This document discusses migraine headaches. It notes that lifetime prevalence is around 90% for women and 95% for men. Migraines affect 18.2% of females and 6.5% of males. Three quarters of migraine sufferers experience severe or extremely severe pain, and over half experience severe disability, with 31% missing at least one day of work or school in the past three months. It then discusses anatomical structures involved in migraine pain transmission both inside and outside the skull. The document outlines several theories for migraine triggers and mechanisms of pain transmission and modulation in the central nervous system. It lists warning signs that could indicate an underlying condition is causing headache symptoms. Finally, it references a meta-analysis on the use of oral t

1. DR SRIRAMA ANJANEYULU MD DM
NEUROPHYSICIAN

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).

5.  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.

6.  Inflammation, traction,
compression, maligt.inf
of pain-sensitive
structures .
 Signals reach CNS by
the 1st division of the V.
 Infra tentorial lesions -
posterior pain .

7.  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.

8. Genetic
Vascular
CSD
Trigemino vascular
5-HT
Dopamine
Empty neuron theory

9. A) Meningeal blood vessel
D) Higher CNS centres
B) Trigeminal sensory
C) Trigeminal nucleus nerve
caudalis
Pain transmission Nerve activation 
Neuropeptid
e release

14.  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

34. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin
5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials Lancet, 2001;