Migrine is a common headache afflicting approximately 18% of woman and 8’M) of men. The first migraine

BOX 25-9

IHS Criteria for Migraine Headache without Aura

A. Two of the following:
I • ‘Unilateral headache pain location ..
• Headache pain has pullating q’uality .
• Moderate-ta-severe intensity
• Aggravation by routine physical activity
B. At least one ‘of the following:
• Nausea
• Photophobia and phonophobia’
C.Headache, untreated, lasting” to 72 hours
D. Both of the following:
• Similar pain in.the past
• No evidence of organic disease

BOX 29-6

IHS Criteria for Migraine Headache with Aura

A. Headache pain is preceded by fully reversible neurologic
symptoms, occurring over 5 to 60 minutes,
such ·as the following:
• Visual
• S.cintillating scotoma
• Fortific’ation spectra
• Photopsia •
• Paresthesia
• Numbness
• Unilateral weakness
• Speech disturbance
1 Common migraine characteristics:
I 1 Duration-usually 12 to 72 hours i :’! Sex-female/male ratio is > 2: 1
Neurologic aura40%

disorders ITM[)~IIThe mechanism for migraine headache: although not completely understood, appears to involve neurogenic Inflammation of intracranial blood vessels seeondarv to neurotransmitter imbalance iri certain brain stem centers. It is a referred pain process, and the intracranial
vessel involved determines the site of perceived pain ‘(e.g., the orbit, temple, jaw, vertex of the head). Preventive’ treatment is directed at normalizing neurotransmitter imbalance with antidepressants, anticonvulsants, .betablockers, and other drugs. Biofeedback and other therapies are also helpful. Treatment of acute attacks is with the – “triptans” (e.g., sumatriptan-Imitrex, zolmitriptan-Zomig, rizatriptan-Maxalt, naratriptan-Amerge, almotrtptan- Axert), ergots, nonsteroidal antiinflammatory drugs (NSAIDs), opioid analgesics, anti emetics, and other agents. For the dentist knowledge of migralne, is important,
because temporomandibular disorders may precipitate a migraine attack in a migraine-prone patient. Likewise, cervical spine and cervical muscular disorders may precipitate mlgraine. It is also important for the dentist to
recognize that cervical and mastjcatory muscle hyperactivity often occurs during a.migraine headache. Migraine may therefore be a perpetuating factor in-some TMDs or a reason for misdiagnosis.Although toothache and jaw, pains are. not a common expression of migraine, a number
of cases have been reported in the literature and are seen with some frequency by pain specialists. When migraine is a cause of jaw or face pain, the key to the diagnosis is recognizing that nausea,soriophobia, and
photophobia are not accompaniments of masticatory musculoskeletal disorders or jaw and tooth pain, of dental orign

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