has been tried with success. Our study investigated the use of RFA and PRF for the management of CHA.Recent FindingsIn the present investigation, a review of the literature was conducted using PubMed (1966 to February 2017). The quality assessment was determined using The Cochrane Risk of Bias. After initial search and co...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Headache Diagnosis in Children and Adolescents
This article reviews different types of pediatric headaches and headache evaluation in children and teens, and focuses on the approach for diagnosis of secondary headaches.Recent FindingsCommon thought is that increased frequency and severity of headache may reflect secondary pathology; however, headache phenotype may not be fully developed and can evolve in adolescence or adulthood. Headache location, particularly occipital headache alone, does not necessarily signify secondary intracranial pathology. Certain warning signs warrant neuroimaging, but others only warrant imaging in certain clinical contexts. Brain MRI is the...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Cognitive Behavioral Therapy (CBT) for Subacute Low Back Pain: a Systematic Review
AbstractPurpose of ReviewChronic low back pain (CLBP) is a major source of physical and psychiatric morbidity and mortality, and the current overreliance on opioid analgesics has contributed to a burgeoning epidemic in the USA. Cognitive behavioral therapy (CBT) is an empirically supported treatment for CLBP, but little information exists regarding its potential efficacy for CLBP ’s precursor condition, subacute low back pain (sALBP), defined here as having a 7–12-week duration. Earlier intervention with CBT at the sALBP stage could produce larger clinical benefits. This systematic review was undertaken to char...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Migraine and Autonomic Dysfunction: Which Is the Horse and Which Is the Jockey?
AbstractPurpose of ReviewSymptoms of autonomic dysfunction are common in patients with migraine, both during and between migraine attacks. Studies evaluating objective autonomic testing in patients have found significant, though somewhat conflicting results. The purposes of this review are to summarize and interpret the key findings of these studies, including those evaluating heart rate variability, autonomic reflex testing, and functional imaging in patients with migraine. The neuroanatomy of the central autonomic network as it relates to migraine is also reviewed.Recent FindingsSeveral studies have evaluated autonomic b...
Source: Current Pain and Headache Reports - February 23, 2018 Category: Neurology Source Type: research

Pediatric Intracranial Hypertension: a Current Literature Review
AbstractPurpose of ReviewThe purpose of this review is to provide an update on pediatric intracranial hypertension.Recent FindingsThe annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population.SummaryPediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of l...
Source: Current Pain and Headache Reports - February 13, 2018 Category: Neurology Source Type: research

Complex Regional Pain Syndrome, Current Concepts and Treatment Options
AbstractPurpose of ReviewComplex regional pain syndrome (CRPS) refers to a chronic pain condition that is characterized by progressively worsening spontaneous regional pain without dermatomal distribution. The symptomatology includes pain out of proportion in time and severity to the inciting event. The purpose of this review is to present the most current information concerning epidemiology, diagnosis, pathophysiology, and therapy for CRPS.Recent FindingsIn recent years, discovery of pathophysiologic mechanisms of CRPS has led to significant strides in the understanding of the disease process.SummaryContinued elucidation ...
Source: Current Pain and Headache Reports - February 5, 2018 Category: Neurology Source Type: research