Le Jeunne C
Centre de prise en charge des migraines et céphalées, hôpital Laënnec, Paris, France.
Pathol Biol (Paris). 2000 Sep;48(7):690-6.
Because of the outcome of the 5 HT1B/1D agonists or "triptans" for the treatment of migraine attacks, it has been thought that migraine prophylaxis was not useful anymore. However, some patients are not responders to the triptans and some responders who have more than one attack a week still feel the need for prophylactic treatment. Apart from non-pharmacological treatments that are always needed, the different drugs that have shown their efficiency in clinical trials are analysed. The choice of a prophylactic treatment mostly depends on the benefits/risk ratio. In migraine prophylaxis beta-blockers have a good benefits/risk ratio, serotonin receptor antagonists that are effective as well, have a high frequency of adverse effects, especially weight gain and fatigue, which are limiting factors for prescription. In France dihydroergotamine is still largely prescribed because it is well tolerated. Second-line treatments may be considered, they have been studied through clinical trials, they are efficient, but they have severe side effects: flunarizine, sodium valproate and methysergide. The management of all these side effects has to be known, because prophylactic treatment is still necessary for the well-being of migraineurs.
由于5-HT1B/1D激动剂或“曲坦类药物”治疗偏头痛发作的效果，人们曾认为偏头痛预防性治疗不再有用。然而，一些患者对曲坦类药物无反应，一些每周发作不止一次的有反应者仍觉得需要预防性治疗。除了始终需要的非药物治疗外，还对在临床试验中显示出疗效的不同药物进行了分析。预防性治疗的选择主要取决于效益/风险比。在偏头痛预防性治疗中，β受体阻滞剂的效益/风险比良好，同样有效的5-羟色胺受体拮抗剂不良反应发生率高，尤其是体重增加和疲劳，这是限制其处方使用的因素。在法国，双氢麦角胺仍被大量处方，因为它耐受性良好。可考虑二线治疗，它们已通过临床试验进行了研究，有效，但有严重副作用：氟桂利嗪、丙戊酸钠和麦角新碱。必须了解所有这些副作用的处理方法，因为预防性治疗对偏头痛患者的健康仍然必要。
