Headache Collection

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

2011-09-04T23:42:00.000-07:00

Eur Arch Otorhinolaryngol. 2011 Aug 13. [Epub ahead of print]

Source

Department of Otorhinolaryngology, Gazi University School of Medicine, Gazi Ün. Tıp. Fak. KBB A.D., Beşevler, 06500, Ankara, Turkey, utkuaydil@yahoo.com.

Abstract

Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck painentities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

Headache during airplane travel (“airplane headache”): first case in Greece

2011-08-25T04:45:00.000-07:00

The Journal of Headache and Pain
Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"
Evangelia Kararizou¹, Evangelos Anagnostou¹, George P. Paraskevas¹, Sofia D. Vassilopoulou¹, Dimitrios Naoumis², Grigoris Kararizos² and Konstantinos Spengos¹

(1)	Department of Neurology, Athens National University, Eginition Hospital, 72-74 Vas.Sofias av., 11528 Athens, Greece

(2)	Neurological Department, 251 Air Force Hospital, Athens, Greece

Evangelia Kararizou
Email: ekarariz@med.uoa.gr

Received: 21 February 2011 Accepted: 22 March 2011 Published online: 6 April 2011

Abstract

Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15–20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

http://www.springerlink.com/content/t86630777t603224/fulltext.html

Free Full Text (Open Access):

Treatment of neuropathic pain with 5% lidocaine-medicated plaster: Five years of clinical experience

2011-08-23T06:23:00.000-07:00

	July/August 2011, Volume 16 Issue 4: 259-262

C Delorme, M Navez, V Legout, R Deleens, D Moyse BACKGROUND: Neuropathic pain is often severe and adversely affects patients' quality of life. OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine-medicated plaster, in patients attending pain centres. METHODS: Medical records from 467 patients treated with 5% lidocaine- medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow-up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age. RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post-traumatic pain. The time from onset to referral was more than one year in two- thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11-point numerical rating scale score 5.2±2.4 to 8.2±1.6). Treatment with 5% lidocaine-medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications. CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine-medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.

Effects of light deprivation on visual evoked potentials in migraine without aura

2011-07-31T21:40:00.000-07:00

BMC Neurology 2011, 11:91doi:10.1186/1471-2377-11-91


Published:	27 July 2011

Research article

Gianluca Coppola , Julien Cremers , Pascale Gerard , Francesco Pierelli and Jean Schoenen

Abstract (provisional)

Background

The mechanisms underlying the interictal habituation deficit of cortical visual evoked potentials (VEP) in migraine are not well understood. Abnormal long-term functional plasticity of the visual cortex may play a role and it can be assessed experimentally by light deprivation (LD).

Methods

We have compared the effects of LD on VEP in migraine patients without aura between attacks (MO, n=17) and in healthy volunteers (HV, n=17). Six sequential blocks of 100 averaged VEP at 3.1 Hz were recorded before and after 1 hour of LD. We measured VEP P100 amplitude of the 1st block of 100 sweeps and its change over 5 sequential blocks of 100 responses.

Results

In HV, the consequence of LD was a reduction of 1st block VEP amplitude and of the normal habituation pattern. By contrast, in MO patients, the interictal habituation deficit was not significantly modified, although 1st block VEP amplitude, already lower than in HV before LD, further decreased after LD.

Conclusions

Light deprivation is thought to decrease both excitatory and subsequent inhibitory processes in visual cortex, which is in line with our findings in healthy volunteers. The VEP results in migraine patients suggest that early excitation was adequately suppressed, but not the inhibitory mechanisms occurring during long term stimulation and habituation. Accordingly, deficient intracortical inhibition is unlikely to be a primary factor in migraine pathophysiology and the habituation deficit

Highly localized interactions between sensory neurons and sprouting sympathetic fibers observed in a transgenic tyrosine hydroxylase reporter mouse

2011-07-31T21:36:00.000-07:00

Molecular Pain 2011, 7:53 doi:10.1186/1744-8069-7-53
Published: 27 July 2011

Wenrui Xie, Judith A Strong, Juxian Mao and Jun-Ming Zhang

Abstract (provisional)

Background

Sprouting of sympathetic fibers into sensory ganglia occurs in many preclinical pain models, providing a possible anatomical substrate for sympathetically enhanced pain. However, the functional consequences of this sprouting have been controversial. We used a transgenic mouse in which sympathetic fibers expressed green fluorescent protein, observable in live tissue. Medium and large diameter lumbar sensory neurons with and without nearby sympathetic fibers were recorded in whole ganglion preparations using microelectrodes.

Results

After spinal nerve ligation, sympathetic sprouting was extensive by 3 days. Abnormal spontaneous activity increased to 15% and rheobase was reduced. Spontaneously active cells had Aalpha/beta conduction velocities but were clustered near the medium/large cell boundary. Neurons with sympathetic basket formations had a dramatically higher incidence of spontaneous activity (71%) and had lower rheobase than cells with no sympathetic fibers nearby. Cells with lower density nearby fibers had intermediate phenotypes. Immunohistochemistry of sectioned ganglia showed that cells surrounded by sympathetic fibers were enriched in nociceptive markers TrkA, substance P, or CGRP. Spontaneous activity began before sympathetic sprouting was observed, but blocking sympathetic sprouting on day 3 by cutting the dorsal ramus in addition to the ventral ramus of the spinal nerve greatly reduced abnormal spontaneous activity.

Conclusions

The data suggest that early sympathetic sprouting into the sensory ganglia may have highly localized, excitatory effects. Quantitatively, neurons with sympathetic basket formations may account for more than half of the observed spontaneous activity, despite being relatively rare. Spontaneous activity in sensory neurons and sympathetic sprouting may be mutually re-enforcing.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

What initiates a migraine attack? Conclusions from four longitudinal studies of quantitative EEG and steady-state visual-evoked potentials in migraineurs.

2011-07-14T21:32:00.000-07:00

Acta Neurol Scand: 2011: 124 (Suppl. 191): 56–63. © 2011 John Wiley & Sons A/S.

Bjørk M, Stovner LJ, Hagen K, Sand T.

Objectives – Quantitative electroencephalograpic (QEEG) frequency spectra and steady-state visual-evoked potentials (SSVEP) are indicators of corticothalamic excitability (e.g., arousal). Increased interictal excitability is suggested to be an important element in the migraine pathophysiology. In this paper, we summarize our results from four studies of QEEG and SSVEP recordings in migraineurs interictally and in the days before an attack with the intention to shed light on attack-initiating mechanisms.

Material and methods – Thirty-two healthy controls, 33 migraineurs without and eight with aura each had three EEGs with photic stimulation on different days. Using the patient headache diaries, we classified the recordings as interictal, preictal, ictal, or post-ictal retrospectively. Interictal recordings were compared pairwise with attack-related EEGs from the same patient as well as with control EEGs. We also correlated clinical variables with the QEEG and SSVEP data.

Results – Between attacks, we found increased relative theta activity and attenuated medium-frequency photic responses in migraineurs without aura compared with those in controls. Within 36 h before the attack, slow and asymmetric EEG activity developed. Increased trigger sensitivity and photophobia correlated with higher theta power and depressed photic responses. Attack duration, migraine history duration, and pain intensity were associated with EEG slowing.

Conclusions – A general tendency toward EEG slowing and depression of photic responses characterized the migraine group. This pattern was also related to increased severity of symptoms. A change in cortical activity occurred within 36 h before attacks. Our results indicate that thalamocortical hypoexcitability is associated with attack initiation and sensory hypersensitivity in migraine.

What initiates a migraine attack? Conclusions from four longitudinal studies of quantitative EEG and steady-state visual-evoked potentials in migraineurs.

2011-07-06T05:02:00.000-07:00

Acta Neurol Scand: 2011: 124 (Suppl. 191): 56–63. © 2011 John Wiley & Sons A/S.
Bjørk M, Stovner LJ, Hagen K, Sand T.

Objectives – Quantitative electroencephalograpic (QEEG) frequency spectra and steady-state visual-evoked potentials (SSVEP) are indicators of corticothalamic excitability (e.g., arousal). Increased interictal excitability is suggested to be an important element in the migraine pathophysiology. In this paper, we summarize our results from four studies of QEEG and SSVEP recordings in migraineurs interictally and in the days before an attack with the intention to shed light on attack-initiating mechanisms.

