偏头痛的药物治疗。指南比较。
Pharmacologic treatment of migraine. Comparison of guidelines.
作者信息
Schuurmans A, van Weel C
机构信息
Dutch Institute for Effective Use of Medicine in Utrecht, The Netherlands.
出版信息
Can Fam Physician. 2005 Jun;51(6):838-43.
OBJECTIVE
To compare guidelines (not the primary studies) for pharmacologic treatment of migraine as to methods of guideline development; recommendations, particularly on triptans; and quality of supporting evidence (with emphasis on comparative studies of triptans versus ergot alkaloids and nonsteroidal anti-inflammatory drugs [NSAIDs]).
DATA SOURCES
We searched MEDLINE via PubMed for guidelines on migraine management published since 1990 in any language; in addition, we browsed the Internet for information.
STUDY SELECTION
We found nine clinical guidelines on migraine; one guideline, not supported by references, was excluded.
SYNTHESIS
Preference for triptans is not well founded and is largely based on comparisons with placebo. Too few studies compared new drugs with established ones (NSAIDs or dihydroergotamine). Guidelines that propose a hierarchy for selection of drugs are opinion-based rather than evidence-based.
CONCLUSION
The current lack of evidence from comparative studies seriously limits development of evidence-based clinical practice guidelines for pharmacologic treatment of migraine.
目的
比较偏头痛药物治疗指南（而非原始研究）在指南制定方法、推荐意见（尤其是关于曲坦类药物的推荐）以及支持证据质量（重点是曲坦类药物与麦角生物碱和非甾体抗炎药[NSAIDs]的比较研究）方面的情况。
数据来源
我们通过PubMed在MEDLINE中检索自1990年以来以任何语言发表的偏头痛管理指南；此外，我们还在互联网上浏览信息。
研究选择
我们找到了九条关于偏头痛的临床指南；排除了一条未附参考文献支持的指南。
综述
对曲坦类药物的偏好缺乏充分依据，且很大程度上基于与安慰剂的比较。将新药与现有药物（NSAIDs或双氢麦角胺）进行比较的研究太少。提出药物选择层级的指南是基于观点而非证据。
结论
目前比较研究证据的缺乏严重限制了偏头痛药物治疗循证临床实践指南的制定。
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