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2	World prevalence of migraine
3	Prevalence of migraine by sex and age
4	Diagnosis of migraine Diagnosis depends on patient history No specific tests or clinical markers for migraine
5	Migraine Criteria ³5 attacks lasting 4–72 h ³2 of the following 4 Unilateral Pulsating Moderate or severe intensity Aggravation by routine physical activity ³1 of the following Nausea and/or vomiting Photophobia and phonophobia Not attributable to another disorder
6	What is migraine? Migraine without aura (MO)
7	Clinical features of migraine
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10	IMPORTANT DIAGNOSTIC CONSIDERATIONS
11	Premonitory, aura and postdromal symptoms
12	MIGRAINE WITH AURA (FORMERLY “CLASSIC” MIGRAINE)
13	MIGRAINE AURA “Cheiro-oral”
14	Fortification Spectrum
15	DIAGNOSIS AND TESTING
16	Alice in Wonderland
17	REASONS FOR MISDIAGNOSIS OF MIGRAINE AS TTH OR SINUS
18	Differential diagnosis of primary headaches
19	WORRISOME HEADACHE RED FLAGS “SNOOP”
20	Headache ‘red flags’ First or worst headache Significant change from previous headache pattern no longer fulfils IHS criteria New onset headache in middle age or later New or progressive headache that lasts for days
21	EVALUATION STRATEGIES
22	SUDDEN ONSET HEADACHE
23	LUMBAR PUNCTURE
24	SENSITIVITY OF CT SCAN IN SUBARACHNOID HEMORRHAGE (SAH)
25	DIAGNOSIS TESTING CT AND MRI
26	DIAGNOSTIC TESTING ELECTROENCEPHALOGRAPHY
27	MR AND CONVENTIONAL ANGIOGRAPHY
28	INDICATIONS FOR GADOLINIUM ENHANCED MRI Cerebrovascular Arterial dissection (MRA) Cerebral venous sinus thrombosis (MRV) CNS vasculitis Tumors Posterior fossa Pituitary Leptomeninges
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31	STRATEGIES FOR MIGRAINE TREATMENT
32	ACUTE MIGRAINE TREATMENT
33	PRINCIPLES OF MIGRAINE MANAGEMENT
34	NONPHARMACOLOGIC TREATMENTS
35	MIGRAINE TRIGGERS
36	ACUTE MIGRAINE MEDICATIONS
37	ACUTE THERAPIES FOR MIGRAINE
38	ACUTE THERAPIES FOR MIGRAINE
39	CONSIDERATIONS IN INITIAL ACUTE THERAPY
40	Trigeminovascular model of migraine
41	Mechanisms for treatment
42	TRIPTANS
43	TRIPTANS: TREATMENT CHOICES Are there differences between the triptans? If one triptan fails, will another triptan work?
44	ROUTES OF ADMINISTRATION
45	FORMULATION: ONSET
46	Sumatriptan Sumatriptan (Glaxo Wellcome) 5-HT_1B/1D agonist
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49	Headache responses continue to improve over time after eletriptan dosing Time course for headache response
50	ACUTE TREATMENT PRINCIPLES
51	STEP VS. STRATIFIED CARE
52	BASIS OF STRATIFICATION
53	MIDAS Score Days in Last 3 months You’ve missed work or school due to your headaches? Your productivity at work or school reduced by half or more due to your headaches? (Please do not include days you counted in question 1 where you missed work or school) You not do household work because of your headaches? Your productivity in household work reduced by half or more because of your headaches? (Do not include days you counted in question 3 where you did not do household work) You missed family, social or leisure activities because of your headaches? A. Had a Headache? If a headache lasted more than one day count each day. B. On a scale of 1-10 on average how painful were those headaches? (Where 0 is no pain, 10 is as bas as pain could be??
54	GradeDefinitionScore I Minimal or infrequent disability 0-5 II Mild or infrequent disability 6-10 III Moderate disability 11-20 IV Severe disability 21+
55	DISABILITY IN STRATEGIES OF CARE (DISC) STUDY
56	TREAT MIGRAINE WHEN PAIN IS MILD
57	TRIPTANS IN THE SPECTRUM OF MIGRAINE
58	RECURRENCE & REBOUND
59	APPROACH TO DIFFICULT HEADACHE PROBLEMS
60	SUMMARY OF ACUTE MIGRAINE MANAGEMENT
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64	Chronic Daily HA
65	Tension (v. migraine) ³10 attacks lasting 30 min–7 days ³2 of the following 4 Bilateral Not pulsating Mild or moderate intensity Not aggravated by routine physical activity No nausea or vomiting One or neither photophobia or phonophobia Not attributable to another disorder
66	MIGRAINE ADDITIONAL FEATURES
67	UNDIAGNOSED MIGRAINE SUFFERERS OFTEN RECEIVE OTHER MEDICAL DIAGNOSES
68	AURA: MIMICS AND SECONDARY CAUSES
69	LATE-LIFE MIGRAINE ACCOMPANIMENTS VS TIA
70	MIGRAINE AND STROKE
71	CADASIL
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74	GUIDELINES: WHEN TO USE PREVENTIVE MANAGEMENT
75	GOALS OF PREVENTIVE TREATMENT
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77	GENERAL PRINCIPLES OF PREVENTIVE TREATMENT
78	PREVENTIVE MEDICATIONS: DRUG CLASSES
79	GENERAL PRINCIPLES OF PREVENTIVE TREATMENT
80	Comorbidities
81	COMORBID AND COEXISTENT CONDITIONS
82	PREVENTIVE TREATMENT: DRUG CHOICE
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85	PREVENTIVE TREATMENT: USE OF ACUTE MEDICATION
86	CAUTIONS IN ACUTE MEDICATION USE
87	NONPHARMACOLOGIC TREATMENT: POTENTIAL INDICATIONS
88	SUMMARY OF PREVENTION
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