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Conservative Management of Occipital Neuralgia Supported by Physical Therapy: A Review of Available Research and Mechanistic Rationale to Guide Treatment. 物理治疗支持下的枕神经痛保守治疗:现有研究综述和指导治疗的机制原理。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-03 DOI: 10.1007/s11916-024-01288-6
Daniel Deuel, Andrew Sandgren, Evan O Nelson, Michael Cropes, Albojay Deacon, Tiffany Houdek, Alaa Abd-Elsayed

Purpose of review: Conservative management is consistently recommended as a first line intervention for occipital neuralgia (ON); however, there is limited clinical research regarding conservative intervention for ON. This lack of research may lead to underutilization or unwarranted variability in conservative treatment. This article provides mechanism-based guidance for conservative management of ON as a component of a multimodal treatment approach, and discusses the role of the physical therapist in the care team. It also highlights opportunities for further research to refine conservative management of this condition.

Recent findings: Published research on conservative interventions specific to ON is limited to very low-quality evidence for the use of TENS. The contemporary shift toward precision pain management emphasizing treatment based on a patient's constellation of clinical features-a phenotype-rather than solely a diagnosis provides more personalized and specifically targeted pain treatment. This paradigm can guide treatment in cases where diagnosis-specific research is lacking and can be used to inform conservative treatment in this case. Various conservative interventions have demonstrated efficacy in treating many of the symptoms and accepted etiologies of ON. Conservative interventions provided by a physical therapist including exercise, manual therapy, posture and biomechanical training, TENS, patient education, and desensitization have mechanistic justification to treat symptoms and causes of ON. Physical therapists have adequate time and skill to provide such progressive and iterative interventions and should be included in a multimodal treatment plan for ON. Further research is required to determine appropriate dosing, sequencing, and progression of conservative treatments.

综述目的:保守治疗一直被推荐为治疗枕神经痛(ON)的一线干预措施;然而,有关枕神经痛保守治疗的临床研究却十分有限。研究的缺乏可能会导致保守治疗的利用不足或不必要的变异。本文为保守治疗ON提供了基于机制的指导,将其作为多模式治疗方法的一部分,并讨论了理疗师在护理团队中的作用。文章还强调了进一步研究的机会,以完善对该病症的保守治疗:已发表的针对 ON 的保守干预研究仅限于使用 TENS 的低质量证据。当代疼痛治疗向精准化转变,强调根据患者的一系列临床特征(表型)进行治疗,而不仅仅是诊断,这提供了更加个性化和有针对性的疼痛治疗。这种模式可以在缺乏特定诊断研究的情况下指导治疗,并可用于指导本病例的保守治疗。各种保守干预已证明对治疗 ON 的许多症状和公认病因具有疗效。理疗师提供的保守干预措施包括运动、手法治疗、姿势和生物力学训练、TENS、患者教育和脱敏疗法,这些措施在治疗ON的症状和病因方面具有机理上的合理性。物理治疗师有足够的时间和技能来提供这种渐进和反复的干预措施,因此应将其纳入ON的多模式治疗计划中。要确定保守治疗的适当剂量、顺序和进展,还需要进一步的研究。
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引用次数: 0
Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. 不同射频技术治疗腰椎面关节疼痛的疗效比较:结合解剖学。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-25 DOI: 10.1007/s11916-024-01241-7
Ling Na Qi, Ye Sun, Yu Tong Shi, Jing Han Yang, Yi Ran Yang, Xiang Zheng Qin

Purpose of review: Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy.

Recent findings: There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.

