Estrogen and chronic daily headache

P2X3 receptor expression in dorsal horn of spinal cord and pain threshold after estrogen therapy for prevention therapy in neuropathic pain

INTRODUCTION

Neuropathic pain may arise from conditions that affecting the central or peripheral nervous system. This study was held to determine the difference P2X3 receptor expression in the dorsal horn of the spinal cord and pain threshold after estrogen therapy in neuropathic pain.

METHODS

This study design was an experimental research laboratory. The 24 mice samples divided into negative control group, positive control, and treatment groups. The treatment groups were given subcutaneous injections of estrogen 0.4 ml and also examined for the onset of thermal hyperalgesia in every rat. On day 15, an autopsy was performed on rats, and the spine was taken. The spinal cord was stained by hematoxylin-eosin, and the expression of P2X3 receptors was investigated. P2X3 receptor expression was examined in the dorsal horn on each sample.

RESULTS

From 24 subjects of the study revealed an increase in the onset of thermal hyperalgesia on the estrogen group compared with the placebo group, a higher start. This study also obtained a decrease in the expression of P2X3 on the therapy group compared to the positive control group with significant differences. Statistical test results revealed the appearance of the P2X3 estrogen group had a substantial difference with the placebo group (p = 0.000) and the mean of the negative control group (p = 0.030). The placebo group had a significant difference from the negative control group (p = 0.035).

CONCLUSION

Estrogen could decrease the expression of P2X3 receptors and prolonged the onset of thermal hyperalgesia. So, both of these explained that estrogen has a role in preventing the occurrence of neuropathic pain after peripheral nerve lesions.

Tension-Type Headache in Children: The Cinderella of Headache Disorders!

Tension-type headache (TTH) may be as common a headache disorder as migraine in children and adolescents. TTH has a neurobiological basis with genetic and environmental factors making variable contributions to the different sub-types. The diagnostic criteria for TTH in the second edition of the “International Classification of Headache Disorders” appear to be applicable to children. Anxiety and mood disorders may be co-morbid with frequent episodic and chronic TTH. Psychosocial stressors play an important role in precipitating and maintaining TTH. Hence, a biopsychosocial approach should be adopted for care. Standardized histories and examinations together with prospective headache diaries are the foundations for good management; attention to ‘red flags’ will help identify secondary causes that present with headache similar to TT. There are no randomized controlled drug trials for the treatment of TTH. Relaxation and cognitive behavioral therapies are effective. TTH in children and adolescents warrants greater recognition from the clinician and scientist. Studies focusing on TTH are overdue.

Headache in pregnancy: a nuisance or a new sense?

Headache is a very commonly encountered symptom in pregnancy and is usually due to primary headache disorders which are benign in nature. It can however be quite debilitating for some women who may need therapeutic treatment of which there are several options safe to use in pregnancy. It is equally important though to recognise that headache may be a sign of serious underlying pathology. This paper aims to provide a clinically useful guidance for differentiation between primary and secondary headaches in pregnancy. The primary headache disorders and their management in pregnancy are explored in depth with brief overviews of the causes for secondary headaches and their further investigation and management.

Headache and pregnancy

BACKGROUND

Many women who suffer from migraine and tension-type headaches (TTHs) have an improvement in the frequency of these headaches during pregnancy. At the same time pregnancy predisposes women to a number of potentially life-threatening conditions which can present with headache. Accurate diagnosis and treatment of headache during pregnancy is essential.

REVIEW SUMMARY

The primary objectives of this review are to: (1) Summarize the natural history of primary headache disorders, including migraine, tension-type, and cluster headaches during pregnancy, as well as the impact of migraine on pregnancy outcomes and complications.(2) Summarize the therapeutic options and strategies for managing headaches in pregnancy and (3) Discuss the causes of secondary headaches and the diagnostic evaluation for new onset headache during pregnancy.

CONCLUSION

Primary headache disorders, in particular TTHs and migraines, generally improve during pregnancy. However the frequency of improvement varies greatly. Because the pathophysiology of both migraines and TTHs is poorly understood, this limits our ability to predict improvement. Future research should be focused on headache pathophysiology and the effect of ovarian hormones and the pregnant state on headache pathogenesis.