dr manzo lucio

Manjit S Matharu Headache Group, Institute of Neurology & The National Hospital for Neurology and Neurosurgery London UK St Jude Medical Intractable Chronic Migraine Course nd22 February 2012 ICHD-II Diagnostic Criteria Episodic attacks of headache lasting 4-72 hours with the following features: Headache has at least two of the following During headache at least one of the following: characteristics: Nausea and/or vomiting Unilateral location Photophobia and phonophobia Pulsating quality Moderate or severe pain intensity Aggravation by routine physical activity Further sub-classified on basis of frequency of headaches Episodic migraine 15 days/month {???? {?? Phases of Migraine Time Headache & Premonitory Aura Resolution Associated Features Complex array of Aura symptoms occur with symptoms reflecting focal headache: cortical or brainstem – Always 18% dysfunction – Sometimes 13% – Never 69% Gradual evolution Types of aura: 5-30minutes ( > > ? ? X Aura: Pathophysiological Hypotheses Wolff’s vascular hypothesis Cortical spreading depression of Leao Migraine aura secondary to cerebral Wave of excitation followed by inhibition that hypoxia traverses the cortex at 3-6 mm/min Hyperperfusion Normal CBF Hypo- perfusion Aura Headache 2 6 4 8 10 12 Hours after angiography Leao. J. Neurophysiol. 1944; Leao and Morison. J. Neurophysiol. 1945 Wolff. Headache and other head pain.