HEADACHE

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Basics ,approach and management of migraine for GP's

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HEADACHE

  1. 1. DR SRIRAMA ANJANEYULU MD DM NEUROPHYSICIAN
  2. 2.  lifetime prev- men =90,women=95 Migraine females 18.2 %,Male=6.5% 75% - severe or extremely severe pain . 53% -severe disability . 3 1% - missed at least 1 day ( in the preceding 3 months).
  3. 3.  Intracranial arteries of the COW, 1st cms of their medium-sized branches, meningeal arteries, large veins ,dural venous sinuses and portions of the dura near vessels. External to the skull cavity ECA and its branches, scalp and neck muscles, skin, cutaneous nerves, cervical nerves , nerve roots, mucosa of sinuses and teeth. Pain carried by cranial nerves V, VII, IX, and X.
  4. 4.  Inflammation, traction, compression, maligt.inf of pain-sensitive structures . Signals reach CNS by the 1st division of the V. Infra tentorial lesions - posterior pain .
  5. 5.  Afferent pain impulses into the TN modified and modulated by descending facilitatory and inhibitory influences from critical BS structures, PAG, rostral VM medulla,LC, and dorsal raphe nuclei. Opioids diminish pain perception by activating the inhibitory systems. Fear, anxiety, and overuse of analgesics activate facilitatory systems.
  6. 6. GeneticVascularCSDTrigemino vascular5-HTDopamineEmpty neuron theory
  7. 7. A) Meningeal blood vessel D) Higher CNS centres B) Trigeminal sensoryC) Trigeminal nucleus nerve caudalis Pain transmission Nerve activation  Neuropeptid e release
  8. 8.  Sub acute and progressive headache New onset >40 yrs of age Change in pattern(intensity of pain, frequency of attacks, new features, decreased response to treatment) Association : nausea or vomiting not explained by migraine or systemic illness ; nocturnal occurrence or morning awakening; precipitation or worsening by changes in posture or Valsalva maneuver; confusion, seizures, weakness Abnormalities on neuro.examination
  9. 9. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials Lancet, 2001;

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