Welcome to the WCN 2021 Interactive Program
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Please note that all sessions will run at their scheduled time and be followed by a LIVE Q&A/Discussion at the end
The viewing of sessions, cannot be accessed from this conference calendar. All sessions are accessible via the Virtual Platform
- Shuu-Jiun Wang (Taiwan)
MIGRAINE PATHOPHYSIOLOGY, CLINICAL CORRELATES
- Fabiola Dach (Brazil)
Migraine is well known by the headache itself, however there are many other signals and symptoms that can occur during an attack. Some symptoms, called premonitory symptoms, such as yawning and feeling tired, occur in 72-84 % of patients. About 20% of migraineurs present aura. The most common aura is visual disturbances, following by sensitive symptoms. The headache of migraine is characterized by pulsatile unilateral pain, of moderate to severe intensity, that worsen by routine physical activities, associated with photo/phonofobia, nausea and vomiting. About 68-80% of migraine patients present the last phase called postdrome or resolution, in which the most common symptoms are tiredness and cognitive difficulties. This lecture will discuss the pathophysiological aspects of the main signals and symptoms of a migraine attack.
- Shuu-Jiun Wang (Taiwan)
Shuu-Jiun Wang, MD
College of Medicine & Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
The prevalence of vestibular migraine (VM) ranges from 1% to 2.7%. Despite migraine and vertigo are both common disorders, a close association between vestibular symptoms and migraine is beyond coincidence. VM, a clinical entity that incorporates vestibular and migrainous symptoms, is now defined by the International Headache Society and Barany Society. According to the proposed criteria, VM is defined as a migraine patient who has episodes of moderate-to-severe vestibular symptoms, and >50% of them with migrainous headache. Diagnosis of VM depends on a thorough clinical history because there are no definitive signs nor laboratory tests. The pathophysiology still remains unknown. However, based on current understanding of migraine pathophysiology, the main hypothesis focuses on the connections between trigeminal-vascular system, vestibular system, thalamus, and associated cortices. The theory is supported by recent evidence from human functional neuroimaging studies and animal studies. There is still no consensus on how to treat this group of patients due to the lack of strong evidence. Most patients only need symptomatic treatment during attacks of vestibular symptoms. For acute treatment, triptans, anti-histamines, anti-emetic agents, or even steroids can be used. For preventive treatment, calcium channel blockers (such as flunarizine), and antidepressants may be considered. In addition, vestibular rehabilitation may also be effective.
MIGRAINE TREATMENT UPDATE
- Cristina Tassorelli (Italy)
Migraine is a highly disabling neurological disorder that affects more than 1 billion individuals worldwide. For decades, migraine has been thought to be a complex and indecipherable condition, poorly understood with regards to pathogenesis. Migraine is caused by the interaction of genetic and environmental factors on the functioning of multiple brain areas. Because of major progress in the understanding of its pathogenesis, novel mechanism-based drugs for preventing the debilitating attacks or for acutely treat them have recently emerged, thus enriching the armamentarium of treatments. In addition, neuromodulation and digital therapeutics are progressively gaining space in the migraine arena, which was entered in the last few years by monoclonal antibodies targeting CGRP, CGRP antagonists, 5HT1F agonists (ditans), peripheral nerve stimulation device and a more widespread and conscious use of electronic systems to identify and control attack triggers.
Migraine management is presently undergoing a positive revolution where the paradigm is slowly, but progressively switching from the trial-and-error or comorbidity-driven approach to an informed clinical management built on the combination of evidence-based data and a panel of individual features: frequency and severity of attacks, previous treatment failures and patient's preferences.
The availability of mechanism-specific drugs will hopefully facilitate the identification of biomarkers of response, which the scientific community is vigorously searching. Such an achievement will allow the final transition to the next level of migraine treatment, tailored therapies to individuals, thus granting the maximum effectiveness of treatments with the least possible amount of side effects.