审查目的:腰椎切面疼痛一般被认为是慢性腰痛的主要原因之一。每个腰椎面关节都受本级及以上脊神经后支内侧支支配。脊神经后支内侧支射频(RF)是治疗腰椎切面疼痛的有效方法。射频技术多种多样,包括传统射频(TRF)、脉冲射频(PRF)、冷却射频(CRF)、低温等离子射频消融(CA)等治疗方法。本文旨在比较不同射频技术的疗效,并结合解剖学分析其原因:已有研究证实不同射频技术的疗效存在差异。然而,大多数研究只比较了两种射频技术,而不是 TRF、CRF、PRF 和 CA 四种技术,也没有分析疗效差异的原因。本文回顾了上述四种射频技术的疗效差异,明确了差异主要是由于无法精确定位脊神经后支的内侧支,结合解剖学分析了无法精确定位脊神经后支的原因,并提出腰椎面神经痛的射频技术发展需要更深入的解剖学、影像学和临床研究。
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引用次数: 0
Neuropsychiatric Effects Associated with Opioid-Based Management for Palliative Care Patients. 对姑息治疗患者进行阿片类药物治疗的神经精神影响
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-04-02 DOI: 10.1007/s11916-024-01248-0
Alan D Kaye, Kylie Dufrene, Jada Cooley, Madeline Walker, Shivam Shah, Alex Hollander, Sahar Shekoohi, Christopher L Robinson

Purpose of review: The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care.

Recent findings: Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.

审查目的:在姑息治疗中大量使用阿片类药物曾一度被认为是一种标准的治疗方法,但现在却要求医疗服务提供者对患者进行评估,以发现与阿片类药物的异常使用和成瘾有关的意外和有害症状。阿片类药物的多重药理作用会对患者的神经系统产生动态影响,处方量的增加不仅会对患者本人,还会对其家人和医疗服务提供者产生不利影响。本综述旨在拓宽阿片类药物后果的视角,让人们认识到接受姑息治疗的患者最常服用的阿片类药物对神经精神产生的诸多影响:大量临床和研究发现,有证据支持阿片类药物的使用和滥用以及不良神经系统后果的增加。在这种情况下,使用阿片类药物最常见和最令人担忧的影响是谵妄和与药物有关的问题行为变化,如对家人和医生的欺骗行为、发怒、超量服药和提早要求更换处方。最近的研究详细阐述了其他神经精神影响,包括寻求药物的行为、耐受性、依赖性、成瘾性障碍、焦虑、药物使用障碍、情绪困扰、继续服用阿片类药物以避免阿片类药物戒断综合症、抑郁和自杀倾向。阿片类药物的使用具有有害和混杂的影响,多年来一直被姑息关怀提供者和接受姑息关怀的病人所忽视。有必要认识到阿片类药物可能对个体产生的潜在神经精神影响,尤其是对接受姑息关怀的患者而言,这甚至是拯救生命的关键。通过提高对阿片类药物潜在神经精神作用的理解和认识,可以改善患者的生活质量,降低医疗系统成本,达到甚至超过患者的治疗效果。
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引用次数: 0
Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine. 眩晕之外:前庭性偏头痛的前庭、听觉和知觉症状。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-23 DOI: 10.1007/s11916-024-01245-3
Claire E J Ceriani

Purpose: To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo.

Recent findings: Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.

目的:回顾可能与眩晕同时出现的前庭性偏头痛(VM)的前庭、听觉和知觉症状:最近的研究结果:研究人员越来越关注前庭性偏头痛患者所表现出的各种症状,从而提高了人们对这种疾病的认识,最近还发现了五种不同的前庭性偏头痛表型。对眩晕症与其他慢性前庭综合征(如持续性姿势感知性眩晕和前庭功能障碍综合征)之间临床重叠的研究揭示了一系列前庭症状,并暗示了偏头痛与前庭功能障碍之间的病理生理学联系。对偏头痛治疗听力损失的研究表明,出现听力症状的患者可能有偏头痛的潜在诊断,值得试用偏头痛预防药物。对感知障碍 "爱丽丝梦游仙境综合征 "的神经学基础进行的研究揭示了可能涉及的大脑区域,这可能有助于解释其在偏头痛患者中的发病率。眩晕症是一种感觉处理障碍,其表现不仅仅是眩晕。如果只考虑诊断标准中确定的症状,可能会漏诊偏头痛患者。
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引用次数: 0
Optimal Perioperative Pain Management of the Transgender Patient for Gender Affirming Surgery: A Scoping Review. 变性患者接受性别确认手术的最佳围手术期疼痛管理:范围综述。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-24 DOI: 10.1007/s11916-024-01219-5
Alopi Patel, Vinit Palayeker, Paul Shekane

Introduction: As we increasingly encounter transgender patients in the perioperative setting, it is important to be cognizant of appropriate medical management of the transgender patient. There is limited literature on the appropriate perioperative techniques to implement for adequate pain control in the transgender patient presenting for gender affirming procedures.

