Taylor Frederick R
Park Nicollet Headache Clinic & Research Center and the University of Minnesota School of Medicine, Minneapolis, Minnesota 55426, USA.
Clin Ther. 2008 Jun;30(6):1069-80. doi: 10.1016/j.clinthera.2008.06.005.
Medications administered long term, such as those used for migraine prophylaxis, are often associated with weight change as a side effect. Such effects may compromise general health status, exacerbate coexisting medical conditions, and affect medication adherence. Weight gain should be of particular concern in patients with migraine, as there is evidence that overweight and obese patients with migraine are at risk for an increased frequency and severity of migraine attacks.
This article reviews weight-change data from recent clinical studies of migraine-preventive medications in children, adolescents, and adults with migraine.
A PubMed search was conducted for English-language articles published between January 1970 and November 2007. Among the search terms were migraine prevention, migraine prophylaxis, migraine treatment, antidepressant drug, beta-adrenergic-receptor blockers, antiepileptic drug, anticonvulsant drug, weight gain, and weight loss. Studies that reported weight-change data (gain, loss, or neutral) were included. When available, double-blind, placebo-controlled studies were selected for review. Open-label, retrospective or prospective trials may also have been included.
Most of the migraine-preventive medications classified by the United States Headache Consortium as group 1 based on the high level of evidence for their efficacy--for instance, amitriptyline, propranolol, and divalproex sodium-have been associated with varying degrees of weight gain. The exceptions are timolol, which is weight neutral, and topiramate, which is associated with weight loss. Among the drugs that have been associated with weight gain, a higher incidence of weight gain was observed with amitriptyline and divalproex sodium than with propranolol.
Weight-change effects require careful consideration when selecting migraine-preventive medications, and weight should be monitored carefully over the course of any migraine treatment plan.
长期服用的药物，如用于偏头痛预防的药物，常常伴有体重变化这一副作用。此类影响可能损害总体健康状况，加重并存的内科疾病，并影响药物依从性。体重增加在偏头痛患者中应特别引起关注，因为有证据表明，超重和肥胖的偏头痛患者发作频率增加、发作严重程度加剧的风险更高。
本文回顾了近期针对儿童、青少年和成年偏头痛患者的偏头痛预防性药物临床研究中的体重变化数据。
在PubMed上检索1970年1月至2007年11月发表的英文文章。检索词包括偏头痛预防、偏头痛 prophylaxis、偏头痛治疗、抗抑郁药、β肾上腺素能受体阻滞剂、抗癫痫药、抗惊厥药、体重增加和体重减轻。纳入报告了体重变化数据（增加、减少或无变化）的研究。如有可能，选择双盲、安慰剂对照研究进行综述。开放标签、回顾性或前瞻性试验也可能被纳入。
美国头痛协会根据疗效证据水平将其归类为第1组的大多数偏头痛预防性药物——例如，阿米替林、普萘洛尔和丙戊酸钠——都与不同程度的体重增加有关。例外的是噻吗洛尔，其对体重无影响，以及托吡酯，其与体重减轻有关。在与体重增加有关的药物中，观察到阿米替林和丙戊酸钠的体重增加发生率高于普萘洛尔。
选择偏头痛预防性药物时，需要仔细考虑体重变化影响，并且在任何偏头痛治疗方案过程中都应仔细监测体重。
