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FANSBenzodiazepine Calcio-antagonisti Flunarizina Nimodipina Nimodipina Betabloccanti Propanololo Timololo Timololo.

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Presentation on theme: "FANSBenzodiazepine Calcio-antagonisti Flunarizina Nimodipina Nimodipina Betabloccanti Propanololo Timololo Timololo."— Presentation transcript:

1 FANSBenzodiazepine Calcio-antagonisti Flunarizina Nimodipina Nimodipina Betabloccanti Propanololo Timololo Timololo

2 ANTICONVULSIVANTICarbamazepinaOxcarbazepinaGabapentinTopiramatoLamotriginaPregabalinClonazepam

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

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

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8 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

9 Acute 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

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13 ANTICONVULSANTS Carbamazepine Lamotrigine Carbamazepine Lamotrigine Oxcarbazepine Pregabalin Oxcarbazepine Pregabalin Gabapentin Clonazepam Gabapentin Clonazepam Topiramate Topiramate

14 DrugDose (mg)Action GABA ergic Sodium channel Antiglut- aminergic calcium ion channels Carbamazepine Lamotrigine Baclofen Sodium valproate Gabapentin Clonazepam Oxcarbazepine Topiramate Pregabalin – – ?

15 DrugSide 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 DrugDose (mg) Carbamazepine Lamotrigine Gabapentin Oxcarbazepine Pregabalin – –

19 Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

20 DrugDose (mg) Gabapentin Clonazepam Pregabalin 300 – –

21 Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

22 DrugDose (mg) Topiramate100

23 Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

24 Drug Dose (mg) Carbamazepine Lamotrigine Sodium valproate Gabapentin Clonazepam Oxcarbazepine Topiramate Pregabalin – –

25 Psychiatric comorbidity Muscle parafunction/hyperfunction Muscle contracture

26 NONPHARMACOLOGICAL TREATMENT

27 PAIN NOCICEPTIVENEUROPATHICPSYCHOGENIC LOCAL FACTORS JAW STRUCTURE ALTERATIONS MUSCLE DYSFUNCTION POSTURE DISORDERS LOCAL NEUROLOGIC DISORDERS SYSTEMIC FACTORS NEUROLOGICVASCULARHORMONALPSYCHIATRIC

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33 Psychiatric comorbidity Muscle parafunction/hyperfunction Muscle contracture

34 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

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43 Month 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


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