Lewis Donald W, Winner Paul
Division of Pediatric Neurology, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, 23501, USA.
NeuroRx. 2006 Apr;3(2):181-91. doi: 10.1016/j.nurx.2006.01.002.
The treatment of children and adolescents who suffer from migraine headaches must be individually tailored, flexible, and balanced with a blend of bio-behavioral measures, agents for acute treatment and, if needed, daily preventive medicines. While controlled data is limited, there is now enough evidence available to provide a rational framework to build treatment plans appropriate for the pediatric population. Essentially, the pharmacological management of pediatric migraine divides into agents for the acute attacks and agents used daily to prevent or reduce the frequency of attacks. For the acute treatment, the most rigorously studied agents are ibuprofen, acetaminophen, and the nasal spray forms of sumatriptan and zolmitriptan, all of which have shown both safety and efficacy in controlled trials. For preventive treatment the calcium channel blocker flunarezine has the best efficacy profile in controlled trials, but is not available in the U.S. A growing body of data, mostly uncontrolled, is emerging regarding the use of several anti-epileptic agents (e.g. topiramate, disodium valproate, levateracetam), as well as the antihistamine cyproheptadine and the anti-depressant amitriptyline.
患有偏头痛的儿童和青少年的治疗必须个体化定制、灵活且平衡地结合生物行为措施、急性发作治疗药物，以及必要时的每日预防性药物。虽然对照数据有限，但现在已有足够的证据提供一个合理框架，以制定适合儿科人群的治疗方案。从本质上讲，儿科偏头痛的药物治疗分为急性发作药物和每日用于预防或减少发作频率的药物。对于急性治疗，研究最充分的药物是布洛芬、对乙酰氨基酚，以及舒马曲坦和佐米曲坦的鼻喷雾剂，所有这些药物在对照试验中均显示出安全性和有效性。对于预防性治疗，钙通道阻滞剂氟桂利嗪在对照试验中疗效最佳，但在美国无法获得。关于几种抗癫痫药物（如托吡酯、丙戊酸钠、左乙拉西坦）以及抗组胺药赛庚啶和抗抑郁药阿米替林的使用，越来越多的数据（大多未受控）正在涌现。