Material and methods – Thirty-two healthy controls, 33 migraineurs without and eight with aura each had three EEGs with photic stimulation on different days. Using the patient headache diaries, we classified the recordings as interictal, preictal, ictal, or post-ictal retrospectively. Interictal recordings were compared pairwise with attack-related EEGs from the same patient as well as with control EEGs. We also correlated clinical variables with the QEEG and SSVEP data.

Results – Between attacks, we found increased relative theta activity and attenuated medium-frequency photic responses in migraineurs without aura compared with those in controls. Within 36 h before the attack, slow and asymmetric EEG activity developed. Increased trigger sensitivity and photophobia correlated with higher theta power and depressed photic responses. Attack duration, migraine history duration, and pain intensity were associated with EEG slowing.

Conclusions – A general tendency toward EEG slowing and depression of photic responses characterized the migraine group. This pattern was also related to increased severity of symptoms. A change in cortical activity occurred within 36 h before attacks. Our results indicate that thalamocortical hypoexcitability is associated with attack initiation and sensory hypersensitivity in migraine.

Causes of headache in patients with a primary diagnosis of sinus headache

2011-06-12T12:06:00.000-07:00

European Archives of Oto-Rhino-Laryngology (May 2011)

Foroughipour M, Sharifian SM, Shoeibi A, Ebdali Barabad N, Bakhshaee M;

Headache is a common occurrence among the general population. Although the pain could be a symptom of acute sinusitis, chronic sinusitis is not considered as a usual cause of headache. In addition, autonomic-related symptoms in the sinonasal region may be associated with vascular pain. Confusion regarding these symptoms could lead to an incorrect diagnosis of sinusitis. A prospective cross-sectional study was conducted at two tertiary referral centers with residency programs in otorhinolaryngology, head and neck surgery and neurology. The study included 58 patients with a diagnosis of "sinus headache" made by a primary care physician. Exclusion criteria were as follows: previous diagnosis of migraine or tension-type headache; evidence of sinus infection during the past 6 months; and the presence of mucopurulent secretions. After comprehensive otorhinolaryngologic and neurologic evaluation, appropriate treatment was started according to the final diagnosis and the patient was assessed monthly for 6 months. The final diagnoses were migraine, tension-type headache and chronic sinusitis with recurrent acute episodes in 68, 27 and 5% of the patients, respectively. Recurrent antibiotic therapy was received by 73% of patients with tension-type headache and 66% with migraine. Sinus endoscopy was performed in 26% of the patients. Therapeutic nasal septoplasty was performed in 16% of the patients with a final diagnosis of migraine, and 13% with tension-type headache. Many patients with self-described or primary care physician labeled "sinus headache" have no sinonasal abnormalities. Instead, most of them meet the IHS criteria for migraine or tension-type headache.

Management of vestibular migraine

2011-06-12T12:03:00.000-07:00

Therapeutic Advances in Neurological Disorders
May 2011 vol. 4 no. 3 183-191
Alexandre R. Bisdorf f, Centre Hospitalier Emile Mayrisch, rue Emile Mayrisch, Esch-sur-Alzette, 4003 Luxembourg alexbis@pt.lu

Vestibular Migraine is considered to be the second most common cause of vertigo and the most common cause of spontaneous episodic vertigo. The duration of attacks varies from seconds to days, usually lasting minutes to hours, and they mostly occur independently of headaches. Long-lasting individual attacks are treated with generic antivertiginous and antiemetic drugs. Specific antimigraine drugs are unlikely to be very effective for rescue. The mainstay of the management of vestibular migraine is prophylactic medication. To date, there are no controlled trials available; the body of knowledge builds on case series and retrospective or observational studies. Most drugs are also used for the prevention of migraine headaches. The choice of medication should be guided by its side effect profile and the comorbidities of patients. Betablockers such as propanolol or metoprolol are preferred in patients with hypertension but in the absence of asthma. Anticonvulsants include topiramate when patients are obese, valproic acid and lamotrigine. Lamotrigine is preferred if vertigo is more frequent than headaches. Calcium antagonists include verapamil and flunarizine. If patients have anxiety, tricyclic antidepressants such as amitryptiline or nortryptiline or SSRIs and benzodiazepines such as clonazepam are recommended. Acetazolamide is effective in rare genetic disorders related to migraine-like episodic ataxia; however, its place in vestibular migraine is still to be established. Nonpharmacological measures such as diet, sleep, hygiene and avoidance of triggers are recommended as they are for migraine. Vestibular rehabilitation might be useful when there are complications such as loss of confidence in balance or visual dependence.

Electrophysiologic Evidence of Spinal Accessory Neuropathy in Patients With Cervical Myofascial Pain Syndrome

2011-06-11T11:29:00.000-07:00

Archives of Physical Medicine and Rehabilitation
Volume 92, Issue 6 , Pages 935-940, June 2011

Objective

To evaluate whether or not spinal accessory neuropathy exists in patients with cervical myofascial pain syndrome (MFPS).

Design

Prospective study.

Setting

A neurophysiologic laboratory in a university hospital.

Participants

Patients with cervical MFPS (n=25) and healthy controls (n=20).

Interventions

Not applicable.

Main Outcome Measures

We performed nerve conduction studies (NCSs) in bilateral spinal accessory nerves, and electromyography and stimulated single-fiber electromyography in the trapezius muscles of all patients and controls. Parameters including nerve conduction velocities (NCVs), amplitudes and areas of compound muscle action potentials (CMAPs), and mean consecutive differences (MCDs) in single-fiber electromyography were measured, analyzed, and compared with the disease durations of the patients.

Results

Spinal accessory NCSs showed normative NCVs but with prominently reduced CMAP amplitude in the patients with cervical MFPS, which is recognized as an axonal neuropathy of the spinal accessory nerves. Electromyography showed prominent evidence of denervation and reinnervation patterns in 48% of the MFPS patients. The abnormal MCDs in single-fiber electromyography indicated a synaptic delay of motor endplates in the motor units, and may signify evolving instability of neuromuscular transmission in the spinal accessory nerves innervating trapezius muscles of the patients.

Conclusions

This study demonstrates electrophysiologic evidence of neuroaxonal degeneration and neuromuscular transmission disorder in a significant proportion of patients with cervical MFPS. We suggest that spinal accessory neuropathy may be associated with cervical MFPS.

List of Abbreviations: CMAP, compound muscle action potential, EMG, electromyogram, MCD, mean consecutive difference, MFPS,myofascial pain syndrome, MUAP, motor unit action potential, NCS, nerve conduction study, NCV, nerve conduction velocity, SFEMG, single-fiber electromyography

Pneumatized superior turbinate as a cause of headache.

2011-06-09T22:43:00.000-07:00

Head Face Med. 2007 Jan 9;3:3.

Homsioglou E, Balatsouras DG, Alexopoulos G, Kaberos A, Katotomichelakis M, Danielides V.

Source

Department of Otolaryngology, Medical School, Democritus University of Thrace. Dragana, Alexandroupolis, Greece. homsioglou@hol.gr

Abstract

BACKGROUND:

A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis.

CASE PRESENTATION:

We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained.

CONCLUSION:

Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.

Polyp in concha bullosa: a case report and review of the literature.

2011-06-09T22:34:00.000-07:00

HEAD & FACE MEDICINE
http://www.head-face-med.com/content/2/1/11

Erkan AN, Canbolat T, Ozer C, Yilmaz I, Ozluoglu LN.
Source
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com

Abstract

Polyp originating within a concha bullosa is uncommon; we report only the third such case in the English literature. A 45-year-old man presented with nasal obstruction and headache. Examination of the nose revealed right septal deviation and a hypertrophic left middle concha. Computed tomography confirmed right septal deviation and identified left concha bullosa with thickening of the mucosa covering this lesion. The lateral lamella of the affected turbinate was removed and a mass was excised. Histopathologic examination of the excised mass revealed polypoid hyperplasia. The rare finding of polyp in concha bullosa is discussed with a review of the literature. In any case of concha bullosa, computed tomography images should be carefully evaluated before surgery to check for other pathologies that might have arisen within the lesion.