Methods: In this scoping review, the authors identify publications that address perioperative pain control techniques that can be implemented by the anesthesiologist such as regional anesthesia, multimodal medications, or non-pharmacologic modalities.

Results: This scoping review included two retrospective reviews, two case reports, and one letter to the editor. There are no prospective, randomized controlled trials on this topic. The limitations of this scoping review include the limited publications that are available to analyze as this is a growing area of medicine.

Conclusion: There are numerous variables that may play a factor in the pain experience of the transgender patient including biological factors, psychological and social factors. Techniques that are necessary for comprehensive pain management include pharmacologic, injections, physical therapy, acupuncture, massage, and more. There are limited publications on the comprehensive pain management of the transgender patient; therefore, the authors advocate that as perioperative physicians, anesthesiologists implement comprehensive preemptive analgesia techniques to avoid progression to chronic pain. Clearly more research is necessary to standardize acute pain management techniques in the transgender patient.

导言:随着我们在围手术期遇到的变性患者越来越多,认识到对变性患者进行适当的医疗管理非常重要。关于变性患者在接受性别确认手术时应采用哪些适当的围手术期技术来充分控制疼痛的文献十分有限:在这篇范围综述中,作者确定了有关麻醉医师可采用的围术期疼痛控制技术的出版物,如区域麻醉、多模式药物或非药物模式:本次范围界定综述包括两篇回顾性综述、两篇病例报告和一封致编辑的信。目前还没有关于此主题的前瞻性随机对照试验。由于这是一个不断发展的医学领域,本范围综述的局限性包括可用于分析的出版物有限:变性患者的疼痛经历中可能存在许多变量,包括生物因素、心理和社会因素。综合疼痛治疗所需的技术包括药物治疗、注射、物理治疗、针灸、按摩等。有关变性患者综合疼痛管理的出版物非常有限;因此,作者主张,作为围手术期的医生,麻醉师应实施全面的预防性镇痛技术,以避免发展为慢性疼痛。显然,有必要开展更多研究,以规范变性患者的急性疼痛管理技术。
{"title":"Optimal Perioperative Pain Management of the Transgender Patient for Gender Affirming Surgery: A Scoping Review.","authors":"Alopi Patel, Vinit Palayeker, Paul Shekane","doi":"10.1007/s11916-024-01219-5","DOIUrl":"10.1007/s11916-024-01219-5","url":null,"abstract":"<p><strong>Introduction: </strong>As we increasingly encounter transgender patients in the perioperative setting, it is important to be cognizant of appropriate medical management of the transgender patient. There is limited literature on the appropriate perioperative techniques to implement for adequate pain control in the transgender patient presenting for gender affirming procedures.</p><p><strong>Methods: </strong>In this scoping review, the authors identify publications that address perioperative pain control techniques that can be implemented by the anesthesiologist such as regional anesthesia, multimodal medications, or non-pharmacologic modalities.</p><p><strong>Results: </strong>This scoping review included two retrospective reviews, two case reports, and one letter to the editor. There are no prospective, randomized controlled trials on this topic. The limitations of this scoping review include the limited publications that are available to analyze as this is a growing area of medicine.</p><p><strong>Conclusion: </strong>There are numerous variables that may play a factor in the pain experience of the transgender patient including biological factors, psychological and social factors. Techniques that are necessary for comprehensive pain management include pharmacologic, injections, physical therapy, acupuncture, massage, and more. There are limited publications on the comprehensive pain management of the transgender patient; therefore, the authors advocate that as perioperative physicians, anesthesiologists implement comprehensive preemptive analgesia techniques to avoid progression to chronic pain. Clearly more research is necessary to standardize acute pain management techniques in the transgender patient.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":" ","pages":"663-671"},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can Long-Term Outcomes of Posttraumatic Headache be Predicted? 创伤后头痛的长期结果可以预测吗?
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-05-07 DOI: 10.1007/s11916-024-01254-2
Olivia Kingsford, Mustafa Yehya, Glynnis Zieman, Kerry L Knievel

