Göbel H, Heinze A
Neurologisch-verhaltensmedizinische Schmerzklinik Kiel in Kooperation mit der Universität Kiel, Germany.
Schmerz. 2002 Jun;16(3):223-40. doi: 10.1007/s00482-002-0146-1.
Migraine prophylaxis with drugs is still an essential part of migraine therapy. This is especially true for those patients with frequent migraines who are in danger of developing drug-induced headaches. Migraine prophylaxis should be taken in consideration in patients who suffer from 7 or more migraine days per months in spite of all non-pharmacological efforts. When choosing a prophylactic drug not only efficacy but tolerability and safety for long-term intake should be considered. Prophylactic drugs used to be classified as drugs of first, second and third choice. According to this step care model treatment was started with a drug of first choice and only in case of lack of efficacy or adverse events a drug of lower choice was selected. Today, in contrast to the traditional step care a stratified care is favored. Treatment is individualized based on an assessment of the patients' medical needs, on comorbidity, the migraine phenotype and most important the individual situation of the patient in life. The paper gives an overview of the efficacy and tolerability of drugs used in migraine prophylaxis.
药物预防偏头痛仍然是偏头痛治疗的重要组成部分。对于那些频繁偏头痛且有发生药物性头痛风险的患者来说尤其如此。尽管采取了所有非药物治疗措施，但每月偏头痛发作天数达7天或更多的患者，应考虑进行偏头痛预防。选择预防性药物时，不仅要考虑疗效，还要考虑长期服用的耐受性和安全性。预防性药物过去曾被分为首选、次选和第三选择药物。根据这种阶梯式治疗模式，治疗从首选药物开始，只有在缺乏疗效或出现不良事件时才选择较低选择的药物。如今，与传统的阶梯式治疗不同，分层治疗更受青睐。治疗是根据对患者医疗需求、合并症、偏头痛表型以及最重要的患者生活中的个体情况的评估进行个体化的。本文概述了用于偏头痛预防的药物的疗效和耐受性。
