Ashkenazi Avi, Silberstein Stephen D
Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Gibbon Building, Suite #8130, 111 South Eleventh Street, Philadelphia, PA 19107, USA.
Curr Opin Neurol. 2003 Jun;16(3):341-5. doi: 10.1097/01.wco.0000073935.19076.47.
To review recent advances in acute and preventive migraine treatment.
The number of migraine drugs continues to expand, allowing for more flexible and tolerable treatment plans. Two new triptans, frovatriptan and eletriptan, and a nasal formulation of zolmitriptan have been recently developed. Eletriptan is effective for acute migraine treatment and may have some pharmacologic and clinical advantages. Frovatriptan has a longer half-life and lower headache recurrence rates compared with other triptans. It may be useful for patients who have prolonged attacks and high headache recurrence rate. Zolmitriptan nasal spray has a rapid onset of action and high efficacy. It should be considered when patients have rapid-onset attacks, especially when associated with severe nausea or vomiting. The butyrophenone neuroleptic droperidol is very effective in aborting acute migraine attacks. Central nervous system side effects are common, however, and the ECG should be monitored. Botulinum toxin type A shows promise as a safe, tolerable and effective drug for migraine prevention, with the unique advantages of almost no systemic adverse events and a long interval between treatments. The anticonvulsant topiramate is effective for migraine prevention. Cognitive side effects are of less concern with the lower doses needed for migraine. The angiotensin converting enzyme receptor blocker candesartan appears to be effective and highly tolerable in the prevention of migraine, but needs to be further evaluated.
New drugs expand the spectrum of migraine treatment both for the acute attack and for prevention.
综述急性偏头痛和预防性偏头痛治疗的最新进展。
偏头痛药物的种类持续增加，使治疗方案更加灵活且耐受性更好。最近研发出了两种新型曲坦类药物，即夫罗曲普坦和依立曲坦，以及佐米曲普坦的鼻腔制剂。依立曲坦对急性偏头痛治疗有效，可能具有一些药理和临床优势。与其他曲坦类药物相比，夫罗曲普坦半衰期更长，头痛复发率更低。对于发作持续时间长且头痛复发率高的患者可能有用。佐米曲普坦鼻喷雾剂起效迅速且疗效高。当患者发作迅速，尤其是伴有严重恶心或呕吐时，应考虑使用。丁酰苯类抗精神病药氟哌利多在终止急性偏头痛发作方面非常有效。然而，常见中枢神经系统副作用，应监测心电图。A型肉毒毒素有望成为一种安全、耐受性好且有效的偏头痛预防药物，具有几乎无全身不良事件且治疗间隔时间长的独特优势。抗惊厥药托吡酯对偏头痛预防有效。偏头痛所需较低剂量时，认知副作用较少受到关注。血管紧张素转换酶受体阻滞剂坎地沙坦在预防偏头痛方面似乎有效且耐受性高，但需要进一步评估。
新药拓宽了偏头痛急性发作和预防治疗的范围。