Purpose of review: Headache is one of the most common symptoms of traumatic brain injury, and it is more common in patients with mild, rather than moderate or severe, traumatic brain injury. Posttraumatic headache can be the most persistent symptom of traumatic brain injury. In this article, we review the current understanding of posttraumatic headache, summarize the current knowledge of its pathophysiology and treatment, and review the research regarding predictors of long-term outcomes.

Recent findings: To date, posttraumatic headache has been treated based on the semiology of the primary headache disorder that it most resembles, but the pathophysiology is likely to be different, and the long-term prognosis differs as well. No models exist to predict long-term outcomes, and few studies have highlighted risk factors for the development of acute and persistent posttraumatic headaches. Further research is needed to elucidate the pathophysiology and identify specific treatments for posttraumatic headache to be able to predict long-term outcomes. In addition, the effect of managing comorbid traumatic brain injury symptoms on posttraumatic headache management should be further studied. Posttraumatic headache can be a persistent symptom of traumatic brain injury, especially mild traumatic brain injury. It has traditionally been treated based on the semiology of the primary headache disorder it most closely resembles, but further research is needed to elucidate the pathophysiology of posttraumatic headache and determine risk factors to better predict long-term outcomes.

审查目的:头痛是脑外伤最常见的症状之一,在轻度脑外伤患者中比中度或重度脑外伤患者更常见。创伤后头痛可能是脑外伤最持久的症状。在本文中,我们回顾了目前对创伤后头痛的理解,总结了目前对其病理生理学和治疗的认识,并回顾了有关长期结果预测因素的研究:最新研究结果:迄今为止,创伤后头痛一直是根据其最相似的原发性头痛疾病的符号学来治疗的,但其病理生理学可能有所不同,长期预后也不尽相同。目前还没有预测长期预后的模型,也很少有研究强调发生急性和持续性创伤后头痛的风险因素。需要进一步研究以阐明病理生理学并确定创伤后头痛的具体治疗方法,从而能够预测长期预后。此外,还应进一步研究处理合并脑外伤症状对创伤后头痛治疗的影响。创伤后头痛可能是脑外伤,尤其是轻度脑外伤的一种持续性症状。传统的治疗方法是根据与其最相似的原发性头痛疾病的半身像进行治疗,但还需要进一步的研究来阐明创伤后头痛的病理生理学,并确定风险因素,以便更好地预测长期结果。
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引用次数: 0
IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review. IPACK 阻滞对全膝关节置换术后急性疼痛治疗的疗效:综述。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-03-23 DOI: 10.1007/s11916-024-01237-3
William C Upshaw, John M Richey, Joseph P Tassin, Mark V Frolov, Benjamin C Miller, Aaron J Kaye, Jeffrey Sterritt, Charles J Fox, Shahab Ahmadzadeh, Sahar Shekoohi, Alan D Kaye

Purpose of review: Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy.

Recent findings: 5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. In most instances, the IPACK + ACB showed superior efficacy in managing patients' pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient's pain following TKR.

