Evers Stefan
University of Münster, Department of Neurology, Albert-Schweitzer-Street 33, 48129 Münster, Germany.
Expert Opin Pharmacother. 2008 Oct;9(15):2565-73. doi: 10.1517/14656566.9.15.2565.
Migraine is among the 10 most disabling disorders worldwide. Besides acute attack treatment, drug prophylaxis of migraine is important in order to improve the quality of life.
The aim of this paper is to describe the indications, principles and appropriate drugs with published evidence for the prophylaxis of migraine in general and in specific situations.
Based on the American and European guidelines for the treatment of migraine, the evidence for different drugs in the prophylaxis of migraine was evaluated. In addition, all trials on migraine drug prophylaxis published since the publication of the guidelines were included in the evaluation. These trials were identified by a literature search in MedLine, Embase and the Cochrane library.
The drugs of first choice are beta-blockers, flunarizine, valproic acid and topiramate and, in the US, amitriptyline is also grouped among the first-choice drugs. Drugs of second choice, with less efficacy or poorer evidence, are venlafaxine, gabapentin, naproxen, butterbur root, vitamin B(2) and magnesium. The potential side effects are considered when choosing the appropriate prophylactic drug. All drugs used in migraine prophylaxis have been detected by chance and not by pathophysiological considerations. In the future, drugs developed on the basis of the current knowledge of migraine pathophysiology will hopefully be more effective.
偏头痛是全球十大致残性疾病之一。除了急性发作治疗外，偏头痛的药物预防对于提高生活质量也很重要。
本文旨在描述偏头痛一般及特定情况下预防的适应证、原则和有公开证据支持的合适药物。
基于美国和欧洲的偏头痛治疗指南，评估不同药物预防偏头痛的证据。此外，指南发布后发表的所有偏头痛药物预防试验都纳入了评估。这些试验通过在MedLine、Embase和Cochrane图书馆进行文献检索来确定。
首选药物是β受体阻滞剂、氟桂利嗪、丙戊酸和托吡酯，在美国，阿米替林也被归为首选药物。次选药物疗效较差或证据不足，包括文拉法辛、加巴喷丁、萘普生、小白菊提取物、维生素B2和镁。选择合适的预防性药物时要考虑潜在的副作用。所有用于偏头痛预防的药物都是偶然发现的，而非基于病理生理考虑。未来，基于目前偏头痛病理生理学知识开发的药物有望更有效。
