Age and sex-specific incidence of migraine

Transkript

1 Migrän anfall av svår, sprängande eller dunkande huvudvärk på en eller båda sidorna av huvudet illamående, överkänslighet mot ljud och ljus aura (20% av fallen) - förkänningar ca 10-15% av befolkning drabbade av migrän, ärftlighet

2 Migraine In contrast to tension-type headaches, which tend to be bilateral and constant, migraine is predominantly unilateral in pain location and throbbing. Some of the symptoms of these 2 headache types overlap for instance, migraine pain may occasionally present as bilateral and constant. However, migraine can usually be distinguished by the fact that associated pain is aggravated by routine activity. Migraine can be associated with gastrointestinal distress and with certain sensory disturbances, such as aura.

3 Age and sex-specific incidence of migraine

4 Migraine triggers

5 Migraine triggers

6 Migraine diagnosis

7 Migraine diagnosis

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9 Migrän modeller The convergence hypothesis 1. vaskulär - vasokonstriktion/vasodilatation - huvudvärk 2. hjärna/cortex - spreading depression, hög extracel. kalium i barken 3. sensoriska nerver - hjärnhinnor, trigeminal nerv

10 Migraine mechanisms Role of 5-HT 1D -receptorns

11 Migraine mechanisms -current view Migraine is now known to be a neurological process of the trigeminovascular system, rather than a vascular event. The vascular theory has been debunked for several reasons: - vascular changes do not explain the premonitory and other symptoms linked with migraine. - some useful migraine treatments have little effect on vasculature. - according to blood flow studies, vascular changes only occur randomly in migraine - attacks and do not correlate with the clinical features of the condition. Migraine is a neurochemical chain reaction that involves 5 distinct phases of a neurological process: 1) prodrome, 2) aura (may or not be present), 3) mild, 4) moderate, or severe pain, and 5) postdrome.

12 Migraine mechanisms -current view

13 Migraine mechanisms The trigeminal nerve and its connections

14 Migraine mechanisms

15 Acute treatment Acute treatments stop a migraine attack that is in progress. These medications tend to work better if taken early in the attack. Acute, or abortive, therapies are indicated for those patients who experience occasional migraines. Ideally, such a patient will have 2 acute agents on hand: one as their drug of choice and the other to use when their first choice fails, which can happen from time to time. Preventive treatment Preventive, or prophylactic, treatments are used when migraine headaches occur frequently or are debilitating. These treatments can be used episodically in certain conditions (such as unavoidable exposure to a trigger) or long term. Many effective preventive treatments are available.

16 Behandling av migrän analgetika: acetylsalicylyra (ofta i kombination med koffein) paracetamol - COX hämmare: diklofenak, naproxen - - Dopamin D 2 receptor antagonister: metoklopramid, - 5-HT 1D receptor agonister: triptaner, sumatripatan, noratriptan, zolmitriptan - Ergot peparat (mjöldrygealkaloider): ergotamin, dihydroergotamin - 5-HT 2 anatgonist: pizotifen, methysergide - Profylaxis: pizotifen, propraponol

17 Summary Many advances have been made in our understanding of migraine pathophysiology. We now consider migraine to be a neurovascular process. The nervous system of the headache sufferer probably carries a threshold for activation of this inherent physiology that is lower than in the nonmigraineur. The migraine sufferer who becomes a patient typically has developed a pattern of disabling headaches that impairs his ability to function. There is a sequential progression of migraine pathophysiology that explains the better treatment outcomes patients achieve with early intervention (treating when pain is still mild). The nervous system has the ability to terminate the process of migraine, and the sufferer may experience different clinical expressions of migraine depending on how far the pathophysiologic process has progressed before being terminated.

18 Migrän Hjärnan saknar i sig nociceptiv innervation. Smärta från huvudet medieras av smärtkänsliga nerver belägna i större blodkärl, hjärnhinnor, periost och skalpmuskulatur. I främre och mellersta skallgropen medieras smärta av grenar till n. ophthalmicus. Spänningshuvudvärk och - vanliga huvudvärksformer MIndre vanliga Hortons huvudvärk ansträngnings- och köldutlöst huvudvärk idiopatisk stabbing headache hostutlöst huvudvärk

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