审查目的:全膝关节置换术(TKR)后,患者常常会感到膝关节疼痛。为缓解这种疼痛,可进行神经阻滞,如内收肌管阻滞(ACB)。但是,内收肌阻滞无法缓解源自膝关节后部的疼痛。一种被称为 IPACK 阻滞的新型神经阻滞可与 ACB 结合使用,因为 IPACK 阻滞旨在抑制支配该区域的神经分支。在本文中,我们将探讨 IPACK 阻滞术的原理、实施方法以及研究其疗效的临床试验:本文研究的 7 项临床试验中有 5 项显示,IPACK + ACB 阻滞在治疗 TKR 后疼痛方面的疗效优于其他阻滞。这些阻滞包括 PMDI+ACB、SPANK+ACB、PAI+ACB、单纯 ACB 和 SCAB。7 项临床试验中有 2 项显示,与其他阻滞(包括 CACB 和 4 合 1 阻滞)相比,IPACK + ACB 在治疗患者 TKR 术后疼痛方面的效果较差。在大多数情况下,与其他类型的神经阻滞相比,IPACK + ACB 在治疗患者接受 TKR 后的疼痛方面显示出更高的疗效。这是在测量阿片类药物的使用量、术后疼痛报告和 TKR 术后住院时间后得出的结论。因此,我们认为 IPACK 阻滞可与 ACB 结合使用,以有效减轻 TKR 术后患者的疼痛。
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引用次数: 0
Subsume Pediatric Headaches in Psychiatric Disorders? Critiques on Delphic Nosology, Diagnostic Conundrums, and Variability in the Interventions. 将小儿头痛归入精神疾病?对德尔菲命名法、诊断难题和干预措施变异性的批判》。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-02-17 DOI: 10.1007/s11916-024-01225-7
Aditya Sharma, Priyal Khurana, Akila Venkatraman, Mayank Gupta

Purpose of review: Tension-type headache (TTH) continues to be the most prevalent type of headache across all age groups worldwide, and the global burden of migraine and TTH together account for 7% of all-cause years lived with disability (YLDs). TTH has been shown to have a prevalence of up to 80% in several studies and presents a wide range and high variability in clinical settings. The aim of this review is to identify gaps in diagnostics, nosology, and variability in the treatment of children and adolescents who present with headaches without an identifiable etiology.

Recent findings: Migraine and TTH have been debated to have more similarities than distinctions, increasing chances of misdiagnosis and leading to significant cases diagnosed as probable TTH or probable migraine. The lack of specificity and sensitivity for TTH classification often leads to the diagnosis being made by negating associated migraine symptoms. Although pathology is not well understood, some studies have suggested a neurological basis for TTH, in need of further validation. Some research indicates that nitric oxide signaling plays an integral part in the pain mechanisms related to TTH. Analgesics and non-steroidal anti-inflammatories are usually the first lines of treatment for children with recurring headaches, and additional treatment options include medication and behavioral therapies. With high prevalence and socioeconomic burden among children and adolescents, it's essential to further study Tension-type headaches and secondary headaches without known cause and potential interventions. Treatment studies involving randomized controlled trials are also needed to test the efficacy of various treatments further.

回顾的目的:紧张型头痛(TTH)仍然是全球各年龄段最常见的头痛类型,偏头痛和紧张型头痛造成的全球负担共占全因残疾生存年数(YLDs)的 7%。多项研究表明,TTH 的发病率高达 80%,而且在临床环境中的发病范围很广,变异性很大。本综述旨在找出诊断、命名和治疗儿童和青少年无明确病因头痛方面的差距:偏头痛和TTH的相似性多于区别,这增加了误诊的几率,导致大量病例被诊断为可能的TTH或可能的偏头痛。TTH分类缺乏特异性和敏感性,往往导致通过否定相关偏头痛症状来做出诊断。虽然病理还不十分清楚,但一些研究认为TTH有神经学基础,需要进一步验证。一些研究表明,一氧化氮信号在与TTH相关的疼痛机制中起着不可或缺的作用。止痛药和非甾体抗炎药通常是治疗儿童反复头痛的首选药物,其他治疗方法包括药物和行为疗法。由于儿童和青少年中的高发病率和社会经济负担,有必要进一步研究紧张型头痛和不明原因的继发性头痛以及潜在的干预措施。还需要进行随机对照试验的治疗研究,以进一步检验各种治疗方法的疗效。
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引用次数: 0
Primary Headache Associated with Sexual Activity: A Review of the Literature. 与性活动有关的原发性头痛:文献综述。
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-02-17 DOI: 10.1007/s11916-023-01206-2
Philip Maynard, Anna Pace

Purpose of review: This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA).

