Buchanan Thomas M, Ramadan Nabih M
Department of Neurology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.
Semin Neurol. 2006 Apr;26(2):188-98. doi: 10.1055/s-2006-939919.
Migraine therapeutics are pharmacological, including acute and preventive, nonpharmacological and/or both. Preventive pharmacological strategies serendipitously were discovered to be effective and include drugs from various pharmacological classes (e.g., beta-adrenergic blocker, anticonvulsant, tricyclic antidepressants, serotonin receptor antagonist). Converging level I evidence and clinical experience support the use of the antidepressant amitriptyline, the anticonvulsants divalproex and topiramate, and the beta-adrenergic blockers propranolol, timolol, and metoprolol in migraine prevention. Other options for migraine prophylaxis exist, but the level of evidence in support of their use is not as robust. All of these drugs have varying degrees of adverse effects, some of which can limit their use. Balancing potential efficacy with risk of adverse effects, addressing patients' expectations and desires, complying with management recommendations, adequate follow up, and accurate assessment of treatment goals are key to migraine prevention. Finally, future migraine-preventive drugs likely will target migraine mechanisms more specifically, which undoubtedly will enhance the therapeutic index.
偏头痛治疗方法包括药物治疗（急性和预防性）、非药物治疗和/或两者结合。预防性药物治疗策略是偶然发现有效的，包括来自各种药理学类别的药物（如β-肾上腺素能阻滞剂、抗惊厥药、三环类抗抑郁药、5-羟色胺受体拮抗剂）。一级证据和临床经验均支持使用抗抑郁药阿米替林、抗惊厥药丙戊酸和托吡酯，以及β-肾上腺素能阻滞剂普萘洛尔、噻吗洛尔和美托洛尔预防偏头痛。偏头痛预防还有其他选择，但支持其使用的证据水平不那么确凿。所有这些药物都有不同程度的不良反应，其中一些可能会限制其使用。平衡潜在疗效与不良反应风险、满足患者期望和需求、遵循管理建议、进行充分随访以及准确评估治疗目标是预防偏头痛的关键。最后，未来的偏头痛预防药物可能会更具体地针对偏头痛机制，这无疑将提高治疗指数。
