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

ANTICONVULSIVANTI Carbamazepina Oxcarbazepina Gabapentin Topiramato Lamotrigina Pregabalin Clonazepam

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

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

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

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

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

                                                                                                                                                      

ANTICONVULSANTS Carbamazepine Lamotrigine Oxcarbazepine Pregabalin Gabapentin Clonazepam Topiramate

Drug Dose (mg) Action GABA ergic Sodium channel 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 + +? ++

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

Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

Drug Dose (mg) Carbamazepine Lamotrigine Gabapentin Oxcarbazepine Pregabalin 400 -1200 150 - 400 300 –1200 0.5 – 2 150-300

Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

Drug Dose (mg) Gabapentin Clonazepam Pregabalin 300 –1200 0.5 – 2 150-300

Trigeminal neuralgia Neuropathic pain Migraine Cluster headache

Drug Dose (mg) Topiramate 100

Trigeminal neuralgia Neuropathic pain Migraine Cluster 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

Muscle parafunction/hyperfunction Muscle contracture Psychiatric comorbidity Muscle parafunction/hyperfunction Muscle contracture

NONPHARMACOLOGICAL TREATMENT

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

Muscle parafunction/hyperfunction Muscle contracture Psychiatric comorbidity Muscle parafunction/hyperfunction Muscle contracture

Muscle parafunction/hyperfunction Muscle contracture Psychiatric comorbidity Muscle parafunction/hyperfunction Muscle contracture

Terapia cognitivo-comportamentale

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

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

PROGRAMMA BASE

Esercizi di rilassamento

Promemoria visivo

Esercizi di postura

Esercizi di postura

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