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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of the present study is to update the reader on atypical odontalgia and to present some preliminary data on the long-term follow-up of a subsample (n = 28) of these patients. Data based on 120 patients tend to support earlier findings that indicate that primarily women (81%) between the ages of 23 and 60 have this condition. Pain is generally localized in the teeth but may involve several areas of the oral cavity. On the basis of this larger sample size, the relationship between atypical odontalgia and migraine does not appear to be as strong as initially reported. Psychologic disturbance also may play a less significant role than initially thought. Follow-up data on 28 patients suggest that many patients will continue to experience episodes of pain. Antidepressant medication still appears to be the treatment of choice for this condition.
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PMID:Atypical odontalgia. Update and comment on long-term follow-up. 157 6

Headache is the most common symptom patients present to their doctors. Current systems classify the most common recurring headaches as either migraine or tension-type. Review of the literature brings into question this traditional approach to headache classification. These two "types" of headache patterns appear, instead, to be different expressions of the same pathophysiological process, having overlapping symptomatic presentations with certain features emphasized to a greater or lesser extent. Additionally, the same therapies have been demonstrated to be effective for patients traditionally classified in either headache group. This article reviews the overlap of clinical symptoms, pathophysiology, and effective treatments for headaches traditionally diagnosed as migraine and tension-type. An alternative continuum classification model is suggested.
Clin J Pain 1992 Mar
PMID:Migraine and tension-type headaches: the questionable validity of current classification systems. 163 81

Clinical and neurophysiological observations indicate that the symptoms of migraine aura result from the spread of an excitatory wave along the cortex from a primary focus. This excitation may start as a consequence of information overload on a low threshold cortical area. The transient neuronal excitatory wave is followed by a longer lasting "depressive" wave, which involves a substantial reduction in cortical blood flow (with an active constriction of resistance vessels) and ionic changes and transmitter release into the extracellular fluid compartment. As a consequence, trigeminal pain fibre endings in cortical venules may become activated and, via branches (axon reflexes) along the venous vascular tree, also multiple endings in dural venules. This will induce a neurogenic inflammation in the vessel walls, primarily in dural venules, experienced as headache by the sufferer when sufficiently many fibres have become activated. The pain fibre endings are equipped with serotonin1D-like receptors, which upon stimulation suppress the inflammatory process. This scenario offers a rational explanation for the beneficial effect of the acute, and some of the prophylactic, medications used in migraine.
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PMID:A cortical excitatory wave may cause both the aura and the headache of migraine. 157 47

Our purpose was to examine the MMPI profiles of 157 patients with chronic headache or facial pain. The following diagnostic groups were considered: tension-type headache (n = 44); migraine + cluster headache + chronic paroxysmal hemicrania (20); trigeminal neuralgia (7); atypical facial pain (AFP) (33); temporomandibular joint dysfunction (TMJ) (53). There were two control groups: C1 of 27 healthy individuals and C2 of 18 patients with chronic pain located elsewhere. A "Pain Index" was calculated (0-10) which quantified pattern, duration and frequency of pain. The Italian MMPI abbreviated version was administered to all subjects. One-way Anova, the Duncan test and correlation analysis were performed. Of the diagnostic groups, AFP scored highest and TMJ lowest in all except three scales. In the AFP group, all neurotic scales scored above 70. The Pain Index correlated with higher scores on most scales. Chronic pain may lead to personality alterations, but some features of craniofacial pain correlate with specific personality disturbances.
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PMID:MMPI profiles in patients with headache or craniofacial pain: a comparative study. 157 44

The exteroceptive suppression (ES) of electrical activity in the temporal muscle is an inhibitory antinociceptive brain-stem reflex. We investigated whether aspirin can significantly modulate latencies or durations of the early (ES1) and late (ES2) exteroceptive suppression periods of electrical activity in the temporal muscle. Participating in the randomized double-blind crossover study were 20 patients with migraine without aura, 20 patients with tension-type headache, and 20 healthy subjects. ES1 and ES2 elicited by an electrical stimulus of 20 mA lasting 0.2 msec were recorded during maximal voluntary contraction of the mastication muscles before and 30 min after medication. In a randomized and double-blind fashion half of the subjects were given 1200 mg of aspirin in the form of an effervescent solution and the other half were given an identically tasting solution without aspirin. One week later the experiment was repeated with the substances exchanged in crossover fashion. The administration of placebo as well as aspirin caused a highly significant increase in ES1 duration (P less than or equal to 0.001). While aspirin caused a highly significant increase in ES2 duration (P less than or equal to 0.001) the taking of placebo showed no significant effect on ES2 duration. In giving aspirin as opposed to the placebo, there was a significant interaction between groups and drug effect on the latency of ES1; whereas in migraine patients and in patients with tension-type headache the latency of ES1 was reduced by administration of aspirin, it was increased in healthy subjects (P less than or equal to 0.05). Neither aspirin nor placebo significantly varied the ES2 latency.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1992 Feb
PMID:Acetylsalicylic acid activates antinociceptive brain-stem reflex activity in headache patients and in healthy subjects. 158 37

