This inflammatory molecule, called tumor necrosis factor-alpha (TNF), is released not only by the herniated or protruding disc, but also in cases of disc tear (annular tear), by facet joints, and in spinal stenosis. In addition to causing pain and inflammation, TNF may also contribute to disc degeneration. If the cause of the pain is not compression, but rather is inflammation mediated by TNF, then this may well explain why surgery might not relieve the pain, and might even exacerbate it, resulting in FBSS. Role of sacroiliac joint (SIJ) in lower back pain (LBP)
A 2005 review by Cohen concluded,The SI joint is a real yet underappreciated pain generator in an estimated 15% to 25% of patients with axial LBP. Studies by Ha, et al., show that the incidence of SI joint degeneration in post-lumbar fusion surgery is 75% at 5 years post-surgery, based on imaging. Studies by DePalma and Liliang, et al., demonstrate that 40–61% of post-lumbar fusion patients were symptomatic for SI joint dysfunction based on diagnostic blocks. Smoking
Recent studies have shown that cigarette smokers will routinely fail all spinal surgery, if the goal of that surgery is the decrease of pain and impairment. Many surgeons consider smoking to be an absolute contraindication to spinal surgery. Nicotine appears to interfere with bone metabolism through induced calcitonin resistance and decreased osteoblastic function.
Cluster headaches occur primarily in men, while CPH is more commonly diagnosed in women. The female to male ratio of diagnosed patients can range anywhere from 1.6:1 to 2.36:1. Symptoms may begin to appear at any age, but onset usually occurs in adulthood with a mean starting age within the thirties. History
CPH was discovered by Norwegians Ottar Sjaastad and Inge Dale in 1974. The term chronic paroxysmal hemicrania was first used in 1976 by Sjaastad to describe a condition seen in two of their patients who were experiencing repeated solitary and limited daily headache attacks on only one side of the cranium.It is possible that chronic paroxysmal hemicrania was first described by Johann Oppermann in 1747 under the term "hemicranias horologica". Oppermanns report included a 35-year-old woman who had hemicranial pain that lasted for 15 minutes and recurred regularly every hour.CPH has been included in the International Headache Societys classification system since 1988. See also
Hemicrania continua
Rebound headaches
Tension headaches
Trigeminal neuralgia

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