headaches and orthodontics 45° sido international congress
TRANSCRIPT
Universitagrave degli studi di CagliariScuola di Specializzazione di OrtognatodonziaProf Vincenzo Piras
Headaches in adults and orthodontics reality or chimera
Enza Robotti Morena Toselli
APPROACH TO HEADACHES
bullNearly everyone willexperience headaches at some time in their lives
bullUp to 10 million people
bullWorld Health Organisationas being among the most disabling disorders
Cefalea is a symtomthat may indicate situational pathological differences
WHY DO HEADACHES NEED A CLASSIFICATION
bull Uniformity
bull Communication
bull Standardized approach to research
bull Formulating treatment guidelines
HISTORY
bull Thomas Willis in De Cephalalgiain 1672
bull 1787 C Baur idiopatic and symptomatic
bull 1960 World FEDERATION ofNEUROLOGY
bull 1988 ICHD I
bull 2004 ICHD II
bull 2013 ICHD III beta January
What should be discussed when you see a patient with a headache during
the first consultation
bull How many different headaches you have
bull How often you get them
bull How old you were when they started
bull A list of current and previous treatments and medications
bull Trigger factors
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
APPROACH TO HEADACHES
bullNearly everyone willexperience headaches at some time in their lives
bullUp to 10 million people
bullWorld Health Organisationas being among the most disabling disorders
Cefalea is a symtomthat may indicate situational pathological differences
WHY DO HEADACHES NEED A CLASSIFICATION
bull Uniformity
bull Communication
bull Standardized approach to research
bull Formulating treatment guidelines
HISTORY
bull Thomas Willis in De Cephalalgiain 1672
bull 1787 C Baur idiopatic and symptomatic
bull 1960 World FEDERATION ofNEUROLOGY
bull 1988 ICHD I
bull 2004 ICHD II
bull 2013 ICHD III beta January
What should be discussed when you see a patient with a headache during
the first consultation
bull How many different headaches you have
bull How often you get them
bull How old you were when they started
bull A list of current and previous treatments and medications
bull Trigger factors
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
WHY DO HEADACHES NEED A CLASSIFICATION
bull Uniformity
bull Communication
bull Standardized approach to research
bull Formulating treatment guidelines
HISTORY
bull Thomas Willis in De Cephalalgiain 1672
bull 1787 C Baur idiopatic and symptomatic
bull 1960 World FEDERATION ofNEUROLOGY
bull 1988 ICHD I
bull 2004 ICHD II
bull 2013 ICHD III beta January
What should be discussed when you see a patient with a headache during
the first consultation
bull How many different headaches you have
bull How often you get them
bull How old you were when they started
bull A list of current and previous treatments and medications
bull Trigger factors
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
HISTORY
bull Thomas Willis in De Cephalalgiain 1672
bull 1787 C Baur idiopatic and symptomatic
bull 1960 World FEDERATION ofNEUROLOGY
bull 1988 ICHD I
bull 2004 ICHD II
bull 2013 ICHD III beta January
What should be discussed when you see a patient with a headache during
the first consultation
bull How many different headaches you have
bull How often you get them
bull How old you were when they started
bull A list of current and previous treatments and medications
bull Trigger factors
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
What should be discussed when you see a patient with a headache during
the first consultation
bull How many different headaches you have
bull How often you get them
bull How old you were when they started
bull A list of current and previous treatments and medications
bull Trigger factors
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
DIAGNOSIS
bull NO specific diagnostic tests for primary headaches
bull exclusively in the case of secondary headaches
YES if there are any danger signs
bull Depends on the patientrsquos history
Family history Allergies Life habits
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
AN OVERVIEW OF INTERNATIONAL CLASSIFICATION 2013 ICHD III beta
Headache
Primary Secondary
Migraine
Tension type headache
Cluster
Miscellaneous
Intracranial
Paracranial
Extracranial
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
What is a ldquoMigrainerdquoMigraine without aura Migraine with aura
