Migrane ppt

migrane

1. MIGRAINE A Concise Presentation By Mr. Deepak Sarangi M.Pharm

2. CONTENTS: Introduction Definition Migraine triggers Phases Classification Pathophysiology Diagnosis Goals for treatment Management Guidelines Summary of prevention Conclusion References 2

3. INTRODUCTION: Migraine is one of the common causes of recurrent headaches. According to IHS, migraine constitutes 16% of primary headaches. Migraine afflicts 10-20% of the general population. In India, 15-20% of people suffer from migraine. Migraine is under diagnosed and undertreated. 3

4. “Migraine is a familial disorder characterized by recurrent attacks of headache widely variable in intensity, frequency and duration. Attacks are commonly unilateral and are usually associated with anorexia, nausea and vomiting”. DEFINITION: 4

5. MIGRAINE TRIGGERS : Disturbed sleep pattern Hormonal changes Drugs Physical exertion Visual stimuli Auditory stimuli Olfactory stimuli Weather changes Hunger Psychological factors 5

6. PHASES: Prodrome Aura Headache Postdrome 6

7. PRODROME: Vague premonitory symptoms that begin from 12 to 36 hours before the aura and headache. Symptoms: Yawning Excitation Depression Lethargy Craving or distaste for various foods Duration: 15 to 20 min. 7

8. AURA: Aura is a warning or signal before onset of headache. Symptoms: Flashing of lights Zig-zag lines Difficulty in focussing Duration : 15-30 min. 8

9. HEADACHE: Headache is generally unilateral and is associated with SYMPTOMS like: 1. Anorexia 2. Nausea 3. Vomiting 4. Photophobia 5. Phonophobia 6.Tinnitus Duration: 4-72 hrs. 9

10. POSTDROME: Following headache, patient complains of - Fatigue Depression Severe exhaustion Some patients feel unusually fresh Duration: Few hours or up to 2 days. 10

11. CLASSIFICATION: According to Headache Classification Committee of the International Headache Society, Migraine has been classified as: Migraine without aura (common migraine) Migraine with aura (classic migraine) Complicated migraine 11

12. PATHOPHYSIOLOGY: VASCULAR THEORY :- Intracranial/ Extracranial blood vessel vasodilation – headache. Intracerebral blood vessel vasoconstriction – aura. SEROTONIN THEORY :- Decreased serotonin levels linked to migraine. Specific serotonin receptors found in blood vessels of brain. 12

13. Release of Neurotransmitter Arterial Activation Worsening of Pain 13

14. DIAGNOSIS: Medical History Headache diary Migraine triggers Investigations EEG CT Brain MRI 14

15. GOALS FOR TREATMENT: Establish diagnosis. Educate patient. Discuss findings. Establish reasonable expectations. Involve patient in decision. Encourage patient to avoid triggers. Choose the best treatment. Create treatment plan. 15

16. LONGTERM TREATMENT: Reducing the attack frequency and severity. Avoiding escalation of headache medication. Educating and enabling the patient to manage the disorder. Improving the patient’s quality of life. 16

17. MANAGEMENT: Non-pharmacological treatment:- Identification of triggers Meditation Relaxation training Psychotherapy Pharmacotherapy:- Abortive therapy Preventive therapy 17

18. ABORTIVE THERAPY Non-specific treatment: 18 Drug Dose Route Aspirin 500-650 mg Oral Paracetamol 500 mg-4 g Oral Ibuprofen 200- 300 mg Oral Diclofenac 50-100 mg Oral/IM Naproxen 500-750 mg Oral

19. Specific treatment : 19 Drug Dose Route Ergot alkaloids Ergotamine 1-2 mg/d; max-6 g/d Oral Dihydroergotamine 0.75-1 mg SC 5-HT receptor agonists Sumatriptan 25-300 mg 6 mg Orally SC Rizatriptan 10 mg Orally

20. PREVENTIVE THERAPY: Drugs Dose (mg/d) Betablockers Propranolol 40-320 Calcium Channel Blockers Flunarizine Verapamil 10-20 120-480 TCAs Amitriptyline 10-20 SSRIs Fluoxetine 20-60 20

21. GUIDELINES: Migraine significantly interferes with patient’s daily routine, despite acute treatment. Acute medications ineffective, intolerable, or overused. Frequent headache. Uncommon migraine conditions. Cost considerations. Patient preference. 21

22. SUMMARY OF PREVENTION: Use preventive medications when needed. Treat long enough. Avoid acute medications overuse. Take coexisting conditions into account. Use drug with best efficacy for individual patient. 22

23. Conclusion: It is more common in adults than children and in women than men. While researchers have some idea of what happens within the brain during migraine attacks, much remains to be discovered about its underlying causes and mechanisms. In addition, treatment focuses on avoiding those things that seem to trigger attacks, identifying drugs that prevent or reduce the severity of attacks and drugs that reduce the intense pain of a severe attack. The good news is that several classes of drugs are effective for different kinds of migraine and most migraine sufferers can work with their doctor to minimize migraine's effects. 23

24. references: Headache Classification Committee The International Classification of Headache Disorders. 2nd edition. Cephalalgia . 2004;24:1–160. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343–9. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache. 2001;41:646–657. Radat F, Swendsen J. Psychiatric comorbidity in migraine: A review. Cephalalgia . 2004;25:165–178. Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF. Migraine, quality of life and depression: A population-based case control study. Neurology. 2000;55:629–35. 24

25. 25 THANKS for viewing the ppt For more ppts on pharma related topics plz contact [email protected] Or find me at following link www.facebook.com/sarangi.dipu