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Prof. dr. Tomaž Pogačnik, dr. med. SPS Nevrološka klinika Klinični center Ljubljana

MIGRENA Epidemiologija, klinična slika in diagnoza. Prof. dr. Tomaž Pogačnik, dr. med. SPS Nevrološka klinika Klinični center Ljubljana. The International Classification of Headache Disorders ( Cephalalgia 2004 , 2 nd Edition ). A. The primary headaches Migraine Tension-type headache

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Prof. dr. Tomaž Pogačnik, dr. med. SPS Nevrološka klinika Klinični center Ljubljana

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  1. MIGRENA Epidemiologija, klinična slika in diagnoza Prof. dr. Tomaž Pogačnik, dr. med.SPS Nevrološka klinikaKlinični center Ljubljana 13/9-2005

  2. The International Classification ofHeadache Disorders(Cephalalgia 2004, 2nd Edition) • A. The primary headaches • Migraine • Tension-type headache • Cluster headache and other trigeminal autonomic cephalalgias • Other headaches not associated with structural lession • B. The secondary headaches • Headache attributed to head and/or neck trauma • Headache attributed to cranial or cervical vascular disorder • Headache attributed to non-vascular intracranial disorder • Headache attributed to a substance or its withdrawal • Headache attributed to infection • Headache attributed to disorder of homoeostasis • Headache or facial painattributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures • Cranial neuralgias • Unclassified headaches Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  3. The International Classification ofHeadache Disorders (Cephalalgia 2004, 2nd Edition) Part 1: The primary headaches • Migraine • Tension-type headache • Cluster headache and other trigeminal autonomic cephalalgias • Other primary headaches Part 2: The secondary headaches • Headache attributed to head and/or neck trauma • Headache attributed to cranial or cervical vascular disorder • Headache attributed to non-vascular intracranial disorder • Headache attributed to a substance or its withdrawal • Headache attributed to infection • Headache attributed to disorder of homoeostasis • Headache or facial painattributed to disorder of cranium, neck, eyes ears, nose, sinuses, teeth, mouth or other facial or cranial structures • Headache attributed to psychiatric disorder Part 3: Cranial neuralgias, central and prim. facial pain and other headaches • Cranial neuralgias and central causes of facial pain • Other headache, cranial neuralgia, central or primary facial pain Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  4. Classification and WHO ICD-10NA Codes (Cephalalgia 2004) • G43Migraine • G43.0 Migraine without aura • G43.1 Migraine with aura • G43.10Typical aura with migraine headache • G43.10 Typical aura with non-migraine headache • G43.104Typical aura without headache • G43.105 Familial hemiplegic migraine (FHM) • G43.105 Sporadic hemiplegic migraine • G43.103 Basilar-type migraine • G43.82 Childhood periodic syndromes that are commonly precursors of migraine • G43.82 Cyclical vomiting • G43.820 Abdominal migraine • G43.821 Benign paroxysmal vertigo of childhood Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  5. Classification and WHO ICD-10NA Codes (Cephalalgia 2004) • G43.81 Retinal migraine • G43.3 Complications of migraine • G43.3 Chronic migraine • G43.2 Status migrainosus • G43.3 Persistent aura without infarction • G43.2 Migrainous infarction • G43.3 Migraine-triggered seizure • G43.83 Probable migraine • G43.83 Probable migraine without aura • G43.83 Probable migraine with aura • G43.83 Probable chronic migraine Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  6. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

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  9. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  10. The socio-economic burden of migraine in Western countries Total annual indirect costs due to lost productivity (US$) • USA = $ 13 billion • Sweeden = $ 1.6 billion • UK = $ 1.1 - 1.3 billion • Netherlands = $ 1.2 billion • Spain = $ 1.1 billion • Australia = $ 568 million Ferrari MD. The economic burden of migraine to society. Pharmacoeconomics 1998; 13: 667-676. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  11. The socio-economic burden of migraine in Western countries Total annual direct costs due to medical care (US$) • USA = $ 1 billion • Sweeden = $ 1.3 million • UK = $ 45 million • Netherlands = $ 300 million • Australia = $ 31 million Ferrari MD. The economic burden of migraine to society. Pharmacoeconomics 1998; 13: 667-676. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  12. Diagnosis of migraine Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  13. The history of headache • Age of onset • Frequency and duration of headaches • Time of onset • Mode of onset • Site, radiation ang quality of pain • Associated symptoms • Precipitating factors • Aggravating and relieving factors • Previous treatment • Family history and personal background (Lance JW, Goadsby PJ. Mechanism and Management of Headache: Oxford: Butterworth-Heinemann, 1998.) Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  14. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  15. Migraine without aura • At least 5 attacks • Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) 3. Headache has at least two of the following characteristics: • unilateral location • pulsating quality • moderate or severe pain intensity • aggravation by or causing avoidance of routine physical activity IHS Guidelines Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  16. Migraine without aura During headache at least one of the following: • photophobia • phonophobia • nausea and/or • vomiting IHS Guidelines Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  17. Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

  18. ID migrena Predhodna vprašanja a. Ali glavoboli omejujejo vaše zmožnosti za delo, učenje? ali b. Ali se želite o glavobolu pogovoriti z vašim zdravnikom? Vprašanja V preteklih 3 mesecih ste ob glavobolih (2 ali več): a. Čutili slabost (siljenje na bruhanje) Da____ Ne____ b. Vas je motila svetloba (bolj kot če niste imeli glavobola) Da____ Ne____ c. Ali vas je glavobol omejeval pri delu, učenju ali drugem opravilu vsaj 1 dan Da____ Ne____ Continuum “Glavobol”T. Pogacnik, KC, Nevrološka klinika, Ljubljana

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