bullduration 4 ndash 72 hoursbullAt least two of the followingare experienced-Unilateral location- Pulsating quality- Moderatesevere intensity- Aggravated by activity
bullAccompanied by at least one ofthe following- Nausea- Vomiting- Photophobia andor
phonophobiabullNo evidence of organic disease
bullPatients with migraineexperiences manysymptoms have otherthan headachesbullSome of these occurduring headaches some occur before and some after the headache hasstopped
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
bull vision(visual aura)
bull sensations (sensory aura)
bull Strength (motor aura
Typical migrainous visual distortion -Alice in Wonderland Syndromerdquo
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
Tension-type headachesbull gt 10 attacks lasting 30 min7 daysbull gt 2 of the following four bilateral not pulsating mildor moderate intensity not aggravated by routine physical activitybull No nausea or vomitingbull One or neither of photophobia or phonophobiabull Not attributable to another disorder
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
Secondary Headaches
Intracranial
ParacranialExtracranial
bullHead traumabullVasculardisordersbullNonvasculardisorders
bullDisorder of -cranium-neck-eyes-nose-sinuses-teeth
bullSubstances or their withdrawalbullNoncephalicinfectionbullMetabolicdisorder
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
ldquoWorst headache of my liferdquoSubarachnoid hemorrhage
bullHeadache occurs in about 90 ofSubarachnoidhemorrhage patientsbullClassic acute severe continuousbullAssociated withnausea vomitingbullCan be fatal
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
HEADACHE treatments
bullReassure and educate patientbullPharmacotherapy-Identify and remove triggersbullStart a wellness programme exercise balanced meals adequate sleep smoking cessationbullPhysical therapybullPsychological therapy
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
Migraine Triggers
bullStress and emotionbullHormonal changesbullDietbullEnvironmental factorsbullToo much or too littlesleepbullPhysical factors
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
COMORBIDITIES
MIGRAINE
DEPRESSIONSLEEP
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
THE MIGRAINE PERSONALITY
bullIntelligentbullCompulsivebullPerfectionisticbullWorking hardbull Life stresses
bull Weekend or during a vacationbull Headache attack
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
Temporomandibular Disorders
American Academy of Orofacial Pain ldquoGuidelines for Assessment Diagnosis and Managementrdquo
General management principles for TMD include
bull Pain controlbullIncreasing mandibular mobility with exercisebullSplint therapybullBehaviour interventionsbullSurgical intervention with arthrocentesis or arthroscopy
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
THERAPY
bull Improve the patientrsquos quality of lifebull Key to effectivemanagment of an acute migraine attack isbull EARLY RECOGNITION bullEARLY TREATMENT bullMistake is to waitbullALLODYNIA
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
Triptan
bullIdentify the migraine processearly interventionbullSelect the best medication for each patientbullInstruct in proper medication usebullEncourage headache diaresbullAchieve a pain response by 2 hours
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
SPREADING DEPRESSION(SD)
J Headache Pain 2013 Jul 231462 doi 1011861129-2377-14-62Cortical spreading depression as a target for anti-migraine agentsCosta C1 Tozzi A Rainero I Cupini LM Calabresi P Ayata C Sarchielli P
bull Is a slowly propagating wave of neuronal and glialdepolarization lasting a few minutes that can develop within the cerebral cortex or other brain areas afterbull electricalbull mechanical bull chemical depolarizing stimulationsbull SD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
BEHIND CEPHALOMETRIC TRACING IS THE BRAIN OF THE PATIENT
ORTHODONZIA
HEADACHE
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
TAKE HOME MESSAGE
bull NO diagnosis in the first consultationbull Patient to compile a history diary of headaches
sufferedbull Classify the patientrsquos information to correspond
with ICHDIIIbull Key to effective managment of an acute migraine
attack is EARLY RECOGNITION and EARLY TREATMENT
bull Palliative care bull Headaches and orthodontic therapies can work
together but in specific ways
THANK YOUFOR YOUR KIND ATTENTION
THANK YOUFOR YOUR KIND ATTENTION