[Coronal computed tomography image shows right septal deviation (yellow arrow), left concha bullosa (thick white arrow), thickening of the mucosa covering the concha bullosa, and bilateral maxillary sinusitis (vertical black arrow). Right: Intraoperative views of the polyp in the left concha bu...]

A Double-Blind Placebo-Controlled Pilot Study of Sublingual Feverfew and Ginger (LipiGesic(TM) M) in the Treatment of Migraine.

2011-06-05T12:03:00.000-07:00

Headache. 2011 Jun 1.
doi: 10.1111/j.1526-4610.2011.01910.x. [Epub ahead of print]
Cady RK, Goldstein J, Nett R, Mitchell R, Beach ME, Browning R.
Source
From the Headache Care Center, Springfield, MO, USA (R.K. Cady); San Francisco Headache Clinic, San Francisco, CA, USA (J. Goldstein); Texas Headache Associates, San Antonio, TX, USA (R. Nett); PuraMed BioScience, Inc., Schofield, WI, USA (R. Mitchell); Clinvest/A Division of Banyan Group, Inc., Springfield, MO, USA (M.E. Beach and R. Browning).

Abstract

Background.- Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high-end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the "gold standard" of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open-label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack.

Methods/Materials.- In this multi-center pilot study, 60 patients treated 221 attacks of migraine with sublingual feverfew/ginger or placebo. All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2-6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non-migraine headache. Subjects were randomized 3:1 to receive either sublingual feverfew/ginger or a matching placebo and were instructed but not required to treat with study medication at the earliest recognition of migraine.

Results.- Sixty subjects treated 208 evaluable attacks of migraine over a 1-month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation. Evaluable diaries were completed for 151 attacks of migraine in the population using feverfew/ginger and 57 attacks for those attacks treated with placebo. At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain-free (P = .02). At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain-free or mild headache) vs 39% for placebo (P = .002). Pain level differences on a 4-point pain scale for those receiving feverfew/ginger vs placebo were -0.24 vs -0.04 respectively (P = .006). Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event.

Conclusion.- Sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.

Potassium channels as a potential therapeutic target for trigeminal neuropathic and inflammatory pain

2011-01-11T03:33:00.000-08:00

Molecular Pain 2011, 7:5 doi:10.1186/1744-8069-7-5
Published: 10 January 2011

Mamoru Takeda, Yoshiyuki Tsuboi, Junichi Kitagawa, Kazuharu Nakagawa, Koichi Iwata and Shigeji Matsumoto

Abstract (provisional)

Previous studies in several different trigeminal nerve injury/inflammation models indicated that the hyperexcitability of primary afferent neurons contributes to the pain pathway underlying mechanical allodynia. Although multiple types of voltage-gated ion channels are associated with neuronal hyperexcitability, voltage-gated K+ channels (Kv) are one of the important physiological regulators of membrane potentials in excitable tissues, including nociceptive sensory neurons. Since the opening of K+ channels leads to hyperpolarization of cell membrane and a consequent decrease in cell excitability, several Kv channels have been proposed as potential target candidates for pain therapy. In this review, we focus on common changes measured in the Kv channels of several different trigeminal neuropathic/inflammatory pain animal models, particularly the relationship between changes in Kv channels and the excitability of trigeminal ganglion (TRG) neurons. We also discuss the potential of Kv channel openers as therapeutic agents for trigeminal neuropathic/inflammatory pain, such as mechanical allodynia.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Treatment of migraine with occipital nerve blocks using only corticosteroids.

2011-01-08T04:52:00.000-08:00

Headache. 2011 Jan;51(1):155-9.

doi: 10.1111/j.1526-4610.2010.01801.x. Epub 2010 Nov 10.

Tobin J, Flitman S.

From 21st Century Neurology, Phoenix, AZ, USA.

Abstract

(Headache 2011;51:155-162) The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.

Neurophysiological markers of central sensitisation in the trigeminal pathway and their modulation by the cyclo-oxygenase inhibitor ketorolac

2011-01-08T04:50:00.000-08:00

Cephalalgia. 2010 Oct;30(10):1241-9. Epub 2010 Apr 7.

Sokolov AY, Lyubashina OA, Panteleev SS, Chizh BA.

Department of Neuropharmacology, Valdman Institute of Pharmacology, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia. leshasokolov1@rambler.ru

Abstract

Central sensitisation is a key mechanism of migraine; understanding its modulation by anti-migraine drugs is essential for rationalising treatment. We used an animal model of central trigeminal sensitisation to investigate neuronal responses to dural electrical stimulation as a putative electrophysiological marker of sensitisation and its modulation by ketorolac. In anaesthetised rats, responses of single convergent wide-dynamic range neurons of the spinal trigeminal nucleus to dural electrical simulation were recorded in parallel to their ongoing activity and responses to facial mechanical stimulation before and after a short-term dural application of an IS. Both ongoing activity and responses to dural electrical stimuli were enhanced by the inflammatory challenge, whereas neuronal thresholds to mechanical skin stimulation were reduced (p < .05, N = 12). Intravenous ketorolac (2 mg/kg, N = 6) reduced ongoing activity and responses to dural electrical stimulation, and increased mechanical thresholds versus vehicle controls (p < .05, N = 6). We conclude that neuronal responses to dural electrical stimulation can serve as a suitable marker which together with admitted electrophysiological signs can objectively detect central trigeminal sensitisation and its modulation by anti-migraine treatments in this preclinical model of migraine.

PMID: 20855370 [PubMed - indexed for MEDLINE]

Bronchial Hyper-Reactivity in Migraine Without Aura: Is It a New Clue for Inflammation?

2010-12-09T09:35:00.000-08:00

Headache: The Journal of Head and Face Pain 10 NOV 2010

Hakan Kaleagasi MD,

Eylem Özgür MD,

Cengiz Özge MD,

Aynur Özge MD

DOI: 10.1111/j.1526-4610.2010.01798.x

Objective.— We attempted to investigate the relationship between migraine without aura (MwoA) and bronchial hyper-reactivity to postulate inflammation as an underlying mechanism in migraine.

Background.— Comorbidity of migraine and atopic diseases such as asthma has been an argument for suspected immune system dysfunction in migraineurs.

Methods.— Twenty patients with MwoA and 5 control subjects without history of atophy and asthma were included in study. Subjects with abnormal physical examination and chest radiographs were excluded. After a normal spirometry, methacholine bronchoprovocation test was performed in all subjects and controls according to 5 breath dosimeter methods.

Results.— Sixteen of 20 patients and 2 of 5 control subjects were women. Mean ages were 37.5 (19-56) and 33.8 (26-43) years, respectively. Methacholine bronchoprovocation test was positive in 3 patients (15%) but was normal in all controls (0%).

Conclusions.— The relationship between MwoA and bronchial hyper-reactivity may help to postulate the inflammation in migraine as an underlying mechanism.

Treatment of Migraine With Occipital Nerve Blocks Using Only Corticosteroids

2010-12-09T09:30:00.000-08:00

Headache: The Journal of Head and Face Pain

10 NOV 2010

Joshua Tobin MD,
Stephen Flitman MD

DOI: 10.1111/j.1526-4610.2010.01801.x

The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.

Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression

2010-12-09T08:58:00.000-08:00

Headache: The Journal of Head and Face Pain; Article first published online: 16 NOV 2010

DOI: 10.1111/j.1526-4610.2010.01802.x

Christiane Cornely MD,
Marius Fischer MD,
Giulio Ingianni MD,
Stefan Isenmann MD

Occipital nerve neuralgia is a rare cause of severe headache, and may be difficult to treat. We report the case of a patient with occipital nerve neuralgia caused by pathological contact of the nerve with the occipital artery. The pain was refractory to medical treatment. Surgical decompression yielded complete remission.

Allergy and Immunotherapy: Are They Related to Migraine Headache?

