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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

Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications
This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature.Recent FindingsChronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Y...
Source: Current Pain and Headache Reports - February 5, 2018 Category: Neurology Source Type: research

Intrathecal Drug Delivery and Spinal Cord Stimulation for the Treatment of Cancer Pain
AbstractPurpose of ReviewThe purpose of the present investigation is to summarize the body and quality of evidence including the most recent studies in support of intrathecal drug delivery systems and spinal cord stimulation for the treatment of cancer-related pain.Recent FindingsIn the past 3  years, a number of prospective studies have been published supporting intrathecal drug delivery systems for cancer pain. Additional investigation with adjuvants to morphine-based analgesia including dexmedetomidine and ziconotide support drug-induced benefits of patient-controlled intrathecal anal gesia. A study has also been r...
Source: Current Pain and Headache Reports - February 5, 2018 Category: Neurology Source Type: research

Migraine and the Hippocampus
AbstractPurpose of ReviewThe hippocampus is involved in pain processing, pain-related attention and anxiety, and stress response. The present review compiles the present knowledge of hippocampal volume, activity, and connectivity regarding migraine.Recent FindingsFor hippocampal volume, a longitudinal study discovered decreased volume in newly diagnosed migraine patients after 1  year. Two cross-sectional studies suggested an adaptive increase of volume at low headache frequency and a maladaptive decrease of volume at higher headache frequency. Patients who carried a COMT Val homozygous were found to have larger hippo...
Source: Current Pain and Headache Reports - February 5, 2018 Category: Neurology Source Type: research

The Effect of Ketamine Infusion in the Treatment of Complex Regional Pain Syndrome: a Systemic Review and Meta-analysis
AbstractPurpose of ReviewComplex regional pain syndrome (CRPS) is a painful debilitating neurological condition that accounts for approximately 1.2% of adult chronic pain population. Ketamine, an NMDA receptor antagonist, is an anesthetic agent that has been used by some pain specialists for CRPS. There is a growing body of clinical evidence to support the use of ketamine in the treatment of neuropathic pain, especially CRPS. This meta-analysis study was aimed to examine the efficacy of ketamine in the treatment of CRPS.Recent FindingsA search of Embase, Pubmed, Web of Knowledge, Cochrane, ClinicalTrial.gov, andFDA.gov bet...
Source: Current Pain and Headache Reports - February 5, 2018 Category: Neurology Source Type: research

Medical Cannabis for Neuropathic Pain
We examined current basic scientific research and data from recent randomized controlled trials (RCTs) evaluating medical cannabis for the treatment of neuropathic pain. These studies involved patients with diverse etiologies of neuropathic pain and included medical cannabis with different THC concentrations and routes of administration. Multiple RCTs demonstrated efficacy of medical cannabis for treating neuropathic pain, with number needed to treat (NNT) values similar to current pharmacotherapies.SummaryAlthough limited by small sample sizes and short duration of study, the evidence appears to support the safety and eff...
Source: Current Pain and Headache Reports - February 1, 2018 Category: Neurology Source Type: research

Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome
AbstractPurpose of ReviewTo describe the current understanding of the role of three-phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients.Recent FindingsCRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available...
Source: Current Pain and Headache Reports - February 1, 2018 Category: Neurology Source Type: research

Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT
AbstractChronic pain is a common medical condition. Patients who suffer uncontrolled chronic pain may require interventions including spinal injections and various nerve blocks. Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilization of image guidance has dramatically improved the accuracy and safety of these interventions. The first image guidance technology adopted by pain specialists was flu...
Source: Current Pain and Headache Reports - January 26, 2018 Category: Neurology Source Type: research

Radio Frequency Ablation and Pulsed Radiofrequency for Treating Peripheral Neuralgias
AbstractPurpose of ReviewPeripheral nerve pain is common among patients with typical management including the use of pain medications, neuropathic agents, steroid injections, and nerve blocks. Additionally, the use of pulsed radiofrequency (PRF) and radiofrequency ablation (RFA) can be used in the management of chronic peripheral nerve pain. Previous studies investigating the effectiveness of RFA and PRF, typically case reports, have demonstrated that peripheral nerve RFA and PRF have the potential to provide relief of chronic pain for long duration. Our study aimed at testing efficacy of RFA/PRF for treating peripheral ne...
Source: Current Pain and Headache Reports - January 25, 2018 Category: Neurology Source Type: research

