Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention
Episodic and Chronic Migraine Headache: Breaking Down Barriers to Optimal Treatment and Prevention
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DOI：
10.1111/head.12505_2
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发表时间：
2015-03-01
期刊：
影响因子：
5
通讯作者：
Silberstein, Stephen D.
中科院分区：
文献类型：
--
作者：
Lipton, Richard B.;Silberstein, Stephen D.
偏头痛是一种常见的致残性原发性头痛疾病，估计影响3600万美国人。偏头痛经常发生在许多年或一个人的一生。根据定义，发作性偏头痛的特征是每月发生少于15天的头痛。根据最近的国际头痛疾病分类（第三次修订）β诊断标准，慢性偏头痛定义为“每月至少15天头痛，持续至少3个月，每月至少8天具有偏头痛特征。然而，区分发作性偏头痛和慢性偏头痛的诊断标准仍在不断发展。随着时间的推移，发作性偏头痛患者可以缓解、不改变或进展为高频发作性或慢性偏头痛。慢性偏头痛与更大的个人和社会负担，更频繁的合并症，并可能与持续和进行性脑异常。许多患者对常规预防性治疗反应不良或不依从。偏头痛治疗的主要目标包括缓解疼痛，恢复功能和减少头痛频率;另一个目标可能是防止进展为慢性偏头痛。虽然所有偏头痛患者都需要流产治疗，所有慢性偏头痛患者都需要预防性治疗，但没有明确的指南来描述哪些发作性偏头痛患者可以从预防性治疗中获益。美国食品和药物协会批准了五种预防发作性偏头痛的策略，但只有注射onabotulinumtoxinA被批准用于预防慢性偏头痛。识别需要偏头痛预防的人，选择并启动最合适的治疗策略，可以防止从发作性偏头痛进展为慢性偏头痛，并减轻与频繁偏头痛相关的疼痛和痛苦。
Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as "headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month." However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency episodic or chronic migraine over time. Chronic migraine is associated with a substantially greater personal and societal burden, more frequent comorbidities, and possibly with persistent and progressive brain abnormalities. Many patients are poorly responsive to, or noncompliant with, conventional preventive therapies. The primary goals of migraine treatment include relieving pain, restoring function, and reducing headache frequency; an additional goal may be preventing progression to chronic migraine. Although all migraineurs require abortive treatment, and all patients with chronic migraine require preventive treatment, there are no definitive guidelines delineating which persons with episodic migraine would benefit from preventive therapy. Five US Food and Drug Association strategies are approved for preventing episodic migraine, but only injections with onabotulinumtoxinA are approved for preventing chronic migraine. Identifying persons who require migraine prophylaxis and selecting and initiating the most appropriate treatment strategy may prevent progression from episodic to chronic migraine and alleviate the pain and suffering associated with frequent migraine.