Sternieri E, Ferrari A
Centro per lo Studio delle Cefalee, Università degli Studi di Modena.
Ann Ital Med Int. 1992 Jul-Sep;7(3 Suppl):46S-63S.
Within the pharmacological treatment of migraine it is possible to distinguish treatment of attacks and prevention therapy. The aim of attack treatment is to stop pain and accompanying symptoms, or at least to make them more tolerable, whereas the aim of prophylaxis is to reduce the frequency and possibly the severity and duration of the residual episodes. The choice to initiate either treatment, or both, is based on quantitative criteria, such as attack frequency (if greater than 2-3 per month, prophylaxis treatment is recommendable) and on qualitative features, like the degree of disability, the response and the tolerance of the patient to attack treatment. Prophylaxis treatment has not achieved any improvement since 1981, when propranolol was first utilized. The knowledge of the mechanisms of action of drugs used in prophylaxis, as well as their results, are at a standstill. Even with the newer calcium channel antagonists and beta-blockers we achieve a 50% reduction of attacks in less than half of subjects treated. On the other hand, we had important news in the treatment of migraine attacks. Sumatriptan, a selective agonist of serotonin receptors, represents a therapeutic novelty due both to the results obtained and to the studies that have been stimulated on the pathogenesis of migraine. New therapeutic perspectives are now opening and hopefully thanks to the cooperation of basic and clinical scientists, they might become a reality in a short time.
在偏头痛的药物治疗中，可以区分发作期治疗和预防性治疗。发作期治疗的目的是终止疼痛及伴随症状，或至少使其更易于耐受，而预防性治疗的目的是减少发作频率，并可能减轻残余发作的严重程度和持续时间。决定开始进行其中一种治疗或两种治疗，是基于定量标准，如发作频率（如果每月超过2 - 3次，推荐进行预防性治疗）以及定性特征，如残疾程度、患者对发作期治疗的反应和耐受性。自1981年首次使用普萘洛尔以来，预防性治疗没有取得任何进展。用于预防性治疗的药物的作用机制及其效果的认知一直停滞不前。即使使用更新的钙通道拮抗剂和β受体阻滞剂，在不到一半的接受治疗的患者中，发作次数也仅减少了50%。另一方面，在偏头痛发作期治疗方面我们有了重要进展。舒马曲坦，一种5 - 羟色胺受体的选择性激动剂，因其所取得的结果以及引发的关于偏头痛发病机制的研究，代表了一种治疗上的新方法。新的治疗前景正在开启，有望在基础科学家和临床科学家的合作下，在短时间内成为现实。