A Short Review of the Non-invasive Transcutaneous Pericranial Electrical Stimulation Techniques and their Application in Headache
AbstractPurpose of ReviewIn this short review, the most common non-invasive neuromodulatory techniques will be described, along with their advantages and disadvantages and their application in headache. Available preventive treatments can be unhelpful or may have unpleasant side effects; moreover, the rate of response to preventive drugs does not exceed 50%, lower in chronic migraine; alternative options would be welcome. Though the concept of neuromodulation was originally developed with invasive methods, newer non-invasive techniques are appearing.Recent FindingsThe novel neuromodulatory techniques have been developed wi...
Source: Current Pain and Headache Reports - January 19, 2018 Category: Neurology Source Type: research

Medical Marijuana: Current Concepts, Pharmacological Actions of Cannabinoid Receptor Mediated Activation, and Societal Implications
AbstractPurpose of ReviewThe purpose of the following review is to summarize the history and current policies related to marijuana use and prevalence, basic and clinical science pharmacological literature regarding efficacy, subpopulations of concern, and varying policies regarding its use at present.Recent FindingsWith the increasingly widespread utilization of marijuana, there is also a growing complexity of public health policy, regulation, and necessity to further assess the medical indications and adverse long-term effects of marijuana use.SummaryHealth care providers as well as the general public must be prepared to ...
Source: Current Pain and Headache Reports - January 18, 2018 Category: Neurology Source Type: research

Giant Cell Arteritis: Practical Pearls and Updates
AbstractPurpose of ReviewThe purpose of this review is to summarize recent updates and distill practical points from the literature which can be applied to the care of patients with suspected and confirmed giant cell arteritis (GCA).Recent FindingsContemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial.SummaryThere have been significant parallel advances ...
Source: Current Pain and Headache Reports - January 17, 2018 Category: Neurology Source Type: research

Neuroimaging Findings in Patients with Medication Overuse Headache
AbstractMedication overuse headache (MOH) is a secondary headache syndrome defined as the deterioration of the headache associated with the overuse of analgesics. The prevalence of MOH is 1 –2% in the general population and even up to 50% in special clinics. Overuse of abortive medications is highly associated with chronic daily headaches and also a known risk factor for headache evolution. Possible mechanisms include neural plasticity changes such as sensitization and defective endo genous pain inhibition. Psychological studies have suggested dependence, even addiction, in patients with MOH. Neuroimaging studies hav...
Source: Current Pain and Headache Reports - January 16, 2018 Category: Neurology Source Type: research

Correction to: Sphenopalatine Ganglion Block in the Management of Chronic Headaches
AbstractThe original version of this article contains an error in an author ’s first name. The spelling of Dr. Mojica’s first name should read “Jeffrey” instead of “Jeffery.” (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - November 20, 2017 Category: Neurology Source Type: research

Correction to: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa
AbstractThe original version of this article contains an error in the spelling of the title. The title should read: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa. (Source: Current Pain and Headache Reports)
Source: Current Pain and Headache Reports - November 18, 2017 Category: Neurology Source Type: research

Headache in Resource-Limited Settings
AbstractPurpose of ReviewThis review summarizes the unmet need of headache burden and management in resource-limited settings. It provides a general overview of the nuances and peculiarities of headache disorders in resource-limited settings. The review delivers perspectives and explanations for the emerging burden of both primary and secondary headache disorders. Important discussion on demographic and epidemiologic transition pertinent to low-resource settings is included. A critical analysis of headache disorders is made within the context of growing burden non-communicable disorders in low-resource countries. Challenge...
Source: Current Pain and Headache Reports - November 16, 2017 Category: Neurology Source Type: research

Nerve Blocks in Pediatric and Adolescent Headache Disorders
AbstractPurpose of ReviewPeripheral nerve blocks of the scalp, mainly greater occipital nerve blocks, have received a renewed interest amongst pediatric providers as they offer an alternate option to provide both acute and chronic relief from the suffering of children with difficult to treat headaches. This narrative review will provide an in-depth discussion of the published pediatric-specific studies exploring the utility of nerve blocks for pediatric headache disorders.Recent FindingsA total of seven pediatric publications have been reported to date and reveal excellent therapeutic effectiveness of bilateral greater occ...
Source: Current Pain and Headache Reports - November 9, 2017 Category: Neurology Source Type: research