2010-12-09T07:33:00.000-08:00

Headache: The Journal of Head and Face Pain; Article first published online: 4 NOV 2010

DOI: 10.1111/j.1526-4610.2010.01792.x

Vincent T. Martin MD,
Fred Taylor MD,
Bruce Gebhardt MD,
Mara Tomaszewski MD,
Joel S. Ellison BS,
Geoffrey V. Martin BS,
Linda Levin PhD,
Enas Al-Shaikh BS,
Joseph Nicolas MD,
Jonathan A. Bernstein MD

Introduction.— Several studies have reported that migraine headaches are more common in patients with allergic rhinitis and that immunotherapy decreases the frequency of headache in atopic headache sufferers.
Objective.— To determine if the degree of allergic sensitization and the administration of immunotherapy are associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis.
Methods.— Consecutive patients between the ages of 18-65 presenting to an allergy practice that received a diagnosis of an allergic rhinitis subtype (eg, allergic or mixed rhinitis) were enrolled in this study. All participants underwent allergy testing as well as a structured verbal headache diagnostic interview to ascertain the clinical characteristics of each headache type. Those reporting headaches were later assigned a headache diagnosis by a headache specialist blinded to the rhinitis diagnosis based on 2004 International Classification Headache Disorders-2 (ICHD-2) diagnostic criteria. Migraine prevalence was defined as the percentage of patients with a diagnosis of migraine headache (ICHD-2 diagnoses 1.1-1.5). Migraine frequency represented the number of days per month with migraine headache self-reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positiveallergy tests) and low (≤45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses.
Results.— A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages <40 years and more prevalent in the immunotherapy group at ages ≥40 years of age. In subjects ≤45 years of age, increasing percentages of allergic sensitization were associated with a decreased frequency and disability of migraine headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency (not disability) in the high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those >45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache.
Conclusions.— Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower “degrees of atopy” are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.

Neurostimulation Therapy

2010-12-07T00:17:00.000-08:00

St. Jude Medical Announces New Approvals Of Five-Column Neurostimulation Lead To Manage Chronic Pain

http://www.medicalnewstoday.com/articles/210228.php

"St. Jude Medical, Inc. (NYSE:STJ), a global medical device company, announced European CE Mark approval and regulatory and reimbursement approval from the Australian Therapeutic Goods Administration (TGA) of its Penta(TM) surgical lead for neurostimulation therapy.

Highlighted at the 14th annual North American Neuromodulation Society meeting in Las Vegas today, this innovative, five-column surgical lead is the first of its kind, featuring the smallest electrodes on the market. Although the Penta lead is only 10.9 mm wide, it offers the broadest lateral electrode span of any neurostimulation paddle lead. This feature is made possible by a proprietary micro-texturing process that enables greater amounts of current to be delivered via the small electrodes. The result is a lead that can more specifically focus current over a greater lateral area of the spinal cord, which may provide better coverage for managing chronic pain..."

....

"...Spinal cord stimulation therapy, or neurostimulation therapy, is used for managing chronic pain of the trunk and limbs and pain from back surgeries that have failed. A lead is a small insulated wire with multiple electrodes that is placed in the epidural space near the spine. Mild electrical pulses are carried from the neurostimulator to the lead's electrodes to interrupt or mask the transmission of pain signals to the brain. Electrodes on the lead can be programmed to meet each individual patient's needs.

"Neurostimulation therapy is often an appropriate choice for patients who have complex pain patterns," said Dr. Ashwini Sharan, Associate Professor, Department of Neurosurgery and Department of Neurology at Jefferson Medical College and Thomas Jefferson University. "The five-column Penta lead provides the most comprehensive spinal cord coverage available, enabling us to specifically stimulate targeted areas in order to potentially better control the patient's pain."

Chronic pain is a largely undertreated and misunderstood condition that affects millions of patients worldwide. The World Health Organization, in conjunction with the International Association for the Study of Pain (IASP), reports that as many as one in five people suffers from moderate to severe chronic pain. .."

Treatment of Chronic Migraine

2010-11-26T02:39:00.000-08:00

CURRENT PAIN AND HEADACHE REPORTS
DOI: 10.1007/s11916-010-0159-x
Hans-Christoph Diener, Dagny Holle and David Dodick

Abstract

Chronic migraine is defined in different ways. The most commonly used definition is headache on more than 15 days per month in patients with migraine. Chronic migraine is difficult to treat and requires a multidisciplinary approach. Only two pharmacological treatments have been shown to be effective in placebo-controlled randomized trials: topiramate and local injection of botulinum toxin. Both therapies are effective in patients with chronic migraine with and without medication overuse. Many other substances have been investigated in chronic daily headache. All trials were underpowered and, therefore, recommendations concerning possible efficacy are not possible.

Smoked cannabis for chronic neuropathic pain: a randomized controlled trial

2010-11-26T02:33:00.000-08:00

CMAJ • October 5, 2010; 182 (14). First published August 30, 2010; doi:10.1503/cmaj.091414
© 2010 Canadian Medical Association or its licensors

Mark A. Ware, MBBS, Tongtong Wang, PhD, Stan Shapiro, PhD,Ann Robinson, RN, Thierry Ducruet, MSc, Thao Huynh, MD, Ann Gamsa, PhD,Gary J. Bennett, PhD and Jean-Paul Collet, MD PhD

From the Department of Anesthesia (Ware), the Department of Family Medicine (Ware), the Department of Epidemiology, Biostatistics and Occupational Health (Wang, Shapiro), the Department of Medicine (Huynh) and the Alan Edwards Centre for Research on Pain (Gamsa, Bennett), McGill University, Montréal, Que.; Boreal Primum (Robinson, Ducruet), Montréal, Que.; and the Centre for Applied Health Research and Evaluation (Collet), University of British Columbia, Vancouver, BC

Correspondence to: Dr. Mark A. Ware, E19.145, Montréal General Hospital, 1650 Cedar Ave., Montréal QC H3G 1A4; mark.ware@muhc.mcgill.ca

Background: Chronic neuropathic pain affects 1%–2% ofthe adult population and is often refractory to standard pharmacologictreatment. Patients with chronic pain have reported using smokedcannabis to relieve pain, improve sleep and improve mood.

Methods: Adults with post-traumatic or postsurgical neuropathicpain were randomly assigned to receive cannabis at four potencies(0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-dayperiods in a crossover trial. Participants inhaled a single25-mg dose through a pipe three times daily for the first fivedays in each cycle, followed by a nine-day washout period. Dailyaverage pain intensity was measured using an 11-point numericrating scale. We recorded effects on mood, sleep and qualityof life, as well as adverse events.

Results: We recruited 23 participants (mean age 45.4 [standarddeviation 12.3] years, 12 women [52%]), of whom 21 completedthe trial. The average daily pain intensity, measured on the11-point numeric rating scale, was lower on the prespecifiedprimary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v.6.1, respectively; difference = 0.7, 95% confidence interval[CI] 0.02–1.4). Preparations with intermediate potencyyielded intermediate but nonsignificant degrees of relief. Participantsreceiving 9.4% tetrahydrocannabinol reported improved abilityto fall asleep (easier, p = 0.001; faster, p < 0.001; moredrowsy, p = 0.003) and improved quality of sleep (less wakefulness,p = 0.01) relative to 0% tetrahydrocannabinol. We found no differencesin mood or quality of life. The most common drug-related adverseevents during the period when participants received 9.4% tetrahydrocannabinolwere headache, dry eyes, burning sensation in areas of neuropathicpain, dizziness, numbness and cough.

