Basics ,approach and management of migraine for GP's

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;