Lobo B L, Cooke S C, Landy S H
Department of Pharmacy, Methodist Healthcare-Central, Memphis, Tennessee 38104, USA.
Clin Ther. 1999 Jul;21(7):1118-30. doi: 10.1016/S0149-2918(00)80017-X.
This review summarizes data on the effectiveness of various symptomatic migraine pharmacotherapies and makes recommendations for treatment. A wide variety of agents are available for the symptomatic treatment of migraine headache, including over-the-counter analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), combination products, opiates, ergot alkaloids, corticosteroids, dopamine antagonists, and triptans. In the stepped-care approach, simple analgesics and NSAIDs are the recommended first step for the treatment of mild-to-moderate migraine headaches. Patients who do not respond to first-step treatments may be given ergots, combination products, dopamine antagonists, or triptans as the second step. Corticosteroids or opiates may be used as rescue treatment in patients who do not respond to second-step treatment. A stratified approach to care individualizes treatment based on the severity of the headache and other patient-specific factors. In a stratified approach, dihydroergotamine or triptans may be the first-step treatment for patients who present with a history of severe migraines that have responded poorly to previous treatments. Sumatriptan was the first triptan approved for the symptomatic treatment of migraine headache; newer triptans include zolmitriptan, naratriptan, and rizatriptan. Since sumatriptan is rapidly absorbed by the subcutaneous route, its time to onset of effect is shortest. Among triptan drugs that are administered orally, the relative time to onset may be shorter with rizatriptan than sumatriptan. Naratriptan has a longer time to onset but is associated with a lower rate of migraine recurrence than other triptans. graine headache, ergot alkaloids, triptans,
本综述总结了各种偏头痛对症药物治疗的有效性数据，并提出了治疗建议。有多种药物可用于偏头痛的对症治疗，包括非处方镇痛药、非甾体抗炎药（NSAIDs）、复方制剂、阿片类药物、麦角生物碱、皮质类固醇、多巴胺拮抗剂和曲坦类药物。在阶梯式治疗方法中，简单镇痛药和NSAIDs是治疗轻至中度偏头痛的推荐第一步。对第一步治疗无反应的患者可在第二步给予麦角生物碱、复方制剂、多巴胺拮抗剂或曲坦类药物。皮质类固醇或阿片类药物可用于对第二步治疗无反应的患者的急救治疗。分层护理方法根据头痛的严重程度和其他患者特定因素进行个体化治疗。在分层治疗方法中，双氢麦角胺或曲坦类药物可能是有严重偏头痛病史且对先前治疗反应不佳的患者的第一步治疗药物。舒马曲坦是首个被批准用于偏头痛对症治疗的曲坦类药物；新型曲坦类药物包括佐米曲坦、那拉曲坦和利扎曲坦。由于舒马曲坦通过皮下途径吸收迅速，其起效时间最短。在口服的曲坦类药物中，利扎曲坦的相对起效时间可能比舒马曲坦短。那拉曲坦起效时间较长，但与其他曲坦类药物相比，偏头痛复发率较低。偏头痛头痛、麦角生物碱、曲坦类药物