Conclusion: A single inhalation of 25 mg of 9.4% tetrahydrocannabinolherbal cannabis three times daily for five days reduced theintensity of pain, improved sleep and was well tolerated. Furtherlong-term safety and efficacy studies are indicated. (InternationalStandard Randomised Controlled Trial Register no. ISRCTN68314063)

Cervical Facet Arthropathy and Occipital Neuralgia: Headache Culprits

2010-11-26T02:29:00.000-08:00

CURRENT PAIN AND HEADACHE REPORTS
Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5
J. D. Hoppenfeld

Abstract

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Acupuncture modulates temporal neural responses in wide brain networks: evidence from fMRI study

2010-11-25T07:09:00.001-08:00

Molecular Pain 2010, 6:73

doi:10.1186/1744-8069-6-73(Open Access)

Lijun Bai¹ , Jie Tian¹^,2 , Chongguang Zhong¹ , Ting Xue² , Youbo you¹ , Zhenyu Liu¹ , Peng Chen³ , Qiyong Gong⁴ , Lin Ai⁵ , Wei Qin² , Jianping Dai⁵ and Yijun Liu⁶^,7

¹Medical Image Processing Group, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China

²School of Life Science and Technology, Xidian University, Xi'an 710071, China

³Beijing TCM Hospital affiliated to Capital University of Medical Sciences, Beijing 10010, China

⁴West China Hospital of Sichuan University, Sichuan 610041, China

⁵Department of Radiology, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, 100050, China

⁶McKnight Brain Institute, Departments of Psychiatry and Neuroscience, University of Florida, Gainesville, FL 32610, USA

⁷Department of Biomedical Engineering, Peking University, Beijing 100871, China


Published:	2 November 2010

Abstract

Background

Accumulating neuroimaging studies in humans have shown that acupuncture can modulate a widely distributed brain network, large portions of which are overlapped with the pain-related areas. Recently, a striking feature of acupuncture-induced analgesia is found to be associated with its long-last effect, which has a delayed onset and gradually reaches a peak even after acupuncture needling being terminated. Identifying temporal neural responses in these areas that occur at particular time -- both acute and sustained effects during acupuncture processes -- may therefore shed lights on how such peripheral inputs are conducted and mediated through the CNS. In the present study, we adopted a non-repeated event-related (NRER) fMRI paradigm and control theory based approach namely change-point analysis in order to capture the detailed temporal profile of neural responses induced by acupuncture.

Results

Our findings demonstrated that neural activities at the different stages of acupuncture presented distinct temporal patterns, in which consistently positive neural responses were found during the period of acupuncture needling while much more complex and dynamic activities found during a post-acupuncture period. These brain responses had a significant time-dependent effect which showed different onset time and duration of neural activities. The amygdala and perigenual anterior cingulate cortex (pACC), exhibited increased activities during the needling phase while decreased gradually to reach a peak below the baseline. The periaqueductal gray (PAG) and hypothalamus presented saliently intermittent activations across the whole fMRI session. Apart from the time-dependent responses, relatively persistent activities were also identified in the anterior insula and prefrontal cortices. The overall findings indicate that acupuncture may engage differential temporal neural responses as a function of time in a wide range of brain networks.

Conclusions

Our study has provided evidence supporting a view that acupuncture intervention involves complex modulations of temporal neural response, and its effect can gradually resolve as a function of time. The functional specificity of acupuncture at ST36 may involve multiple levels of differential activities of a wide range of brain networks, which are gradually enhanced even after acupuncture needle being terminated.

Allergy and Immunotherapy: Are They Related to Migraine Headache?

2010-11-13T03:01:00.000-08:00

Headache. 2010 Nov 4.

doi: 10.1111/j.1526-4610.2010.01792.x. [Epub ahead of print]

Martin VT, Taylor F, Gebhardt B, Tomaszewski M, Ellison JS, Martin GV, Levin L, Al-Shaikh E, Nicolas J, Bernstein JA.

From the Department of Internal Medicine, Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, USA (V.T. Martin); Department of Neurology, Park Nicollet Clinic, Minneapolis, MN, USA (F. Taylor); Department of Family Practice, Saint Vincent Hospital, Erie, PA, USA (B. Gebhardt); Department of Family Practice, University of Cincinnati College of Medicine, Cincinnati, OH, USA (M.Tomaszewski); University of Cincinnati College of Medicine, Cincinnati, OH, USA (J.S. Ellison and G.V. Martin); Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA (L. Levin and E. Al-Shaikh); Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA (J. Nicolas); Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, OH, USA; Bernstein Allergy Group, Inc., Cincinnati, OH, USA (J.A. Bernstein).

Abstract

Introduction.- Several studies have reported that migraine headaches are more common in patients with allergic rhinitis and that immunotherapy decreases the frequency of headache in atopic headache sufferers.

Objective.- To determine if the degree of allergic sensitization and the administration of immunotherapy are associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis.

Methods.- Consecutive patients between the ages of 18-65 presenting to an allergy practice that received a diagnosis of an allergic rhinitis subtype (eg, allergic or mixed rhinitis) were enrolled in this study. All participants underwent allergy testing as well as a structured verbal headache diagnostic interview to ascertain the clinical characteristics of each headache type. Those reporting headaches were later assigned a headache diagnosis by a headache specialist blinded to the rhinitis diagnosis based on 2004 International Classification Headache Disorders-2 (ICHD-2) diagnostic criteria. Migraine prevalence was defined as the percentage of patients with a diagnosis of migraine headache (ICHD-2 diagnoses 1.1-1.5). Migraine frequency represented the number of days per month with migraine headache self-reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positiveallergy tests) and low (≤45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses. Results.- A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages <40 years and more prevalent in the immunotherapy group at ages ≥40 years of age. In subjects ≤45 years of age, increasing percentages of allergic sensitization were associated with a decreased frequency and disability of migraine headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency (not disability) in the high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those >45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache.

Conclusions.- Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower "degrees of atopy" are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.

PMID: 21054364 [PubMed - as supplied by publisher]

The Pain of Vertebral Compression Fractures Can Arise in the Posterior Elements

2010-11-04T08:27:00.003-07:00

Pain Medicine
Volume 11, Issue 11, pages 1666–1673, November 201
1. Nikolai Bogduk MD,
2. John MacVicar MB, ChB,
3. James Borowczyk MB, ChB
Article first published online: 2 NOV 2010

Abstract

Objectives. To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body.

Methods. The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. Proof of principle was provided by performing controlled diagnostic blocks in six patients.

Results. The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies.

Conclusions. In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies.

Facet Pain in Thoracic Compression Fractures

2010-11-04T08:14:00.001-07:00

Pain Medicine
Volume 11, Issue 11, pages 1674–1677, November 2010

Raj Mitra MD,
Huy Do MD,
Todd Alamin MD,
Ivan Cheng MD
Article first published online: 1 OCT 2010

Abstract

Objective. To determine if thoracic facet joints may be a significant secondary pain generator in patients with compression fractures. Traditionally, pain from vertebral compression fractures has been attributed to vertebral body itself. Compression fractures have been shown to increase thoracic kyphosis and thereby increase the thoracic flexion moment; these changes eventually increase the shear stress on the posterior elements.

Design. We present a small case series of patients with thoracic compression fractures managed with intra-articular facet injections.

Setting. Tertiary care academic medical center.

Participants. Two patients with thoracic compression fractures.

Interventions. The subjects received fluoroscopically guided thoracic facet steroid injections for pain management.

Main Outcome. Change in verbal analog pain score.

Results. Patients with thoracic compression fractures received significant long-lasting relief after receiving fluoroscopically guided intra-articular injections.

Conclusion. Facet joints may be abnormally stressed due to the increasing thoracic flexion moment in anterior compression fractures, which may serve as a secondary pain generator; intra-articular facet blocks may be an alternative to vertebroplasty.

Maldynia: Pathophysiology and Management of Neuropathic and Maladaptive Pain—A Report of the AMA Council on Science and Public Health

2010-11-04T08:01:00.000-07:00

Pain Medicine
Volume 11, Issue 11, pages 1635–1653, November 2010
1. Barry D. Dickinson PhD,
2. C. Alvin Head MD,
3. Stuart Gitlow MD,
4. Albert J. Osbahr, III MD
Article first published online: 2 NOV 2010
DOI: 10.1111/j.1526-4637.2010.00986.x

Abstract

Background. Because of disparate taxonomic arrays for classification, the American Academy of Pain Medicine has proposed categorizing pain on a neurobiologic basis as eudynia (nociceptive pain), Greek for “good pain,” or maldynia (maladaptive pain), Greek for “bad pain.” The latter has been viewed as maladaptive because it may occur in the absence of ongoing noxious stimuli and does not promote healing and repair.

Objective. To address recent findings on the pathogenesis of pain following neural injury and consider whether the development of maladaptive pain justifies its classification as a disease and to briefly discuss the scope of pharmacologic and non-pharmacologic approaches employed in patients with such pain.

Methods. English language reports on studies using human subjects were selected from a PubMed search of the literature from 1995 to August 2010 and from the Cochrane Library. Further information was obtained from Internet sites of medical specialty and other societies devoted to pain management.