Recent findings: Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. There are many secondary headaches that may present with headache during sexual activity, and a thorough workup is indicated to rule out potentially life-threatening etiologies. Many recent case series discuss the efficacy of known treatments of PHASA, as well as suggest other potential therapies for this condition including the newer CGRP-targeted therapies. Headaches during sexual activity can be worrisome events which necessitate urgent evaluation, particularly when presenting with sudden-onset and severe "thunderclap" headaches. A thorough workup including imaging should be conducted to rule out etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection. PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. Pain is primarily occipital, diffuse, and bilateral. The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.

综述的目的:本综述总结了与性活动有关的原发性头痛(PHASA)在诊断、评估和治疗方面的演变:最近的研究结果:尽管患者获取信息的渠道增加了,影像学技术也取得了进步,但人们对 PHASA 的病理生理学仍不完全了解。有许多继发性头痛可能会在性活动时出现头痛,因此需要进行全面检查以排除可能危及生命的病因。最近的许多病例系列讨论了已知的 PHASA 治疗方法的疗效,并提出了其他潜在的治疗方法,包括较新的 CGRP 靶向疗法。性活动中的头痛可能是令人担忧的事件,需要进行紧急评估,尤其是在出现突然发作的剧烈 "雷鸣般 "头痛时。应进行包括影像学检查在内的全面检查,以排除蛛网膜下腔出血、可逆性脑血管收缩综合征(RCVS)、血管痉挛和夹层等病因。PHASA 通常合并偏头痛、紧张型头痛、劳累性头痛和高血压。PHASA 可表现为随着性兴奋而加剧的钝性头痛,也可表现为性高潮时或性高潮前后的爆发性头痛。疼痛主要是枕部、弥漫性和双侧性的。头痛是不连续的、反复发作的事件,通常会自行缓解,但也可能复发和缓解,或在某些患者中长期持续。PHASA 可在性活动前使用吲哚美辛和曲坦类药物进行预防性治疗,或使用β-受体阻滞剂、托吡酯和钙通道阻滞剂进行预防性治疗。根据一些病例报告,CGRP 靶向疗法可能会缓解 PHASA,但目前还没有随机对照试验来研究这些疗法的具体疗效。
{"title":"Primary Headache Associated with Sexual Activity: A Review of the Literature.","authors":"Philip Maynard, Anna Pace","doi":"10.1007/s11916-023-01206-2","DOIUrl":"10.1007/s11916-023-01206-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA).</p><p><strong>Recent findings: </strong>Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. There are many secondary headaches that may present with headache during sexual activity, and a thorough workup is indicated to rule out potentially life-threatening etiologies. Many recent case series discuss the efficacy of known treatments of PHASA, as well as suggest other potential therapies for this condition including the newer CGRP-targeted therapies. Headaches during sexual activity can be worrisome events which necessitate urgent evaluation, particularly when presenting with sudden-onset and severe \"thunderclap\" headaches. A thorough workup including imaging should be conducted to rule out etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection. PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. Pain is primarily occipital, diffuse, and bilateral. The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":" ","pages":"627-632"},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Light Therapy in Chronic Migraine. 慢性偏头痛的光疗
IF 3.2 2区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1007/s11916-024-01258-y
Tsung-Wei Hou, Cheng-Chia Yang, Tzu-Hsien Lai, Ying-Hui Wu, Chun-Pai Yang

Purpose of review: This review assesses the effectiveness and safety of light therapy, particularly green light therapy, as an emerging non-pharmacological treatment for chronic migraine (CM). It aims to highlight alternative or complementary approaches to traditional pharmacological remedies, focusing the need for diverse treatment options.

