Sapienza University and Advanced Molecular Diagnostic Unit, Sant'Andrea Hospital, NESMOS Department, Rome, Italy.
Expert Opin Emerg Drugs. 2012 Sep;17(3):393-406. doi: 10.1517/14728214.2012.709846. Epub 2012 Aug 3.
Chronic migraine (CM), the suffering of 15 or more headache days with at least 8 of these migraine days, afflicts 1.3% - 5.1% of the global population. CM is the most common disorder faced by experts in tertiary headache centers. When resistant to conventional medical treatment and prophylactic medication this condition is known as refractory chronic migraine (RCM). RCM is one of the greatest challenges in headache medicine.
State-of-the-art and future medical treatments of chronic migraine include: OnabotulinumtoxinA, antiepileptic drugs (Levetiracetam, Magnesium valproate hydrate, Lacosamide, BGG-492), 5-HT agonists (Lasmiditan, NXN-188, novel delivery systems of Sumatriptan, a well-established drug treatment for acute migraine), CGRP receptor antagonists (BMS-927711), ML-1 agonists (Ramelteon), orexin receptor antagonist (MK-6096), plant-derived compound (LLL-2011) and other multitarget drugs such as Tezampanel, Tonabersat, intranasal carbon dioxide and BOL-148. The role for neuromodulation, the application of targeted electrical stimulation, will be examined.
Medication overuse headache (MOH) is now recognized to be a major factor in many cases of both chronic and refractory chronic migraine. MOH must be addressed prior to evaluating the effectiveness of new preventative and prophylactic treatment approaches. Innovative new drugs and electrical neuromodulation are promising CM treatments. Future studies must carefully screen patients and acquire data that can lead to personalized, tailored treatment strategies.
慢性偏头痛（CM）是一种全球发病率为 1.3%-5.1%的疾病，其特征是每月至少有 15 天出现头痛，其中至少 8 天为偏头痛。CM 是三级头痛中心专家最常遇到的疾病。当常规医学治疗和预防性药物治疗无效时，这种情况被称为难治性慢性偏头痛（RCM）。RCM 是头痛医学中最大的挑战之一。
慢性偏头痛的最新和未来的医学治疗方法包括：肉毒杆菌毒素 A（OnabotulinumtoxinA）、抗癫痫药物（左乙拉西坦、丙戊酸镁水合物、拉科酰胺、BGG-492）、5-HT 激动剂（拉米地坦、NXN-188、曲坦类药物的新型给药系统，曲坦类药物是治疗急性偏头痛的成熟药物）、降钙素基因相关肽受体拮抗剂（BMS-927711）、ML-1 激动剂（雷美替胺）、食欲素受体拮抗剂（MK-6096）、植物衍生化合物（LLL-2011）和其他多靶点药物，如特扎尼泮、托纳布沙、鼻内二氧化碳和 BOL-148。神经调节的作用，即靶向电刺激的应用，将被检查。
药物过度使用性头痛（MOH）现在被认为是许多慢性和难治性慢性偏头痛病例的主要因素。在评估新的预防性和预防性治疗方法的有效性之前，必须解决 MOH 问题。创新的新药和电神经调节是有前途的 CM 治疗方法。未来的研究必须仔细筛选患者并获取数据，以制定个性化的治疗策略。