Results. Neural damage to either the peripheral or central nervous system provokes multiple processes including peripheral and central sensitization, ectopic activity, neuronal cell death, disinhibition, altered gene expression, and abnormal sprouting and cellular connectivity. A series of neuro-immune interactions underlie many of these mechanisms. Imaging studies have shown that such damage is characterized by functional, structural, and chemical changes in the brain. Such pain is maladaptive in the sense that it occurs in the absence of ongoing noxious stimuli and does not promote healing and repair.

Conclusion. As defined, maldynia is a multidimensional process that may warrant consideration as a chronic disease not only affecting sensory and emotional processing but also producing an altered brain state based on both functional imaging and macroscopic measurements. However, the absolute clinical value of this definition is not established.

Neuroma Removal for Neuropathic Pain: Efficacy and Predictive Value of Lidocaine Infusion

2010-10-28T10:00:00.000-07:00

Clinical Journal of Pain:

Nikolajsen, Lone MD, PhD

November/December 2010 - Volume 26 - Issue 9 - pp 788-793

doi: 10.1097/AJP.0b013e3181ed0823

Abstract

Objective: Injury to peripheral nerves associated with trauma, amputation, or surgery may lead to the formation of neuromas that can produce severe pain refractory to pharmacotherapy. Ectopic impulse activity arising in blindly ending axons within the neuroma, which contain abnormal accumulations of sodium channels, is thought to be a major contributor to this pain. The effect of surgical excision has remained controversial. Here we report a prospective study on the effect of neuroma removal on pain.

Methods: A series of 6 patients with chronic neuropathic pain owing to neuromas after nerve injury were studied before and 3 months after neuroma excision. Quantitative sensory testing included measurement of areas of brush-evoked allodynia, pinprick hyperalgesia, and mechanical and thermal thresholds. The hypothesis that the analgesic response to a preoperative, intravenous infusion of the sodium channel blocker lidocaine can predict outcome of surgery was also tested.

Results: Surgery only relieved spontaneous pain in 2 out of the 6 patients. One of those patients had a prior poor response to neuroma removal. In one patient the pain worsened. Response to surgical removal of neuromas was not predicted by the response to preoperative infusion of intravenous lidocaine.

Discussion: Our findings suggest that, as a therapeutic maneuver, surgical excision of neuromas should be reserved for only those patients with intractable pain, who have failed to respond to other therapies. However, prior poor response to neuroma removal does not preclude relief of pain after a new excision.

Cervicogenic headache, Occipital neuralgia, Cervical facet arthropathy, Occipital nerve stimulation, Occipital nerve block

2010-10-28T09:36:00.000-07:00

CURRENT PAIN AND HEADACHE REPORTS
Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

J. D. Hoppenfeld

Abstract

Migraines and ovarian hyperstimulation syndrome: a dopamine connection

2010-10-13T11:19:00.000-07:00

Corrected Proof

This case-control study shows a strong association between migraine history and development of ovarian hyperstimulation syndrome (OHSS).

We hypothesize there may be a similar gene variant that predisposes women to both migraines and OHSS and identification will lead to optimal therapy, not only for OHSS, but also for women who suffer from migraines.

Method of Injection of OnabotulinumtoxinA for Chronic Migraine: A Safe, Well-Tolerated, and Effective Treatment Paradigm Based on the PREEMPT Clinical Program

2010-10-13T11:15:00.000-07:00

Headache: The Journal of Head and Face Pain
Volume 50, Issue 9, pages 1406–1418, October 2010

Andrew Blumenfeld MD,
Stephen D. Silberstein MD, FACP,
David W. Dodick MD,
Sheena K. Aurora MD,
Catherine C. Turkel PharmD, PhD,
William J. Binder MD, FACS

Article first published online: 4 OCT 2010

Chronic migraine (CM) is a prevalent and disabling neurological disorder. Few prophylactic treatments for CM have been investigated.
OnabotulinumtoxinA, which inhibits the release of nociceptive mediators, such as glutamate, substance P, and calcitonin gene-related peptide, has been evaluated in randomized, placebo-controlled studies for the preventive treatment of a variety of headache disorders, including CM. These studies have yielded insight into appropriate patient selection, injection sites, dosages, and technique. Initial approaches used a set of fixed sites for the pericranial injections. However, the treatment approach evolved to include other sites that corresponded to the location of pain and tenderness in the individual patient in addition to the fixed sites. The Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) injection paradigm uses both fixed and follow-the-pain sites, with additional specific follow-the-pain sites considered depending on individual symptoms. The PREEMPT paradigm for injecting onabotulinumtoxinA has been shown to be safe, well-tolerated, and effective in well-designed, controlled clinical trials and is the evidence-based approach recommended to optimize clinical outcomes for patients with CM.

Cervical Epidural Injections in Chronic Discogenic Neck Pain Without Disc Herniation or Radiculitis: Preliminary Results of a Randomized, Double-Blind, Controlled Trial

2010-08-03T08:56:00.000-07:00

Pain Physician July/August 2010 - Vol 13 Issue 4
2010;13;E265-E278.

Randomized Trial
Laxmaiah Manchikanti, MD, Kimberly A. Cash, RT, Vidyasagar Pampati, MSc, Bradley W. Wargo, DO, and Yogesh Malla, MD

BACKGROUND: Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%. However, there is a lack of consensus regarding the causes and treatments of chronic neck pain.

Despite limited evidence, cervical epidural injections are one of the commonly performed non-surgical interventions in the management of chronic neck pain.

STUDY DESIGN: A randomized, double-blind, active control trial.
SETTING: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
OBJECTIVES: To evaluate the effectiveness of cervical interlaminar epidural injections with local anesthetic with or without steroids in the management of chronic neck pain with or without upper extremity pain in patients without disc herniation or radiculitis or facet joint pain.
METHODS: Patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of 2 groups: injection of local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Seventy patients were included in this analysis. Randomization was performed by computer-generated random allocation sequence by simple randomization.

OUTCOMES ASSESSMENT: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake with assessment at 3, 6, and 12 months post-treatment.

Significant pain relief or functional status was defined as a 50% or more reduction.
RESULTS: Significant pain relief (≥ 50%) was demonstrated in 80% of patients in both groups and functional status improvement (> 50%) in 69% of Group I and 80% of Group II. The overall average procedures per year were 3.9 ± 1.01 in Group I and 3.9 ± 0.8 in Group II with an average total relief per year of 40.3 ± 14.1 weeks in Group I and 42.1 ± 9.9 weeks in Group II over a period of 52 weeks in the successful group.

LIMITATIONS: The results of this study are limited by the lack of a placebo group and a preliminary report of 70 patients, with 35 patients in each group.

CONCLUSION: Cervical interlaminar epidural injections with local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic.

Migraine with aura triggered by cardiac myxoma: Case report and literature review.

2010-07-31T23:59:00.000-07:00

Cephalalgia. 2010 Jul 20. [Epub ahead of print]
de Ceuster L, van Diepen T, Koehler PJ.
Atrium Medical Centre, The Netherlands.

Abstract

We present a new case of cardiac myxoma triggering migraine auras. A 52-year-old woman was suffering from migraine attacks with aura. Magnetic resonance imaging (MRI) showed no abnormalities. Subsequently, she had a minor stroke with multiple ischaemic lesions bilaterally on repeat MRI. An echocardiogram showed a myxoma of the left atrial wall. After removal of the myxoma she was free of symptoms. In the past, seven cardiac myxoma associated migraine patients have been reported. Other cardiac abnormalities, patent foramen ovale in particular, are known to be associated with migraine with aura. We attempted to compare the mechanisms by which cardiac myxoma and other cardiac abnormalities could trigger cortical spreading depression leading to migraine with aura.

