Yoon Min-Suk, Savidou Irini, Diener Hans-Christoph, Limmroth Volker
University Hospital Essen, Department of Neurology, Hufelandstrasse 55, 45122 Essen, Germany.
Expert Rev Neurother. 2005 May;5(3):333-41. doi: 10.1586/14737175.5.3.333.
Migraine headache is a chronic, painful, disabling and potentially progressive, condition primarily occurring in early and middle adulthood. For many patients, daily activities are impaired by the sudden and unpredictable occurrence of migraine attacks. In recent years, significant progress has been made in the field of migraine treatment. For the acute treatment of migraine attacks, 5-hydroxytryptophan(1B/D) agonists (so called triptans), were the most innovative development, successfully aborting attacks in less than 1 h. The search for innovative drugs usable for migraine prevention, however, was less successful, mainly due to the lack of reliable and predictive animal models. Recently, neuromodulators such as valproic acid and topiramate, initially developed as anticonvulsants, have been shown in large clinical trials to be effective in the prevention of migraine. As for the acute treatment of migraine attacks more than 10 years ago, large clinical trial programs are now setting new standards for evidence-based medicine in migraine prevention. This review summarizes the current options in migraine prevention with special emphasis on clinical trial design and new developments such as topiramate.
偏头痛是一种慢性、疼痛性、致残性且可能进展的疾病，主要发生在成年早期和中期。对许多患者而言，偏头痛发作的突然且不可预测，会损害日常活动。近年来，偏头痛治疗领域取得了重大进展。对于偏头痛发作的急性治疗，5-羟色胺（1B/D）受体激动剂（即所谓的曲坦类药物）是最具创新性的进展，能在不到1小时内成功终止发作。然而，寻找可用于预防偏头痛的创新药物不太成功，主要原因是缺乏可靠且可预测的动物模型。最近，丙戊酸和托吡酯等最初作为抗惊厥药开发的神经调节剂，在大型临床试验中已显示对预防偏头痛有效。就10多年前偏头痛发作的急性治疗而言，大型临床试验项目如今正在为偏头痛预防的循证医学设定新标准。本综述总结了偏头痛预防的当前选择，特别强调临床试验设计以及托吡酯等新进展。
