Ashkenazi Avi, Silberstein Stephen D
Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Annu Rev Med. 2004;55:505-18. doi: 10.1146/annurev.med.55.091902.104440.
The number of migraine treatments and our understanding of migraine pathophysiology are both increasing. Newer treatments focus on migraine prevention. Botulinum toxin (BTX) is a potent neurotoxin used primarily to treat diseases associated with increased muscle activity. Recently, BTX was found to have antinociceptive effects that are probably independent of its muscle-relaxant action. Clinical trials support the efficacy of BTX type A (and possibly also type B) in the treatment of migraine. The anticonvulsant topiramate was recently shown to be effective for migraine prevention. At the low doses used for this indication, cognitive side effects are not a major concern. Another new approach to migraine prevention is angiotensin type 1 (AT1) receptor blockade. The high tolerability of the AT1 receptor blocker candesartan warrants further studies to assess its role in migraine prevention.
偏头痛治疗方法的数量以及我们对偏头痛病理生理学的理解都在不断增加。新型治疗方法侧重于偏头痛的预防。肉毒杆菌毒素（BTX）是一种强效神经毒素，主要用于治疗与肌肉活动增加相关的疾病。最近发现，BTX具有可能与其肌肉松弛作用无关的镇痛作用。临床试验支持A型肉毒杆菌毒素（可能还有B型）治疗偏头痛的疗效。抗惊厥药托吡酯最近被证明对预防偏头痛有效。用于该适应症的低剂量时，认知副作用不是主要问题。偏头痛预防的另一种新方法是血管紧张素1型（AT1）受体阻断。AT1受体阻滞剂坎地沙坦的高耐受性值得进一步研究，以评估其在偏头痛预防中的作用。
