Migraine

 Genetic condition in which a person has a predisposition to headaches, GI dysfunction

and neurological dysfunction.
 Inherited in a autosomal dominant fashion.
 Migraine attack occurs when a trigger is encountered, triggers include hormonal changes,
stress, stress letdown, foods, alcohol, smells, sleep disturbance.

Pathophysiology of migraine
 Neuronal hyper-excitability between headaches
 Cortical spreading depression involved in aura
 Trigeminal nerve activation peripherally or centrally causes headache

Cluster headache
 Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal, or and
any combination of these sites, lasting 15-180 minutes and occurring from once every other
day to 8 times a day. The attacks are associated with one or more of the following, all of
which are ipsilateral, conjunctival injection, lacrimation, nasal congestion, rhinorrhoea,
forehead and facial sweating. Most patients are restless or agitated during in attack
1. Suicide headache because of its severity
2. Alarm clock headache
3. Cilliary neuralgia
4. Autonomic faciocephalalgia

Clinical Manifestations

Sharp stabbing
Pain is usually located around the eye, radiating to the temple, forehead, cheek,
nose or gums
Piercing, stabbing pain
Majority of sufferers are male

Etiology and Pathophysiologi

Neither causes nor pathophysiologic mechanism is known

Extracranial vasodilation occurs in affected part of face
Trigeminal nerve is implicated
Involved dysfunction of intracranial blood vessels, sympathetic nervous system
and pain modulation systems
Genetic component has been noted in some families
Smoking and alcohol may be associated with headaches
Trigeminal Neuralgia

 Painful episodes associated with trigger zones around the mouth and nostril
 Can be triggered by wind on the face, brushing teeth, shaving or even talking
 Majority of cases are idiopathic
 Suspicion of a secondary cause should arise when a chronic continuous pain is
punctuated by paroxysms of pain or when the is signs of trigeminal nerve dysfunction
 Lesions associated with the trigeminal roots within a few millimeters of the pons cause
TN demage to the myelin sheath. This causes chronic irritation of the nerve and results in
a failure of segmental inhibition in the trigeminal nucleus and increased activity in the
trigeminal nerve due to ectopic action potentials