fansbenzodiazepine calcio-antagonisti flunarizina nimodipina nimodipina betabloccanti propanololo...
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FANSFANS
BenzodiazepineBenzodiazepine
Calcio-antagonisti Calcio-antagonisti FlunarizinaFlunarizina
Nimodipina Nimodipina
Betabloccanti Betabloccanti PropanololoPropanololo TimololoTimololo
ANTICONVULSIVANTIANTICONVULSIVANTI
Carbamazepina Carbamazepina
OxcarbazepinaOxcarbazepina
GabapentinGabapentin
TopiramatoTopiramato
LamotriginaLamotrigina
PregabalinPregabalin
ClonazepamClonazepam
Cluster Headache
Treatment: first-choice
preventive verapamil symptomatic sumatriptan IM
opens rapidly upon depolarizationopens rapidly upon depolarization
closes to a fast inactivated state
resting state from which activation is again possible
Normal Windup Reduced opioid effects
Neuropathic Injury discharge Hyperalgesia Allodynia Reduced opioid effects
Inflammatory Neuronal responses Hyperalgesia Reduced opioid effects (time-dependent)
Long-Term Gene induction Novel neurotransmission Cell death Pain memory Reduced opioid effects
Results of NMDA-Receptor Activation
Acute painAcute pain
The normal, predictable, appropriate response to a noxious The normal, predictable, appropriate response to a noxious stimulus or disease process that threatens or produces tissue stimulus or disease process that threatens or produces tissue injury, and that abates following remission of the stimulus or injury, and that abates following remission of the stimulus or healing of the injuryhealing of the injury
Chronic painChronic pain
Pain associated with a chronic disorder, or pain that persists Pain associated with a chronic disorder, or pain that persists beyond resolution of an underlying disorder or healing of an beyond resolution of an underlying disorder or healing of an injury, and that is often more intense than the underlying injury, and that is often more intense than the underlying process would predictprocess would predict
Peripheral sensitizationPeripheral sensitization
Increased excitability of peripheral nociceptors, Increased excitability of peripheral nociceptors, often mediated by an inflammatory processoften mediated by an inflammatory process
Central sensitizationCentral sensitization
Increased excitability of central pain-transmitting Increased excitability of central pain-transmitting neurons that may be mediated by an neurons that may be mediated by an inflammatory processinflammatory process
Dual mechanism painDual mechanism pain
Pain that is amplified and maintained by both Pain that is amplified and maintained by both peripheral and central sensitizationperipheral and central sensitization
ANTICONVULSANTSANTICONVULSANTS
Carbamazepine LamotrigineCarbamazepine Lamotrigine
Oxcarbazepine PregabalinOxcarbazepine Pregabalin
Gabapentin ClonazepamGabapentin Clonazepam
TopiramateTopiramate
Drug Dose (mg) Action
GABAergic
Sodiumchannel
Antiglut-aminergic
calcium ion channels
Carbamazepine
Lamotrigine
Baclofen
Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
400 -1200
150 - 400
10 - 25
800 -1600
300 –1200
0.5 – 2
300
100
150-300
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Drug Side effects
Carbamazepine
Lamotrigine
Baclofen
Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
Nausea, drowsiness, skin rashes, blood alterationsSkin rashes
Hepatic dysfunction
Sedation
Sedation
Nausea, drowsiness, skin rashes, blood alterationsAtaxia, paresthesia,visual disturbances, appetite loss
Trigeminal neuralgiaTrigeminal neuralgia
Neuropathic painNeuropathic pain
MigraineMigraine
Cluster headacheCluster headache
Trigeminal neuralgiaTrigeminal neuralgia
Neuropathic painNeuropathic pain
MigraineMigraine
Cluster headacheCluster headache
Drug Dose (mg)
Carbamazepine
Lamotrigine
Gabapentin
Oxcarbazepine
Pregabalin
400 -1200
150 - 400
300 –1200
0.5 – 2
150-300
Trigeminal neuralgiaTrigeminal neuralgia
Neuropathic painNeuropathic pain
MigraineMigraine
Cluster headacheCluster headache
Drug Dose (mg)
Gabapentin
Clonazepam
Pregabalin
300 –1200
0.5 – 2
150-300
Trigeminal neuralgiaTrigeminal neuralgia
Neuropathic painNeuropathic pain
MigraineMigraine
Cluster headacheCluster headache
Drug Dose (mg)
Topiramate 100
Trigeminal neuralgiaTrigeminal neuralgia
Neuropathic painNeuropathic pain
MigraineMigraine
Cluster headacheCluster headache
Drug Dose (mg)
Carbamazepine
Lamotrigine
Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
400 -1200
150 - 400
800 -1600
300 –1200
0.5 – 2
300
100
150-300
Psychiatric comorbidity
Muscle parafunction/hyperfunction Muscle contracture
NONPHARMACOLOGICAL
TREATMENT
PAINPAIN
NOCICEPTIVENOCICEPTIVE
NEUROPATHICNEUROPATHIC
PSYCHOGENICPSYCHOGENIC
LOCAL FACTORSLOCAL FACTORS
JAW STRUCTURE JAW STRUCTURE ALTERATIONSALTERATIONS
MUSCLE DYSFUNCTIONMUSCLE DYSFUNCTION
POSTURE DISORDERSPOSTURE DISORDERS
LOCAL NEUROLOGIC LOCAL NEUROLOGIC DISORDERSDISORDERS
SYSTEMIC FACTORSSYSTEMIC FACTORS
NEUROLOGICNEUROLOGIC
VASCULARVASCULAR
HORMONALHORMONAL
PSYCHIATRICPSYCHIATRIC
Psychiatric comorbidity
Muscle parafunction/hyperfunction Muscle contracture
Psychiatric comorbidity
Muscle parafunction/hyperfunction Muscle contracture
Terapia cognitivo-Terapia cognitivo-comportamentalecomportamentale
COMPORTAMENTOCOMPORTAMENTO
Complesso di azioni o reazioni di Complesso di azioni o reazioni di un individuo in risposta a un individuo in risposta a
determinati stimoli esterni o determinati stimoli esterni o interni interni
La Terapia Comportamentale mira La Terapia Comportamentale mira a modificare tali reazioni facendole a modificare tali reazioni facendole rientrare in un ambito per così dire rientrare in un ambito per così dire “normale”. Essa insegna dunque alle “normale”. Essa insegna dunque alle persone a reagire in modo differente persone a reagire in modo differente a diverse condizionia diverse condizioni
PROGRAMMA BASE
Esercizi di rilassamentoEsercizi di rilassamento
Promemoria visivoPromemoria visivo
Esercizi di posturaEsercizi di postura
Esercizi di posturaEsercizi di postura
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14
2
1
Control Group
Study Group
Examination 2 both groups
Examination 1 both groups
Examination 3 both groups
Intervention Study group
Intervention Control group
Both groups start diaries
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14