Prophylactic pharmacotherapy for migraine headaches
Prophylactic pharmacotherapy for migraine headaches
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DOI：
10.1055/s-2006-939919
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发表时间：
2006-04-01
影响因子：
2.7
通讯作者：
Ramadan, NM
中科院分区：
文献类型：
--
作者：
Buchanan, TM;Ramadan, NM
偏头痛的治疗是药理学的，包括急性和预防性，非药理学和/或两者兼而有之。预防性药理学策略偶然被发现是有效的，包括各种药理学类别的药物（例如，β -肾上腺素能阻滞剂，抗惊厥药，三环抗抑郁药，血清素受体拮抗剂）。越来越多的I级证据和临床经验支持使用抗抑郁药阿米替林、抗惊厥药双丙戊酸和托吡酯，以及-肾上腺素能阻滞剂心得安、替洛尔和美托洛尔预防偏头痛。预防偏头痛的其他选择也存在，但支持其使用的证据水平不那么有力。所有这些药物都有不同程度的副作用，其中一些可能会限制它们的使用。平衡潜在的疗效和不良反应的风险，满足患者的期望和愿望，遵守管理建议，充分的随访，准确评估治疗目标是预防偏头痛的关键。最后，未来的偏头痛预防药物可能会更具体地针对偏头痛的机制，这无疑将提高治疗指数。
Migraine therapeutics are pharmacological, including acute and preventive, nonpharmacological and/or both. Preventive pharmacological strategies serendipitously were discovered to be effective and include drugs from various pharmacological classes (e.g., beta-adrenergic blocker, anticonvulsant, tricyclic antidepressants, serotonin receptor antagonist). Converging level I evidence and clinical experience support the use of the antidepressant amitriptyline, the anticonvulsants divalproex and topiramate, and the beta-adrenergic blockers propranolol, timolol, and metoprolol in migraine prevention. Other options for migraine prophylaxis exist, but the level of evidence in support of their use is not as robust. All of these drugs have varying degrees of adverse effects, some of which can limit their use. Balancing potential efficacy with risk of adverse effects, addressing patients' expectations and desires, complying with management recommendations, adequate follow up, and accurate assessment of treatment goals arc key to migraine prevention. Finally, future migraine-preventive drugs likely will target migraine mechanisms more specifically, which undoubtedly will enhance the therapeutic index.