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).
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.
Inflammation, traction, compression, maligt.inf of pain-sensitive structures . Signals reach CNS by the 1st division of the V. Infra tentorial lesions - posterior pain .
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.
GeneticVascularCSDTrigemino vascular5-HTDopamineEmpty neuron theory
A) Meningeal blood vessel D) Higher CNS centres B) Trigeminal sensoryC) Trigeminal nucleus nerve caudalis Pain transmission Nerve activation Neuropeptid e release
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
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;