migraine

1
migraine

• Department of neurology
• Ruijing hospital SSMU

2
definition

• Migraine is a benign recurring throbbing
  headache, recurring neurologic dysfunction, or
  both.
• Far more common in woman.
• Hereditary predisposition.
• Attended by pain-free interludes and always
  provoked by stereotyped stimuli.

3
etiology

• Diet chocolate, red wine, cheese
• Drug vasodilating agent, reserpine
• Endocrine
• Hereditory
• Emotion and other factors

4
pathogenesis

• Brain stem generation
• Vasomotor activation
• Trigeminal nucleus caudalis become activated
• 5-hydroxyrtryptamine play an important role.

5
Classic migraine

• Premonitory symptom
• Prodrome visual, sensory, motor symptoms,
  lasting 5-20min
• Headachelocation, characteristics, duration,
  accompanied symptoms, lasting 4-72hours, 1-3
  times per month
• Postheadache phase

6
Common migraine and other subtypes

• Commom migraine
• Basilar migrainesymptom imply altered brain stem
  function
• Hemiplegic migraine
• Ophthalmoplegic migraine
• Retinal migraine
• Late-life migraine agegt45y

7
Common migraine and other subtype

• Transformational migainemixed tension-vascular
  headache
• Migraine equivalents

8
diagnosis

• Family predisposition
• Recurrent headache or/and neurolgic dysfunction
  without focal neruologic signs
• Alleviated by antimigraine drugs
• exclude headache caused by other reasons

9
Differentiated diagnosis

• Vascular disease hypertension, hypotension,
  unruptured intracranial aneurysm, vascular
  malformation, chronic subdural hematoma
• Intracranial mass neoplasm, abscess, parasite
  infection
• Carotidynia facial migraine

10
treatment

• Acute treatment
• light to moderate analgesics or non-steroid
  anti-inflammatory drugs, isometheptene,
• Severe headache ergotamine (DHE), 5-HT 1B/1D/1F
  agonist
• Symptomatic therapy

11
treatment

• Prophylaxis
• 1 avoid the provoking factor
• 2drug therapy
• B receptor blocker propranalol
• calcium antagonist flunarizime
• Antihistamine
• ergotamine derivatives methysergide
• Antiepileptic drugs carmabazepine
• Antidepressant drug fluxetine