dr manzo lucio

Paul Shanahan

Description

Manjit S Matharu Headache Group, Institute of Neurology & The National Hospital for Neurology and Neurosurgery London UK St Jude Medical Intractable Chronic Migraine Course nd22 February 2012 ICHD-II Diagnostic Criteria Episodic attacks of headache lasting 4-72 hours with the following features: Headache has at least two of the following During headache at least one of the following: characteristics: Nausea and/or vomiting Unilateral location Photophobia and phonophobia Pulsating quality Moderate or severe pain intensity Aggravation by routine physical activity Further sub-classified on basis of frequency of headaches Episodic migraine 15 days/month {???? {?? Phases of Migraine Time Headache & Premonitory Aura Resolution Associated Features Complex array of Aura symptoms occur with symptoms reflecting focal headache: cortical or brainstem – Always 18% dysfunction – Sometimes 13% – Never 69% Gradual evolution Types of aura: 5-30minutes ( > > ? ? X Aura: Pathophysiological Hypotheses Wolff’s vascular hypothesis Cortical spreading depression of Leao Migraine aura secondary to cerebral Wave of excitation followed by inhibition that hypoxia traverses the cortex at 3-6 mm/min Hyperperfusion Normal CBF Hypo- perfusion Aura Headache 2 6 4 8 10 12 Hours after angiography Leao. J. Neurophysiol. 1944; Leao and Morison. J. Neurophysiol. 1945 Wolff. Headache and other head pain.

Informations

• Publié par: neurochirurgiechufortdefrance
• Publié le: 24 janvier 2013
• Nombre de lectures: 501
• Langue: English
• Poids de l'ouvrage: 13 Mo

Extrait

Manjit S Matharu
Headache Group, Institute of Neurology &
The National Hospital for Neurology and Neurosurgery
London
UK

St Jude Medical
Intractable Chronic Migraine Course
nd22 February 2012 ICHD-II Diagnostic Criteria
Episodic attacks of headache lasting 4-72 hours with the following
features:
Headache has at least two of the following During headache at least one of the following:
characteristics: Nausea and/or vomiting
Unilateral location Photophobia and phonophobia
Pulsating quality
Moderate or severe pain intensity
Aggravation by routine physical activity
Further sub-classified on basis of frequency of headaches
Episodic migraine <15 days/month
Chronic migraine >15 days/month
{????{??Phases of Migraine
Time
Headache & Premonitory Aura Resolution
Associated Features Complex array of Aura symptoms occur with
symptoms reflecting focal headache:
cortical or brainstem – Always 18%
dysfunction – Sometimes 13%

– Never 69% Gradual evolution
Types of aura: 5-30minutes (<60minutes)
– Visual 99%
Usually before headache; – Sensory 31%
can be during or even – Language 18%
after headache – Motor 6%

{{{{{Pain: • Unilateral or bilateral
• Throbbing, worsened by movement or
activity
• Cutaneous allodynia
• Neck stiffness/pain (80%)

Associated Sensory hyperexcitability
Symptoms: • Photophobia, phonophobia, osmophobia
• Motion sensitivity/vertigo

Gastrointestinal disturbance
• Nausea/Vomiting/Diarrhoea

MIGRAINE IS A FEATUREFUL HEADACHE ICHD-IIR DIAGNOSTIC CRITERIA
Migraine headache occurring on ? ? UU
of medication overuse, not attributed to another disorder. ? UH UUD
On During headache at least one
has at least two of the following characteristics: of the following:
Unilateral location Nausea and/or vomiting
Pulsating quality Photophobia and phonophobia
Moderate or severe pain intensity and/or treated and relieved by triptan(s) or
ergot before developing into a migraine
Aggravation by routine physical activity
1. ICHD 2006 Headache Classification Committee of the International Headache Society. Olesen J et al. Cephalalgia 2006;26:742
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?1 One-year prevalence of migraine is approximately 10%
Migraine is more prevalent than common disorders such as
2 diabetes and asthma.
In Europe and America, WHO estimates the prevalence of
3 migraine to be 6–8% in men and 15–18% in women.
4 Chronic migraine affects 1.4-2.2% of people wordwide
European Union
Chronic Medically Refractory Migraine 50M
Migraine Chronic Migraine
7.3M 1M?
1. Stovner LJ et al. Cephalalgia 2007;27:193–210. 2. World Health Organization. The Global Burden of Disease: 2004 update, Part 3, 28–37.
3. World Health Organization. Headache disorders, 2004. 4. Natoli JL, et al. Cephalagia 2010;30:599-609. Migraine is one of the 20 most common causes of
1 years of life lived with disability
WHO global burden of disease survey rates severe
migraine, along with quadriplegia, psychosis and
dementia, in a group as the most disabling chronic
1disorders
80% of migraine patients report severe or very severe
2pain
291% of migraine patients report disability
1. Menken M,Munsat T, Toole J. Archives of Neurology 2000; 57:418-420.
2. Lipton RB et al. Headache. 2001.
91% of migraine patients report disability
Work/School Productivity 51%
Reduced by 50%
Unable to Do Chores/ 76%
Household Work
67% Household Work Productivity
Reduced by 50%
Missed Family/Social 59%
Leisure Activity
0% 20% 40% 60% 80% 100%
Lipton RB et al. Headache. 2001.
tt 1 Affects 1.4-2.2% of people wordwide
Significantly more burdensome than episodic
2 migraine:
80
71.7 * 67.2 70 * 61.4
* 56.5 60
48.3 50 44.4
40 Chronic migraine
Episodic migraine 30
20
* P<0.0001
10
0
Unable to perform normal Difficult to perform Emotional effects
activities normal activities
1. Natoli JL, et al. Cephalagia 2010;30:599-609.
2. Blumenthal AM et al Lancet 2010
Mean MSQ score