Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, via della Pisana 235, 00163 Rome, Italy.
Neurol Sci. 2012 May;33 Suppl 1:S137-40. doi: 10.1007/s10072-012-1058-1.
Migraine prevention hinges on a variety of non-specific drugs that mainly reduce neuronal hyperexcitability, the putative pathophysiological hallmark for migraine. The improved knowledge about migraine circuitry and neurobiology has prompted research to develop new specific migraine preventive medications targeted to innovative sites and mechanisms. Drugs designed to inhibit cortical spreading depression, for example tonabersat, might offer a useful option for the management of migraine with aura but not for migraine without aura. Inducible nitric-oxide synthase (iNOS) inhibition seems ineffective as a prophylactic strategy. Results are awaited from recent and ongoing phase II trials with glutamate receptor antagonists, third-generation antiepileptics, melatonin agonists, vitamin D3 and statins.
偏头痛的预防取决于各种非特异性药物，这些药物主要可降低神经元的过度兴奋，而神经元的过度兴奋是偏头痛潜在的病理生理学特征。对偏头痛回路和神经生物学的认识不断提高，促使研究人员开发新的针对创新靶点和机制的特定偏头痛预防药物。例如，旨在抑制皮质扩散性抑制的药物托纳司特（tonabersat）可能为伴有先兆的偏头痛管理提供有用的选择，但对不伴先兆的偏头痛无效。诱导型一氧化氮合酶（iNOS）抑制似乎不是一种有效的预防策略。目前正在进行的谷氨酸受体拮抗剂、第三代抗癫痫药、褪黑素激动剂、维生素 D3 和他汀类药物的 II 期临床试验的结果正在等待中。
