The medical management of migraine.
The medical management of migraine.
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DOI：
10.1097/00045391-200403000-00008
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发表时间：
2004-03-01
影响因子：
4.2
通讯作者：
Krymchantowski, Abouch V
中科院分区：
文献类型：
--
作者：
Bigal, Marcelo E;Lipton, Richard B;Krymchantowski, Abouch V
偏头痛是一种常见的慢性神经系统疾病，影响西方国家 11% 的成年人。在本文中，我们回顾了目前偏头痛的药物治疗方法。一旦诊断出偏头痛并评估疾病严重程度，临床医生和患者应共同根据患者的需求和偏好制定治疗计划。治疗计划的目标通常包括减少发作频率、强度和持续时间；最大限度地减少头痛相关的残疾；改善与健康相关的生活质量；避免头痛加剧和药物滥用。偏头痛的药物治疗可分为预防性药物（无论是否存在头痛，每天服用）和急性药物（用于治疗个别发作）。急性治疗进一步分为非特异性治疗和偏头痛特异性治疗。美国头痛协会指南建议根据残疾程度进行分层护理，以帮助医生进行个体化治疗。简单的镇痛药适合作为残疾程度较轻的患者的一线急性治疗；如果简单的镇痛药不成功，治疗就会升级。对于残疾程度较高的患者，建议将偏头痛特异性急性疗法（例如曲坦类药物）作为初始治疗，并在选定的患者中使用预防药物。各种行为干预措施都有帮助。临床医生的医疗设备中的药物种类不断增加。凭借经验，临床医生可以将个体患者的需求与药物的具体特性相匹配，以优化治疗效果。
Migraine is a common, chronic neurologic disorder that affects 11% of the adult population in Western countries. In this article, we review the current approaches to the pharmacologic treatment of migraine. Once migraine is diagnosed, and illness severity has been assessed, clinicians and patients should work together to develop a treatment plan based on the patient needs and preferences. The goals of the treatment plan usually include reducing attack frequency, intensity, and duration; minimizing headache-related disability; improving health-related quality of life; and avoiding headache escalation and medication misuse. Medical treatments for migraine can be divided into preventive drugs, which are taken on a daily basis regardless of whether headache is present, and acute drugs taken to treat individual attacks as they arise. Acute treatments are further divided into nonspecific and migraine-specific treatments. The US Headache Consortium Guidelines recommend stratified care based on the level of disability to help physicians individualize treatment. Simple analgesics are appropriate as first-line acute treatments for less disabled patients; if simple analgesics are unsuccessful, treatment is escalated. For those with high disability levels, migraine-specific acute therapies, such as the triptans, are recommended as the initial treatment, with preventive drugs in selected patients. A variety of behavioral interventions are helpful. The clinicians have in their armamentariums an ever-expanding variety of medications. With experience, clinicians can match individual patient needs with the specific characteristics of a drug to optimize therapeutic benefit.