1. Calcio-antagonisti Flunarizina
FANS
Benzodiazepine
Calcio-antagonisti Flunarizina
Nimodipina
Betabloccanti Propanololo
Timololo

2. ANTICONVULSIVANTI Carbamazepina Oxcarbazepina Gabapentin Topiramato
Lamotrigina
Pregabalin
Clonazepam

3. Treatment: first-choice
Cluster Headache
Treatment: first-choice
preventive verapamil
symptomatic sumatriptan IM

6. resting state from which activation is again possible
opens rapidly upon depolarization
closes to a fast inactivated state

8. Results of NMDA-Receptor Activation
Normal
Windup
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
Neuropathic
Injury discharge
Hyperalgesia
Allodynia
Reduced opioid effects

9. Acute pain Chronic pain
The normal, predictable, appropriate response to a noxious stimulus or disease process that threatens or produces tissue injury, and that abates following remission of the stimulus or healing of the injury
Chronic pain
Pain associated with a chronic disorder, or pain that persists beyond resolution of an underlying disorder or healing of an injury, and that is often more intense than the underlying process would predict

10. Peripheral sensitization
Increased excitability of peripheral nociceptors, often mediated by an inflammatory process
Central sensitization
Increased excitability of central pain-transmitting neurons that may be mediated by an inflammatory process
Dual mechanism pain
Pain that is amplified and maintained by both peripheral and central sensitization

13. ANTICONVULSANTS
Carbamazepine Lamotrigine
Oxcarbazepine Pregabalin
Gabapentin Clonazepam
Topiramate

14. Drug
Dose (mg)
Action
GABA
ergic
Sodium
channel
Antiglut-aminergic
calcium ion
channels
Carbamazepine
Lamotrigine
Baclofen
Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
300 –1200
0.5 – 2
300
100 + +? ++

15. Drug Side effects Carbamazepine Lamotrigine Baclofen Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
Nausea, drowsiness, skin rashes, blood alterations
Skin rashes
Hepatic dysfunction
Sedation
Nausea, drowsiness, skin rashes, blood alterations
Ataxia, paresthesia,visual disturbances, appetite loss

16. Trigeminal neuralgia
Neuropathic pain
Migraine
Cluster headache

17. Trigeminal neuralgia
Neuropathic pain
Migraine
Cluster headache

18. Drug
Dose (mg)
Carbamazepine
Lamotrigine
Gabapentin
Oxcarbazepine
Pregabalin
300 –1200
0.5 – 2

19. Trigeminal neuralgia
Neuropathic pain
Migraine
Cluster headache

20. Drug
Dose (mg)
Gabapentin
Clonazepam
Pregabalin
300 –1200
0.5 – 2

21. Trigeminal neuralgia
Neuropathic pain
Migraine
Cluster headache

22. Drug
Dose (mg)
Topiramate
100

23. Trigeminal neuralgia
Neuropathic pain
Migraine
Cluster headache

24. Drug
Dose (mg)
Carbamazepine
Lamotrigine
Sodium valproate
Gabapentin
Clonazepam
Oxcarbazepine
Topiramate
Pregabalin
300 –1200
0.5 – 2
300
100

25. Muscle parafunction/hyperfunction Muscle contracture
Psychiatric comorbidity
Muscle parafunction/hyperfunction
Muscle contracture

26. NONPHARMACOLOGICAL
TREATMENT

27. JAW STRUCTURE ALTERATIONS LOCAL NEUROLOGIC DISORDERS
NOCICEPTIVE
NEUROPATHIC
PSYCHOGENIC
PAIN
LOCAL FACTORS
JAW STRUCTURE ALTERATIONS
MUSCLE DYSFUNCTION
POSTURE DISORDERS
LOCAL NEUROLOGIC DISORDERS
SYSTEMIC FACTORS
NEUROLOGIC
VASCULAR
HORMONAL
PSYCHIATRIC

33. Muscle parafunction/hyperfunction Muscle contracture
Psychiatric comorbidity
Muscle parafunction/hyperfunction
Muscle contracture

34. Muscle parafunction/hyperfunction Muscle contracture
Psychiatric comorbidity
Muscle parafunction/hyperfunction
Muscle contracture

35. Terapia cognitivo-comportamentale

36. COMPORTAMENTO
Complesso di azioni o reazioni di un individuo in risposta a determinati stimoli esterni o interni

37. La Terapia Comportamentale mira
a modificare tali reazioni facendole rientrare in un ambito per così dire “normale”. Essa insegna dunque alle persone a reagire in modo differente a diverse condizioni

38. PROGRAMMA BASE

39. Esercizi di rilassamento

40. Promemoria visivo

41. Esercizi di postura

42. Esercizi di postura

43. Intervention
Stud
y group
Study
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Group B
oth groups
Examination 1
Examination 2
Examination 3 1 2 s
tart diaries
both groups
both groups
both groups
Control
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Group
Intervention
Control group