from episodic to chronic migraine introduction migraine
play

FROM EPISODIC TO CHRONIC MIGRAINE INTRODUCTION Migraine Migraine - PowerPoint PPT Presentation

FROM EPISODIC TO CHRONIC MIGRAINE INTRODUCTION Migraine Migraine is a common neurologic disorder that has a wide variety of subtypes, many comorbidities, and a variable prognosis. Prevalence


  1. 員生醫院.神經內科 蔡宗儒 FROM EPISODIC TO CHRONIC MIGRAINE

  2. INTRODUCTION

  3. Migraine � Migraine is a common neurologic disorder that has a wide variety of subtypes, many comorbidities, and a variable prognosis.

  4. Prevalence � 美國 � 女性: 18% � 男性: 6.5% � 台灣十五歲以上的成人 � 台灣十五歲以上的成人 � 女性 : 14.4% 女性: 女性 女性 : : � 男性: 4.5% � 慢性每日頭痛: 3.2% ������������������������������ ������������������������������� ���� ���

  5. Definition � Recurrent headache disorder manifesting in attacks lasting 4 – 72 hours. � Typical characteristics of the headache are unilateral location, pulsating quality, unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.

  6. Diagnostic Criteria – 1.1 Migraine without Aura � A. At least 5 attacks fulfilling criteria B-D � B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) � C. Headache has at least two of the following characteristics: � 1. Unilateral location 1. Unilateral location � 2. Pulsating quality � 3. Moderate or severe pain intensity � 4. Aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) � D. During headache at least one of the following: � 1. Nausea and/or vomiting � 2. Photophobia and phonophobia � E. Not attributed to another disorder ������������������������������������ ��!�����"����!��� ������������������������������������ ��!�����"����!���� ���!�#!����� ��!�#!����� ��$�����%��&�'���(�����)�$$��(�����&����� ��$�����%��&�'���(�����)�$$��(�����&�����

  7. Diagnostic Criteria – 1.5.1 Chronic Migraine (CM) � Description: � Migraine headache ≧ 15 days/month, > 3 months � Absence of medication overuse � Diagnostic criteria: � Diagnostic criteria: � A. Headache fulfilling criteria C and D for 1.1 Migraine without aura on ≥15 days/month for >3 months � B. Not attributed to another disorder ������������������������������������ ��!�����"����!��� ������������������������������������ ��!�����"����!���� ���!�#!����� ��!�#!����� ��$�����%��&�'���(�����)�$$��(�����&����� ��$�����%��&�'���(�����)�$$��(�����&�����

  8. �������%*����+����,)�$$���-�)� �������%*����+����,)�$$���-�)� – )� )�

  9. CLINICAL COURSE IN MIGRAINE IN MIGRAINE

  10. Clinical Course in Migraine � The conceptual framework for understanding migraine has evolved over the past decade. � More recent evidence supports the concept that migraine is a chronic disorder with that migraine is a chronic disorder with episodic attacks. � Between headaches, patients with migraine have an enduring predisposition to attacks including abnormalities in brain excitability and impaired health-related quality of life. �������%*������������ �������%*������������ – �.. �..

  11. Pathway in the Natural History of Migraine � � � � ����������������������� �������%*������������ �������%*������������ – �.. �..

  12. Four Distinct States of Migraine No migraine No migraine High High- -frequency episodic migraine frequency episodic migraine ������������������������������������������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������������������������������������������ Low Low- -frequency episodic migraine frequency episodic migraine Chronic migraine (CM) Chronic migraine (CM) �������%*����+����,)�$$���-�)� – )� �������%*����+����,)�$$���-�)� )�

  13. TRANSFORMATION OF MIGRAINE

  14. Transformation of Migraine � Daily or near-daily headaches with migrainous features and/or attacks have been described in the literature with multiple names and different classifications (eg, names and different classifications (eg, transformed migraine, chronic migraine).

  15. Chronic daily headache (CDH) = Chronic migraine = Transformed migraine ? Transformed migraine ?

  16. Chronic Daily Headache � CDH: high frequency of headaches (15 days/month) �������%*����+����,)�$$���-�)� �������%*����+����,)�$$���-�)� – )� )�

  17. � Cluster headache � Paroxysmal hemicrania Short-duration � Short-lasting unilateral neuralgiform headache attacks � Idiopathic stabbing headache Primary 4 h/d � Hypnic headache � CM Long-duration Long-duration - - � Hemicrania continua Hemicrania continua � Chronic tension-type headache Underlying cause � New daily persistent headache + � Medication overuse � Head trauma Secondary � Cervical spine disorders � Vascular disorders �������%*����+����,)�$$���-�)� �������%*����+����,)�$$���-�)� – )� )�

  18. Chronic Daily Headache � Long-duration CDH is a prevalent problem, with 3% to 5% of the worldwide population experiencing daily or near-daily headaches. � Most patients with long-duration primary � Most patients with long-duration primary CDH have CM. �������%*����+����,)�$$���-�)� �������%*����+����,)�$$���-�)� – )� )�

  19. Transformation of Migraine � Clinical transformation: increases in attack frequency over time leading to CM, occurs in about 3% of episodic migraine sufferers. � Physiologic transformation: physiologic changes � Physiologic transformation: physiologic changes in the CNS manifested through alterations in in the CNS manifested through alterations in nociceptive thresholds (allodynia) and in pain pathways. � Anatomic transformation: definitive brain lesions including stroke and deep white matter lesions emerge “ �������������������(�%����� �������������������(�%����� ” &��������%*������������ &��������%*������������ – �.. �..

  20. Transformation of Migraine � Although the data for anatomic changes are for patients with episodic migraine with aura only, we consider it a form of migraine as transformation because the prevalence of transformation because the prevalence of brain lesions seems to increases with attack frequency. “ �������������������(�%����� �������������������(�%����� ” &��������%*������������ &��������%*������������ – �.. �..

  21. Conceptual Framework for Transitions in Migraine � Although it is not well established if migraine may not progress abruptly, clinical evidence suggests that most frequently attacks increase in frequency over a period of time. � All transition rates can be modeled as a function of demographic, environmental, and genetic risk factors. “ �������������������(�%����� �������������������(�%����� ” &��������%*������������ &��������%*������������ – �.. �..

Download Presentation
Download Policy: The content available on the website is offered to you 'AS IS' for your personal information and use only. It cannot be commercialized, licensed, or distributed on other websites without prior consent from the author. To download a presentation, simply click this link. If you encounter any difficulties during the download process, it's possible that the publisher has removed the file from their server.

Recommend


More recommend