Current trends in migraine prophylaxis
Current trends in migraine prophylaxis
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DOI：
10.1111/j.1526-4610.2007.00677.x
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发表时间：
2007-04-01
期刊：
影响因子：
5
通讯作者：
Ramadan, Nabih M.
中科院分区：
文献类型：
--
作者：
Ramadan, Nabih M.
来自不同药理学类别的各种药物被用于预防偏头痛。传统上，它们都是偶然发现的。例子包括-肾上腺素能阻滞剂、抗惊厥药、三环抗抑郁药和血清素受体拮抗剂。偏头痛预防药物的作用机制是多种多样的，但一般认为它们集中在两个目标上：(1)抑制皮质兴奋；(2)恢复痛觉失调。抗癫痫药物（如托吡酯、丙戊酸、加巴喷丁）、钙通道阻滞剂（如维拉帕米）和皮质扩张性抑制抑制剂是一些降低神经元高兴奋性的药物。另一方面，血清素能和肾上腺素能系统的调节剂和胆碱能增强药物可能恢复下降的伤害抑制，并在偏头痛预防中发挥作用。迄今为止，一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、替洛尔和美托洛尔作为一线偏头痛预防药物。其他药物（如维拉帕米）的证据就不那么充分了。偏头痛预防药物有不同程度的副作用，其中一些可能是有限的，它们的疗效应该与它们的副作用风险、患者的期望和愿望以及依从性相平衡。希望未来的偏头痛预防药物能够更有针对性地针对偏头痛的机制，从而更好地提高治疗指标。
A variety of drugs from diverse pharmacological classes are in use for migraine prevention. Traditionally, they have been discovered by serendipity. Examples include beta-adrenergic blockers, anticonvulsants, tricyclic antidepressants, and serotonin receptor antagonists. The mechanisms of action of migraine preventive drugs are multiple but it is postulated that they converge on two targets: (1) inhibition of cortical excitation; (2) restoring nociceptive dysmodulation. The antiepileptic drugs (e.g., topiramate, valproate, gabapentin), calcium channel blockers such as verapamil, and inhibitors of cortical spreading depression are some examples of drugs that reduce neuronal hyperexcitability. On the other hand, modulators of the serotonergic and adrenergic systems and cholinergic enhancing drugs may restore descending nociceptive inhibition and play a role in migraine prevention. To date, Level 1 evidence and clinical experience favor the use of the antidepressant amitriptyline, the anticonvulsants divalproex and topiramate, and the beta-adrenergic blockers propranolol, timolol and metoprolol as first line migraine preventive drugs. The evidence for others (e.g., verapamil) is not as strong. Migraine preventive drugs have varying degrees of adverse effects, some of which could be limiting, and their efficacy should balanced with their risks of adverse effects, patients' expectations and desires, and compliance. It is hoped that future migraine preventive drugs target migraine mechanisms more specifically, which could well enhance the therapeutic index.