PMID: 20647240 [PubMed - as supplied by publisher]

Work and neck pain: A prospective study of psychological, social, and mechanical risk factors

2010-07-28T04:19:00.000-07:00

Pain, 07/28/2010
Jan Olav Christensenab1, Stein Knardahla1

Received 19 November 2009; received in revised form 20 May 2010; accepted 1 July 2010. published online 26 July 2010.
Abstract

To determine the impact of occupational psychological/social and mechanical factors on neck pain, a prospective cohort study with a follow-up period of 2years was conducted with a sample of Norwegian employees. The following designs were tested: (i) cross-sectional analyses at baseline (n=4569) and follow-up (n=4122), (ii) prospective analyses with baseline predictors, (iii) prospective analyses with average exposure over time [(T1+T2)/2] as predictor, and (iv) prospective analyses with measures of change in exposure from T1 to T2 as predictors. A total of 2419 employees responded to both the baseline and follow-up questionnaire. Data were analyzed using ordinal logistic regression. After adjustment for age, sex, neck pain at T1, and other exposure factors that had been estimated to be confounders, the most consistent risk factors were role conflict (highest OR 2.97, 99% CI: 1.29–6.74) and working with arms raised to or above shoulder level (highest OR 1.37, 99% CI: 1.05–1.78). The most consistent protective factors were empowering leadership (lowest OR 0.53, 99% CI: 0.35–0.81) and decision control (lowest OR 0.60, 99% CI: 0.36–1.00). Hence, psychological and social factors are important precursors of neck pain, along with mechanical factors. Although traditional factors such as quantitative demands and decision control play a part in the etiology of neck pain at work, in this study several new factors emerged as more important.

a The National Institute of Occupational Health, Norway
b Department of Psychology, University of Oslo, Norway

Corresponding author. Address: The National Institute of Occupational Health, P.O. Box 8149 Dep, N-0033 Oslo, Norway. Tel.: +47 23 19 52 58; fax: +47 23 19 52 00

Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache

2010-07-14T23:39:00.000-07:00

Cephalalgia 2010

J-H Sohn, H-C Choi, S-M Lee, and A-Y Jun*
Hallym University College of Medicine, Republic of Korea
* To whom correspondence should be addressed. E-mail: ayjun@hallym.or.kr.

Background: Tension-type headache (TTH) is a headache in which musculoskeletal impairments of the craniocervical region may play an important role in its pathogenesis. We investigated the presence of myofascial, postural and mechanical abnormalities in patients with frequent episodic and chronic tension-type headache (ETTH and CTTH, respectively).
Methods: The study population consisted of 36 patients with ETTH, 23 with CTTH and 42 control subjects. Myofascial trigger points (MTrPs) were identified in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles. Sagittal C7-tragus angle was measured to evaluate flexor head posture (FHP), and neck mobility was assessed using an inclinometer.
Results: Only active MTrPs were significantly different between the ETTH and CTTH groups (p < .001). Patients with CTTH showed a larger sagittal C7-tragus angle (p = .011), that is, greater FHP and restricted neck mobility for both rotations compared to controls (p < .001). Although active MTrPs were correlated with the frequency and duration of headache, no correlations were observed for FHP or neck mobility. Conclusion: Active MTrPs in the craniocervical region contribute to triggering or maintenance of TTH and posture or neck mobility may be a result of chronic headache.

First published on July 7, 2010

Cephalalgia 2010, doi:10.1177/0333102410375724

Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache

2010-07-14T23:30:00.000-07:00

Manual Therapy
Toby Hall, Kathy Briffa, Diana Hopper, Kim Robinson
Received 3 December 2009; received in revised form 26 April 2010; accepted 8 June 2010.
published online 07 July 2010.

Abstract

This study investigated the reliability of manual examination procedures and the frequency that each or multiple segments in the upper cervical spine above the C4 vertebra were the dominant source of pain in subjects with cervicogenic headache (CGH). Eighty subjects were evaluated, 60 with CGH (39 females, mean age 33 years) and arbitrarily a further 20 asymptomatic subjects (13 females, mean age 34 years) included to reduce examiner bias, but subsequently omitted from data analysis. Two experienced physiotherapists examined on the same day each subject with standard manual examination procedures, independently rating each segment in the upper cervical spine above the C4 vertebra for involvement. Examiners were blind to each other’s findings and the subject’s clinical status. Standard and adjusted Kappa coefficients were calculated for each segment in symptomatic subjects only. Chi-squared analysis for goodness of fit was used to identify the segment that was most frequently determined the predominant symptomatic segment. Manual examination above the C4 vertebra showed good reliability. The C1/2 segment was most commonly symptomatic, with a positive finding at this segment in 63% of cases. The high frequency of C1/2 involvement in CGH highlights the importance of examination and treatment procedures for this motion segment.

School of Physiotherapy, Curtin Innovation Health Research Institute, Curtin University of Technology, Hayman Road, Bentley, Perth, Western Australia

Generalized Mechanical Nerve Pain Hypersensitivity in Children With Episodic Tension-type Headache

2010-07-14T23:27:00.000-07:00

PEDIATRICS Vol. 126 No. 1 July 2010, pp. e187-e194 (doi:10.1542/peds.2010-0012)
Daniel M. Fernández-Mayoralas, MD, PhDa,b, César Fernández-de-las-Peñas, PT, PhDc,d,e, Ricardo Ortega-Santiago, PTc,d, Silvia Ambite-Quesada, PT, MScf, Rodrigo Jiménez-García, MD, PhDg, Alberto Fernández-Jaén, MDa,b
a Department of Neuropediatry, Hospital Quirón de Madrid, Madrid, Spain;
b Department of Neuropediatry, Centro "CADE," Madrid, Spain;
c Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine,
d Esthesiology Laboratory,
f Department of Anatomy, and
g Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain; and
e Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

OBJECTIVES The objective of this study was to analyze the presence of generalized pressure pain hypersensitivity over nerve tissues in trigeminal and nontrigeminal regions in children with frequent episodic tension-type headache (FETTH).

METHODS Thirty children, 7 boys and 23 girls (mean age: 8.8 ± 1.7 years) with FETTH and 50 age- and gender-matched healthy children (14 boys, 36 girls; mean age: 8.5 ± 2.1 years; P = .743) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3), median (C5), radial (C6), and ulnar (C7) nerves by an assessor who was blinded to the patient's condition.

RESULTS The analysis of variance showed that PPT levels were significantly bilaterally decreased over both trigeminal (supra-orbital, infra-orbital, and mental) and nontrigeminal (median, ulnar, and radial) nerves in children with FETTH as compared with control subjects (all sites, P < .001). There was a greater magnitude of PPT decrease within trigeminal nerves as compared with nontrigeminal nerves (P < .03). PPTs over infra-orbital (rs = –0.4, P < .05) and radial (rs = –0.5, P < .01) nerves were negatively correlated with the duration of headache attacks (P < .05).

CONCLUSIONS Our study revealed bilateral and generalized pressure hypersensitivity over both trigeminal and nontrigeminal nerves in children with FETTH. Diffuse hypersensitivity of peripheral nerves evidences the presence of hyperexcitability of the central nervous system in children with FETTH.

Abbreviations: PPT = pressure pain threshold • CNS = central nervous system • FETTH = frequent episodic tension-type headache • NPRS = numerical pain rate scale • BDI-II = Beck Depression Inventory, Second Edition • TTS = Total Tenderness Score • CI = confidence interval • ANOVA = analysis of variance

Accepted Mar 24, 2010.

Electrical Stimulation of Sphenopalatine Ganglion for Acute Treatment of Cluster Headaches

2010-07-14T23:19:00.000-07:00

Headache 2010;50:1164-1174

Mehdi Ansarinia, MD; Ali Rezai, MD; Stewart J. Tepper, MD; Charles P. Steiner, BS; Jenna Stump, MS; Michael Stanton-Hicks, MD; Andre Machado, MD; Samer Narouze, MD

From the Headache Specialists, Las Vegas, NV, USA (M. Ansarinia); Department of Neurosurgery and Center for Neuromodulation, The Ohio State University, Columbus, OH, USA (A. Rezai and J. Stump); Cleveland Clinic Centers for Headache and Pain and Neurological Restoration and Department of Neurology, Cleveland, OH, USA (S.J. Tepper); Cleveland Clinic Innovations, Product Development Manager, Center for Neurological Restoration, Cleveland, OH, USA (C.P. Steiner); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (M. Stanton-Hicks); Cleveland Clinic Center for Neurological Restoration and Department of Neurosurgery, Cleveland, OH, USA (A. Machado); Cleveland Clinic Center for Pain Anesthesia, Cleveland, OH, USA (S. Narouze).

Correspondence to M. Ansarinia, 3101 South Maryland Parkway, Suite 211, Las Vegas, NV 89109, USA.