Pain, Psychological Comorbidities, Disability, and Impaired Qualify of Life in Hidradenitis Suppurativa
AbstractPurpose of ReviewHidradenitis suppurativa (HS) is a chronic, painful dermatologic disease characterized by recurrent inflammatory nodules and abscesses of intertriginous areas such as the axilla and groin. People with HS suffer from greater pain and associated psychological comorbidities, including depression, anxiety, disability, and impairments in quality of life (QoL), compared to those with other dermatologic conditions. Our review focuses on the occurrence of pain and these relationships.Recent FindingsThe existing literature indicates that acute and chronic pain, depression, anxiety, and disability all contri...
Source: Current Pain and Headache Reports - November 1, 2017 Category: Neurology Source Type: research

Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment
AbstractPurpose of ReviewThis review presents findings from investigations of migraine in children and adults. Similarities and differences in the presentation, related consequences, and treatments between children and adults are reviewed.Recent FindingsSignificant similarities exist in the presentation, disability, and treatments for migraine between children and adults. Despite such similarities, many adult migraine treatments adapted for use in children are not rigorously tested prior to becoming a part of routine care in youth. Existing research suggests that not all approaches are equally effective across age groups. ...
Source: Current Pain and Headache Reports - October 25, 2017 Category: Neurology Source Type: research

Neuroimaging of Cavernous Malformations
This article discusses the most recent guidelines including imaging diagnostic criteria and radiographic standards of CCMs and reviews the utility of currently available imaging techniques.Recent FindingsGradient echo T2*-weighted imaging and susceptibility-weighted imaging are the recommended imaging protocols for evaluation of suspected CCMs. Diffusion tensor imaging-based tractography provides visualization of the eloquent white matter tracks in the brain. This imaging is increasingly used in clinical practice to assist in selecting the optimal surgical approach, especially for brainstem lesions. Quantitative susceptibi...
Source: Current Pain and Headache Reports - October 13, 2017 Category: Neurology Source Type: research

Migraine Treatment in Pregnancy and Lactation
AbstractPurpose of ReviewSince up to 40.9% of reproductive aged women have migraine —and reproductive-aged women often reproduce—it is essential that we have good information and guidelines regarding proper treatment of migraine during pregnancy and lactation.Recent FindingsA review of articles published in the last year on the treatment of migraine during pregnancy and lactation found dishearteningly little. Nevertheless, this article will review the risk/safety information related to migraine treatment in both pregnancy and lactation, citing both new and less recent publications.SummaryThere is little if any ...
Source: Current Pain and Headache Reports - October 4, 2017 Category: Neurology Source Type: research

Treatment Strategies for the Opioid-Dependent Patient
AbstractPurpose of ReviewThis review is intended to help the headache physician think through and plan for management issues concerning the use of opioids. We ask the headache physician to consider if there are instances where prescribing or continuing prescriptions of opiates is plausible, and if so, how can the physician proceed as safely as possible. Our goal is to start a conversation regarding the inevitable encounter with a patient on opiates or requesting opiates.Recent FindingsThe use of opiates in our society has reached a crisis in staggering death and addiction rates. Recent guideline published by the CDC can as...
Source: Current Pain and Headache Reports - September 20, 2017 Category: Neurology Source Type: research

External Nasal Neuralgia: an Update
AbstractPurpose of ReviewExternal nasal neuralgia is a rare syndrome of atypical facial pain for which there is limited reports in the scientific literature. We aim to review diagnosis and provide an update on treatments for this rare condition.Recent FindingsEtiology has been documented as post-traumatic due to direct trauma to the nose area and in few case reports, idiopathic. Sensory innervation of the nose arises from the ophthalmic and maxillary divisions of the trigeminal nerve. Direct injury to the nerve appears to be the etiology of post-traumatic external nasal neuralgia. Pathophysiology for idiopathic nasal neura...
Source: Current Pain and Headache Reports - September 13, 2017 Category: Neurology Source Type: research

Preoperative Assessment for Ambulatory Surgery
AbstractPurpose of ReviewAmbulatory surgery has grown in recent decades in volume and represents a significant number of anesthetics delivered throughout the USA. Preoperative anesthetic assessment in the ambulatory setting has become important because patients with numerous complex comorbidities are now commonplace in this arena. Disease states involving the lungs, the heart, the kidneys, and subpopulations including those who are obese and the elderly commonly receive anesthetics in an ambulatory setting.Recent FindingsThis review presents key aspects of current thinking with regard to preoperative assessment and conside...
Source: Current Pain and Headache Reports - August 31, 2017 Category: Neurology Source Type: research

Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis
AbstractPurpose of ReviewIn contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache.Recent FindingsThe majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17...
Source: Current Pain and Headache Reports - August 26, 2017 Category: Neurology Source Type: research