Participating in the study were 69 persons with migraine and 69 controls, matched for sex and age, and all being patients of a neurologist. They filled out a questionnaire purporting to measure personality traits regarded as characteristic for the migraine personality type, namely ambition, orderliness, and rigidity. No differences between groups in any of the scales were revealed using t tests, results being far from significant. No support was thus given for the assumption of a typical personality structure of migrainous subjects. This is in accordance with our findings from previous studies with non-clinical samples.
Pain 1992 Mar
PMID:Are persons with migraine characterized by a high degree of ambition, orderliness, and rigidity? 159 54

Characteristic personality profiles of patients suffering from either migraine headache (MH) or tension type headache (TTH) have been described in the light of Minnesota Multiphasic Personality Inventory (MMPI). In the present study we evaluated personality profile changes following modifications of the painful symptoms after treatment, through the administration of the MMPI to MH and TTH patients. In TTH patients with no clinical improvement the depression scale scores were higher after 6 months of treatment, whereas in MH patients similar scores were observed before and after therapy, thus suggesting a primary role of depression in the onset of pain in the latter patients. Computerized EMG recording of the neck muscle activity showed different patterns of muscle contraction in resting condition and during stress or maximal muscular activity in patients suffering from TTH as compared to MH patients and normal subjects.
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PMID:Tension type headache: a neuropsychological and neurophysiological study. 160 32

The objectives of this study were to evaluate and compare the efficacy and tolerability of ketoprofen and ergotamine in the treatment of acute migraine attacks without aura. The study design was a single-centre, double-blind, placebo-controlled, cross-over comparison of a single dose of ketoprofen (100 mg) and ergotamine (2 mg) suppositories in the treatment of acute migraine attacks. Fifty patients were included in the statistical evaluation. Ketoprofen was found to be more efficient than ergotamine and placebo in reducing the severity of pain. Ketoprofen was found to be more satisfactory than ergotamine and placebo with regard to influence on working ability, and better than placebo in global assessment. We conclude that ketoprofen (100 mg suppository) is superior to ergotamine (2 mg suppository) and placebo in the symptomatic treatment of acute migraine attacks, and has better tolerability.
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PMID:Ketoprofen and ergotamine in acute migraine. 160 93

Distension of dural sinuses in man produces migraine-like pain. In eight alpha-chloralose anaesthetized cats mechanical distension of the superior sagittal sinus with a small intraluminal device was used to activate single units in the dorsolateral C2 spinal cord. Units in this region have been shown to respond to electrical stimulation of the superior sagittal sinus in the cat model. Linked responses to mechanical dilatation could only be obtained with very rapid stretching stimuli or high amplitudes of distension of the vessel. Lower thresholds for transduction of distension in the vessel wall may depend on transferral to the dura or biochemical or neural pre-sensitization of the superior sagittal sinus. These data are consistent with the view that migraine is not primarily a vascular disorder but requires at least humoral or neural facilitation.
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PMID:Activation of the trigeminovascular system by mechanical distension of the superior sagittal sinus in the cat. 162 3

We investigated whether experimentally determined, suprathreshold pain sensitivity of pericranial musculature in patients with tension-type headache differs from that of migraine patients or from that of healthy subjects. Furthermore, we looked to see whether differences could be found in the effects of experimental pain induction on EMG activity of pericranial musculature and whether subgroups could be discovered with higher and lower pericranial pain sensitivity within the three diagnostic groups in terms of neurophysiological, psychological and clinical variables. In 20 patients with tension-type headache, 23 patients with migraine without aura, and 29 healthy individuals experimental pain was induced in the temporal muscle by mechanical pressure; pain sensitivity in the entire metrically subdivided suprathreshold pain sensitivity range was measured. Surface EMG activity of pericranial muscles was determined before, during and after experimental pain induction. In addition, headache characteristics as well as personality and mood states were determined and recorded in a standardized fashion. There were no significant differences in pain sensitivity of pericranial musculature between the three groups. Patients with tension-type headache showed significantly higher EMG scores during suprathreshold pain stimulation than did migraine patients. EMG scores of healthy subjects fell between these two groups. With respect to pericranial tenderness significant differences in clinical, neurophysiological and psychological variables were found only between subgroups within the group of patients with tension-type headache. The results indicate that significant differences in the examined groups are found not in pain perception but in the processing or reaction to experimental headache stimuli. In patients with tension-type headache subgroups evolve based on pericranial pain sensitivity with quantitatively and/or qualitatively impaired reactions; for this reason diagnostic grouping according to the IHS classification seems to be pathophysiologically relevant. The intraindividual phasic comparison of pain reactions appears to be more important than the absolute interindividual tonic comparison.
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PMID:Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. 162 8


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