Copyright Copyright © 2010 American Headache Society

ABSTRACT
Introduction.—Cluster headaches (CH) are primary headaches marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Despite aggressive management with medications, oxygen therapy, nerve blocks, as well as various lesioning and neurostimulation therapies, a number of patients are incapacitated and suffering. The sphenopalatine ganglion (SPG) has been implicated in the pathophysiology of CH and has been a target for blocks, lesioning, and other surgical approaches. For this reason, it was selected as a target for an acute neurostimulation study.
Methods.—Six patients with refractory chronic CH were treated with short-term (up to 1 hour) electrical stimulation of the SPG during an acute CH. Headaches were spontaneously present at the time of stimulation or were triggered with agents known to trigger clusters headache in each patient. A standard percutaneous infrazygomatic approach was used to place a needle at the ipsilateral SPG in the pterygopalatine fossa under fluoroscopic guidance. Electrical stimulation was performed using a temporary stimulating electrode. Stimulation was performed at various settings during maximal headache intensity.
Results.—Five patients had CH during the initial evaluation. Three returned 3 months later for a second evaluation. There were 18 acute and distinct CH attacks with clinically maximal visual analog scale (VAS) intensity of 8 (out of 10) and above. SPG stimulation resulted in complete resolution of the headache in 11 attacks, partial resolution (>50% VAS reduction) in 3, and minimal to no relief in 4 attacks. Associated autonomic features of CH were resolved in each responder. Pain relief was noted within several minutes of stimulation.
Conclusion.—Sphenopalatine ganglion stimulation can be effective in relieving acute severe CH pain and associated autonomic features. Chronic long-term outcome studies are needed to determine the utility of SPG stimulation for management and prevention of CH.
Accepted for publication February 22, 2010.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2010.01661.x About DOI

Headache Collection

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

Source

Abstract

Headache during airplane travel (“airplane headache”): first case in Greece

Treatment of neuropathic pain with 5% lidocaine-medicated plaster: Five years of clinical experience

Effects of light deprivation on visual evoked potentials in migraine without aura

Background

Methods

Results

Conclusions

Highly localized interactions between sensory neurons and sprouting sympathetic fibers observed in a transgenic tyrosine hydroxylase reporter mouse

Molecular Pain 2011, 7:53 doi:10.1186/1744-8069-7-53Published: 27 July 2011

Abstract (provisional)

Background

Results

Conclusions

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

What initiates a migraine attack? Conclusions from four longitudinal studies of quantitative EEG and steady-state visual-evoked potentials in migraineurs.

Acta Neurol Scand: 2011: 124 (Suppl. 191): 56–63. © 2011 John Wiley & Sons A/S.

What initiates a migraine attack? Conclusions from four longitudinal studies of quantitative EEG and steady-state visual-evoked potentials in migraineurs.

Causes of headache in patients with a primary diagnosis of sinus headache

European Archives of Oto-Rhino-Laryngology (May 2011)

European Archives of Oto-Rhino-Laryngology (May 2011)

Foroughipour M, Sharifian SM, Shoeibi A, Ebdali Barabad N, Bakhshaee M;

Management of vestibular migraine

Therapeutic Advances in Neurological Disorders May 2011 vol. 4 no. 3 183-191Alexandre R. Bisdorff, Centre Hospitalier Emile Mayrisch, rue Emile Mayrisch, Esch-sur-Alzette, 4003 Luxembourg alexbis@pt.lu

Electrophysiologic Evidence of Spinal Accessory Neuropathy in Patients With Cervical Myofascial Pain Syndrome

Archives of Physical Medicine and RehabilitationVolume 92, Issue 6 , Pages 935-940, June 2011

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Pneumatized superior turbinate as a cause of headache.

Homsioglou E, Balatsouras DG, Alexopoulos G, Kaberos A, Katotomichelakis M, Danielides V.

Source

Abstract

BACKGROUND:

CASE PRESENTATION:

CONCLUSION:

Polyp in concha bullosa: a case report and review of the literature.

HEAD & FACE MEDICINEhttp://www.head-face-med.com/content/2/1/11Erkan AN, Canbolat T, Ozer C, Yilmaz I, Ozluoglu LN.SourceBaskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com

Source

Abstract

A Double-Blind Placebo-Controlled Pilot Study of Sublingual Feverfew and Ginger (LipiGesic(TM) M) in the Treatment of Migraine.

Source

Abstract

Potassium channels as a potential therapeutic target for trigeminal neuropathic and inflammatory pain

Molecular Pain 2011, 7:5 doi:10.1186/1744-8069-7-5Published: 10 January 2011

Abstract (provisional)

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Treatment of migraine with occipital nerve blocks using only corticosteroids.

Tobin J, Flitman S.

Abstract

Neurophysiological markers of central sensitisation in the trigeminal pathway and their modulation by the cyclo-oxygenase inhibitor ketorolac

Abstract

Bronchial Hyper-Reactivity in Migraine Without Aura: Is It a New Clue for Inflammation?

Headache: The Journal of Head and Face Pain 10 NOV 2010

Hakan Kaleagasi MD, Eylem Özgür MD,Cengiz Özge MD, Aynur Özge MD

Treatment of Migraine With Occipital Nerve Blocks Using Only Corticosteroids

Headache: The Journal of Head and Face Pain

Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression

Headache: The Journal of Head and Face Pain; Article first published online: 16 NOV 2010

Allergy and Immunotherapy: Are They Related to Migraine Headache?

Headache: The Journal of Head and Face Pain; Article first published online: 4 NOV 2010

Neurostimulation Therapy

St. Jude Medical Announces New Approvals Of Five-Column Neurostimulation Lead To Manage Chronic Pain

Treatment of Chronic Migraine

CURRENT PAIN AND HEADACHE REPORTSDOI: 10.1007/s11916-010-0159-xHans-Christoph Diener, Dagny Holle and David Dodick

CURRENT PAIN AND HEADACHE REPORTSDOI: 10.1007/s11916-010-0159-x

Abstract

Smoked cannabis for chronic neuropathic pain: a randomized controlled trial

CMAJ • October 5, 2010; 182 (14). First published August 30, 2010; doi:10.1503/cmaj.091414© 2010 Canadian Medical Association or its licensors

Cervical Facet Arthropathy and Occipital Neuralgia: Headache Culprits

CURRENT PAIN AND HEADACHE REPORTSVolume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5J. D. Hoppenfeld

CURRENT PAIN AND HEADACHE REPORTSVolume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

Molecular Pain 2011, 7:53 doi:10.1186/1744-8069-7-53
Published: 27 July 2011

Therapeutic Advances in Neurological Disorders
May 2011 vol. 4 no. 3 183-191
Alexandre R. Bisdorf f, Centre Hospitalier Emile Mayrisch, rue Emile Mayrisch, Esch-sur-Alzette, 4003 Luxembourg alexbis@pt.lu

Archives of Physical Medicine and Rehabilitation
Volume 92, Issue 6 , Pages 935-940, June 2011

HEAD & FACE MEDICINE
http://www.head-face-med.com/content/2/1/11

Erkan AN, Canbolat T, Ozer C, Yilmaz I, Ozluoglu LN.
Source
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com

Molecular Pain 2011, 7:5 doi:10.1186/1744-8069-7-5
Published: 10 January 2011

Hakan Kaleagasi MD,

Eylem Özgür MD,

Cengiz Özge MD,

Aynur Özge MD

CURRENT PAIN AND HEADACHE REPORTS
DOI: 10.1007/s11916-010-0159-x
Hans-Christoph Diener, Dagny Holle and David Dodick

CURRENT PAIN AND HEADACHE REPORTS
DOI: 10.1007/s11916-010-0159-x

CMAJ • October 5, 2010; 182 (14). First published August 30, 2010; doi:10.1503/cmaj.091414
© 2010 Canadian Medical Association or its licensors

CURRENT PAIN AND HEADACHE REPORTS
Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5
J. D. Hoppenfeld

CURRENT PAIN AND HEADACHE REPORTS
Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

Pain Medicine
Volume 11, Issue 11, pages 1674–1677, November 2010

Raj Mitra MD,
Huy Do MD,
Todd Alamin MD,
Ivan Cheng MD
Article first published online: 1 OCT 2010