Recent findings: Despite sensitivity to light being a defining feature of migraine, light therapy has shown promising signs in providing substantial symptom relief. Studies have provided insights into green light therapy's role in managing CM. These studies consistently demonstrate its efficacy in reducing the frequency, severity, and symptoms of migraines. Additional benefits observed include improvements in sleep quality and reductions in anxiety. Importantly, green light therapy has been associated with minimal side effects, indicating its potential as a suitable option for migraine sufferers. In addition to green light, other forms of light therapy, such as infrared polarized light, low-level laser therapy (LLLT), and intravascular irradiation of blood (ILIB), are also being explored with potential therapeutic effects. Light therapies, especially green light therapy, are recognized as promising, safe, and non-pharmacological interventions for treating CM. They have been shown to be effective in decreasing headache frequency and enhancing the overall quality of life. However, current studies, often limited by small sample sizes, prompt more extensive clinical trials to better understand the full impact of light therapies. The exploration of other light-based treatments, such as LLLT and ILIB, warrants further research to broaden the scope of effective migraine management strategies.

综述目的:本综述评估了光疗(尤其是绿光疗法)作为治疗慢性偏头痛(CM)的新兴非药物疗法的有效性和安全性。其目的是强调传统药物疗法的替代或补充方法,重点关注对多样化治疗方案的需求:最近的研究结果:尽管对光敏感是偏头痛的一大特征,但光疗法在缓解症状方面已显示出良好的前景。研究深入探讨了绿光疗法在控制偏头痛方面的作用。这些研究一致表明,绿光疗法能有效降低偏头痛的频率、严重程度和症状。观察到的其他益处还包括改善睡眠质量和减轻焦虑。重要的是,绿光疗法的副作用极小,这表明它有可能成为偏头痛患者的合适选择。除绿光外,其他形式的光疗法,如红外线偏振光、低强度激光疗法(LLLT)和血管内照射血液疗法(ILIB),也正在探索其潜在的治疗效果。光疗法,尤其是绿光疗法,被认为是治疗慢性中风的有前途、安全和非药物干预措施。研究表明,它们能有效降低头痛频率并提高整体生活质量。然而,目前的研究往往受到样本量较小的限制,因此需要进行更广泛的临床试验,以更好地了解光疗法的全面影响。对 LLLT 和 ILIB 等其他光疗法的探索值得进一步研究,以扩大有效偏头痛治疗策略的范围。
{"title":"Light Therapy in Chronic Migraine.","authors":"Tsung-Wei Hou, Cheng-Chia Yang, Tzu-Hsien Lai, Ying-Hui Wu, Chun-Pai Yang","doi":"10.1007/s11916-024-01258-y","DOIUrl":"10.1007/s11916-024-01258-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review assesses the effectiveness and safety of light therapy, particularly green light therapy, as an emerging non-pharmacological treatment for chronic migraine (CM). It aims to highlight alternative or complementary approaches to traditional pharmacological remedies, focusing the need for diverse treatment options.</p><p><strong>Recent findings: </strong>Despite sensitivity to light being a defining feature of migraine, light therapy has shown promising signs in providing substantial symptom relief. Studies have provided insights into green light therapy's role in managing CM. These studies consistently demonstrate its efficacy in reducing the frequency, severity, and symptoms of migraines. Additional benefits observed include improvements in sleep quality and reductions in anxiety. Importantly, green light therapy has been associated with minimal side effects, indicating its potential as a suitable option for migraine sufferers. In addition to green light, other forms of light therapy, such as infrared polarized light, low-level laser therapy (LLLT), and intravascular irradiation of blood (ILIB), are also being explored with potential therapeutic effects. Light therapies, especially green light therapy, are recognized as promising, safe, and non-pharmacological interventions for treating CM. They have been shown to be effective in decreasing headache frequency and enhancing the overall quality of life. However, current studies, often limited by small sample sizes, prompt more extensive clinical trials to better understand the full impact of light therapies. The exploration of other light-based treatments, such as LLLT and ILIB, warrants further research to broaden the scope of effective migraine management strategies.</p>","PeriodicalId":50602,"journal":{"name":"Current Pain and Headache Reports","volume":" ","pages":"621-626"},"PeriodicalIF":3.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Current Pain and Headache Reports
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