Migrane Headaches and Variants Flashcards
______ occur Most
frequently on arising in
the morning therefore the
DDS must differentiate if
the head/facial pain is
from migraine, bruxism or
obstructive sleep apnea.
Migraine pathways
Headaches
If located in the lower half of the face in what nerves?
Migraine, cluster headache, or paroxysmal hemicrania can mimic dental
disease and cause tooth pain
V2 and V3
Diagnostic Criteria:
A.Any headache fulfilling criterion C
B.Clinical and/or imaging reveals evidence of TMD
C.Evidence of causation demonstrated by ≥2 of:
1.headache has developed in temporal relation to onset of TMD
2.either or both of:
a) headache has significantly worsened in parallel with progression of
TMD;
b) headache has significantly improved or resolved in parallel with
improvement in or resolution of TMD
3. headache produced or exacerbated by active jaw
movements, passive movements through range of motion of
jaw and/or provocative maneuvers such as pressure on TMJ
and surrounding muscles of mastication
4. headache, when unilateral, is ipsilateral to TMD
D. Not better accounted for by another ICHD-3 diagnosis
Headache attributed to
temporomandibular disorder (TMD)
A. At least five
attacks fulfilling
criteria B–D
B. Facial and/or oral
pain, without head
pain, lasting
4–72 hours
(untreated or
unsuccessfully
treated)
C. Pain has at least
two of the following
four
characteristics:
1. unilateral location 2. pulsating quality 3. moderate or
severe intensity
4. aggravation by, or
causing avoidance
of, routine
physical activity
(e.g. walking or
climbing stairs)
D. Pain is
accompanied by one
or both of the
following:
1. nausea and/or
vomiting
2. photophobia (light
sensitivity)and
phonophobia (noise
sensitivity)
E. Not better
accounted for by
another ICOP or
ICHD-3 diagnosis
Episodic orofacial migrane
Diagnostic Criteria:
A. Facial and/or oral pain, without head pain, on 15
days/month for >3 months and fulfilling criteria B
and C below
B. Occurring in a patient who has had at least five
attacks fulfilling criteria B–D for 5.1 Episodic orofacial
migraine
C. On 8 days/month for >3 months, fulfilling either
of the following:
1. criteria C and D for 5.1.1 Episodic orofacial
migraine
2. believed by the patient to be orofacial migraine at
onset and relieved by a triptan or ergot derivative
D. Not better accounted for by another ICOP or
ICHD-3 diagnosis.
Comment: A Pain Diary must be kept to track headache frequency
Chronic orofacial migrane
Include: the skin and blood
vessels of the scalp; the
head and neck muscles;
the venous sinuses; the
arteries of the meninges;
the larger cerebral
arteries; the pain-carrying
fibers of the fifth, ninth,
and tenth cranial nerves;
and parts of the dura
mater at the base of the
brain.
The brain itself is
insensitive to pain
Pain sensitive intracranial structures
____% of the world has some form of headaches/migranes
10%
ARe males or females more prone to migranes?
Females
Pathophys of _______
Migraines & trigeminal autonomic cephalgias cause activation of the
Trigeminovascular system causing release of inflammatory chemical
mediators in the brain known as neuropeptides.
The serotonin receptor (5-HT) gets activated. Serotonin acts as a
neurotransmitter in the CNS & is a potent vasoconstrictor. It is found in
the brain, platelets & intestine.
Calcitonin gene related peptide (CGRP) is believed to play a MAJOR role in
migraine pathogenesis
Migranes
daily headache which is now classified as daily
persistent migraine- Headaches occur ≥ 15 times per
Month
Chronic migrane
________ is effective for treatment
of daily persistent migraines.
Onabotulinum A
Chromosome ____ is linked to migranes
Chromosome 19
___-___% of migraineurs have a parent
with the disorder and up to ___ % have
at least one first-degree relative with
migraine
50-60%; 80%
___% of tension-type headaches
sufferers have family members with
similar headaches
40%
What 4 conditions are migranes comorid with?
Stroke
epilepsy
depression
anxiety disorders
___ can precede, accompany, or follow the actual
headache attack.
-2x more common in females
Aura
Diagnostic Criteria
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hr (untreated or unsuccessfully
treated)
C. Headache has 2 of the following characteristics:
* 1. unilateral location
* 2. pulsating quality
* 3. moderate or severe pain intensity
* 4. aggravation by or causing avoidance of routine physical activity (i.e., walking, climbing
stairs)
D. During headache 1 of the following:
* 1. nausea and/or vomiting
* 2. photophobia and phonophobia
E. Not better accounted for by another ICHD-3 diagnosis
Migrane without aura
What are the 4 phases of migranes?
Prodrome
Aura
Migrane
Migrane resolution
Approximately 30% of migraine attacks
are “with aura”.
Many patients have both forms
The aura consists of gradually
spreading neurological symptoms that
usually precede the headache by 5-60
minutes
Most common symptoms are visual
disturbances such as flashing lights
(scotoma) or a zigzag pattern
(fortification spectra)
Aura
Parasthesias: the second most common
aura
often starts with numbness
in the hand which migrates
up the arm and then
involves the face, lips &
tongue. Patient may
believe they are having a
Stroke!
may involve the leg may include loss of position
sense may be bilateral
rarely occur in isolation;
usually follow a visual aura
Sensory aura
A. At least 2 attacks fulfilling criteria B and C
B. Aura of visual, sensory and/or speech/language
symptoms, each fully reversible, but no motor,
brainstem or retinal symptoms
C. 2 of the following 4 characteristics:
1. 1 aura symptom spreads gradually over ≥5 min,
and/or 2 symptoms occur in succession
2. each individual aura symptom lasts 5-60 min
3. 1 aura symptom is unilateral
4. aura accompanied or followed by headache
in <60 min
D. Not better accounted for by another ICHD-3 diagnosis,
and TIA excluded
Migraine with typical aura
Migraines that occur less than twice a
week are managed with ____ meds
abortive
medications
____ are abortive meds given in migraines to increase serotonin
Triptans
(5-HT Serotonin Agonists)
Cause:
Cranial vasoconstriction
Coronary vasoconstriction
Contraindications:
Coronary artery disease
Heart disease & uncontrolled
hypertension
Stroke
Triptans
The following are meds used as ____
1. Serotonin antagonists:
(methergine, methysergide)
2. Anticonvulsants: (valproic
acid, gabapentin,
topiramate))
3. CGRP Antagonists (Aimovig,
Emgality) – injected 2x first
month then monthly
4. NSAIDs
PReventative meds for migranes
INDICATIONS :
* 2 or more attacks per
month that produce
disability > 3 days
* Abortive medications
not effective
* Use of abortive
medications > 2x/week
* Special circumstances
i.e. hemiplegic migraine
Preventative migrane meds
is widely expressed in the peripheral and
central nervous systems
αCGRP is highly expressed in sensory
neurons
Calcitonin Gene Related
Peptide (CGRP)
Potent neurotoxin
Weakens painful muscles
Inhibits muscle contractions
FDA treatment option for Chronic
Migraines >15 days/month
Interrupts pain cycle & may alter
neurotransmitter secretory function in
both afferent & efferent motor nerves
Therapeutic injections have an average
duration of 12 weeks before re-injection is
necessary
Onabotulinum toxin type A
- Used for Chronic Migraine Headache NOT responsive to medications
- Injected at 32 sites
- Repeated every 3 Months
- Research has demonstrated effectiveness in treatment of
headaches and muscle pain - Advantages: no drug-drug interactions and no systemic side effects
- Potential Side Effects: are risk of weakness at injection site
Botox
