Pascual-Gómez J
Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Cantabria, España.
Rev Neurol. 2009;49(1):25-32.
More than one quarter of patients who consult due to migraine need preventive treatment. At least half of these patients do not respond or cannot tolerate classical preventatives: beta-blockers, flunarizine or amitriptyline.
To analyse the role of new antiepileptics (neuromodulators) in migraine prevention.
Critical review of clinical trials carried out with antiepileptics for the treatment of migraine. Topiramate has demonstrated clear efficacy in the prevention of migraine with and without aura, including chronic migraine with and without analgesic overuse, although it is not tolerated by one fifth of patients. Valproic acid also has a demonstrated efficacy in the preventive treatment of migraine with and without aura, but its tolerability profile and the possibility of serious adverse events oblige us to prescribe this neuromodulator for refractory patients. Gabapentin shows a mild efficacy, clearly lower than that of topiramate and valproate. Lamotrigine is the treatment of choice in the prevention of migraine aura, but is not efficacious in the treatment of headache. Levetiracetam has shown some efficacy in open studies in migraine prevention, both in adults and children. Zonisamide has demonstrated good efficacy and tolerability in patients refractory to topiramate and shows a prolonged half life, which improves compliance. The remaining antipileptics have not shown efficacy.
Topiramate and valproic acid have demonstrated efficacy in migraine prevention. Lamotrigine is efficacious for the treatment of migraine aura. Even though new studies are necessary, zonisamide could be a good option for the preventive treatment of migraine.
因偏头痛前来咨询的患者中，超过四分之一需要预防性治疗。这些患者中至少有一半对经典预防性药物无反应或无法耐受，这些药物包括β受体阻滞剂、氟桂利嗪或阿米替林。
分析新型抗癫痫药（神经调节剂）在偏头痛预防中的作用。
对使用抗癫痫药治疗偏头痛的临床试验进行批判性综述。托吡酯已证明在预防有先兆和无先兆偏头痛方面均有明确疗效，包括有和无止痛药过度使用的慢性偏头痛，尽管有五分之一的患者无法耐受。丙戊酸在预防有先兆和无先兆偏头痛方面也已证明有疗效，但其耐受性及严重不良事件的可能性使我们仅为难治性患者开具这种神经调节剂。加巴喷丁显示出轻度疗效，明显低于托吡酯和丙戊酸盐。拉莫三嗪是预防偏头痛先兆的首选治疗药物，但对头痛治疗无效。左乙拉西坦在成人和儿童偏头痛预防的开放研究中已显示出一定疗效。唑尼沙胺在对托吡酯难治的患者中已证明有良好疗效和耐受性，且半衰期延长，这提高了依从性。其余抗癫痫药未显示出疗效。
托吡酯和丙戊酸在偏头痛预防中已证明有疗效。拉莫三嗪对偏头痛先兆治疗有效。尽管还需要新的研究，但唑尼沙胺可能是偏头痛预防性治疗的一个不错选择。
