Evers Stefan, Frese Achim
Department of Neurology, University of Münster, Münster, Germany.
Curr Opin Anaesthesiol. 2005 Oct;18(5):563-8. doi: 10.1097/01.aco.0000183105.73931.6b.
In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given.
Triptans and non-steroidal anti-inflammatory drugs are still the drugs of first choice for the treatment of migraine attacks. Recent studies show that early treatment is clearly effective in migraine and that differential therapy with triptans can be helpful. New drugs with new mechanisms are being developed such as a calcitonin gene-related peptide antagonist. For the prophylaxis of migraine, topiramate has been introduced as an effective new drug. Botulinum toxin did not show convincing evidence of efficacy in migraine and tension-type headache. For migraine and cluster headache, surgical procedures such as the closure of the patent foramen ovale (migraine) and neurostimulation of the hypothalamus (cluster headache) are also under evaluation. A group of miscellaneous headaches (group 4 of the International Headache Society classification) is also described, for which treatment recommendations, in particular indomethacin in most cases, can now be given although no placebo-controlled trials have been performed.
Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.
在过去几年中，特发性头痛疾病的治疗取得了重要进展。针对急性和预防性药物及非药物疗法，已发表了新的对照试验。此外，国际头痛协会描述了新的头痛类型，并可给出相应的治疗建议。
曲坦类药物和非甾体类抗炎药仍然是治疗偏头痛发作的首选药物。最近的研究表明，早期治疗对偏头痛明显有效，且曲坦类药物的差异化治疗可能会有帮助。正在研发具有新作用机制的新药，如降钙素基因相关肽拮抗剂。对于偏头痛的预防，托吡酯已作为一种有效的新药被引入。肉毒杆菌毒素在偏头痛和紧张型头痛中未显示出令人信服的疗效证据。对于偏头痛和丛集性头痛，诸如封堵卵圆孔未闭（偏头痛）和下丘脑神经刺激（丛集性头痛）等外科手术也在评估中。还描述了一组混杂性头痛（国际头痛协会分类中的第4组），尽管尚未进行安慰剂对照试验，但现在可以给出治疗建议，在大多数情况下尤其是吲哚美辛。
头痛治疗的最新进展包括越来越多的证据支持适当的药物给药和差异化药物治疗，而非新药或新治疗方法的开发。外科手术和其他非药物治疗方法正在讨论中，可能会成为未来几年头痛治疗的额外手段。
