Migraine Headache PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 12: Altered Somatic and Special Sensory Function Module 4: Clinical Models Copyright © 2...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 12: Altered Somatic and Special Sensory Function Module 4: Clinical Models Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Migraine Headache Clinical Diagnostic Pathophysiology Treatment manifestations criteria  Migraine Headache Pathophysiology Recurrent headaches Moderate to severe severity Duration of 1-2 days Associated with nausea, vomiting and sensitivity to noise and light Manifestations may be severe More common in women Cause is not clear Alterations in certain cell groups in the brain triggered by inherited gene abnormalities  Migraine Headache Pathophysiology Cause: likely initiated by neurologic and http://www.headaches.org/2007/10/25/migraine/ biochemical events Trigeminal nerve activated releasing neuropeptides causing inflammation Decreased serotonin levels may precipitate the release of chemical mediators from trigeminal nerve Altering blood vessel function Low levels of magnesium cause abnormal communication Cortical spreading depression Women with migraine: increased risk of early-onset ischemic stroke  Migraine Headache ClinicalManifestations Typically 4 phases Prodrome – mood changes, food cravings, constipation, neck stiffness, yawning, fatigue, irritability occurring 24 to 48 hours before headache Aura – classical migraines affecting 15% of individuals, 15 to 30 mins before the onset, include visual, auditory, somatosensory or motor symptoms Headache – unilateral, pulsing and throbbing Postdrome – head movement may precipitate onset of pain, fatigue and positive emotional feelings Migraine categories 1. Common migraines without aura (most patients) 2. Classic or uncommon migraines with aura (~15%)  Migraine Headache DiagnosticCriteria Based on Review of patient history Physical examination Neurologic examination Imaging for acute, sudden onset to exclude other pathology MRI CT Diagnostic criteria Presence of aura: increased risk for ischemic cardiovascular events  Migraine Headache Treatment Prevention Pharmacologic Non-pharmacologic Existing pain Pharmacologic Non-pharmacologic Prevention Indicated for > 2 migraines each month Use of pain relieving medications > 2 times per week Inadequate relief from analgesic treatment Uncommon migraines  Migraine Headache Prevention Nonpharmacologic Avoidance of known triggers Regular exercise Adequate sleep Regular eating habits Smoking cessation Hormone level stabilization (oral contraceptives, hormone replacement therapy) Pharmacologic Analgesics (acetaminophen, NSAIDS, aspirin) Triptans Ergots Prevention – anti-convulsants, Botox DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG; Posey LM. Pharmacotherapy: A Pathophysiologic Approach 8th ed. New York, McGraw-Hill Education, 2011 Surgical deactivation of trigger sites