文档介绍：Pharmacotherapy of Migraine Headache
Edward M. Bednarczyk, .
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Epidemiology of Migraine
10% of . Population experiences 1 episode of migraine HA/year
3:1 ratio of women to men
inverse relationship with socio-economic status
Annual cost of labor lost to migraine in US to billion dollars
59% of women, 71% of men meeting IHS migraine criteria reported no such diagnosis
Migraine Differential
Other vascular
Drugs, post-ictal
Temporal arteritis
HTN
Muscle spasm
Intracranial pressure
Mass lesions, hydrocephalus
SEENT
Sinus, eye, ear, nose, teeth
Meningeal inflamation
Cranial neuralgia
“Tension-type” headache
Migraine Theory
Dr. Harold G. Wolff, 1940’s
Vasoconstriction causing cerebral ischemia precedes migraine headache
If severe enough, produces aural symptoms
Headache occurs during the ensuing vasodilation, with pain resulting from the distention of vascular stretch receptors
CBF in Migraine
CBF has been measured in migraine using
TCD
SPECT, Conventional Nuclear Imaging
PET
Findings have included:
Increased Flow/velocity
Decreased Flow/binations of Increased and Decreased Flow
CBF, Migraine/Migraine Free
Migraine mechanisms
Vascular elements
May be limited in scope
Trigeminal Factors
Sterile Inflammation?
Centrally mediated effects
Decreased CBF
Aura, beyond
IHS Criteria, Migraine with Aura
HA characteristics as for HA w/o aura
At least 2 attacks with ≥3 of the following:
≥1 fully reversible aura symptoms occur
≥ 1 aura SX develops gradually over more than 4 minutes, or 2 or more SX’s develop in ession
no 1 symptom lasts > 60 minutes
HA follows aura ≤ 60 minutes (or concurrent)
No secondary cause identified
Stress & Migraine
“Migraine is an inherited disorder
occuring in people who have both an undue
tendency to seek stress and at the same time
a deficiency in their physiologic adaptation to
stress”
John B. Graham(1952)