Headache Institute and St Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
Headache. 2013 Jun;53 Suppl 1:11-6. doi: 10.1111/head.12111.
Results of randomized, double-blind, controlled studies establish the efficacy of triptans in the acute treatment of migraine, but triptan benefits demonstrated in clinical trials have not consistently been realized in clinical practice. This paper explores the contribution of gastrointestinal manifestations of migraine--namely nausea (with or without vomiting) and gastroparesis--to triptan treatment failure.
Migraine-related nausea and vomiting and migraine-associated gastroparesis appear to be prevalent and highly impactful and have been characterized as being among the greatest challenges affecting migraine care today. These gastrointestinal signs and symptoms have not been satisfactorily taken into account in the management of migraine, which is dominated by the use of oral therapies. Oral triptans are not the optimal therapy in the presence of migraine-related nausea because nausea predicts poor response to oral triptans and because nausea can cause patients to delay oral treatment, which can further compromise therapeutic efficacy. Oral triptans are not the optimal therapy in the presence of migraine-associated gastroparesis because these agents rely on gastric motility and gastrointestinal absorption and may be ineffective or slowly or inconsistently effective in the presence of gastroparesis. Health care providers need to work with their patients to address the still-all-too-frequent problem of treatment failure in migraine. First, health care providers need to have greater appreciation of the importance of nausea, vomiting, and gastroparesis as factors affecting migraine prognosis and treatment success. Second, health care providers need to systematically assess migraine patients for gastrointestinal signs and symptoms. Finally, patients and health care providers need to be willing to practice customized migraine care, in which patients tailor the treatment and formulation to the characteristics and context of the individual migraine episode.
随机、双盲、对照研究的结果确立了曲坦类药物在偏头痛急性治疗中的疗效，但临床试验中显示的曲坦类药物益处并未在临床实践中得到一致体现。本文探讨了偏头痛的胃肠道表现（即恶心（伴或不伴呕吐）和胃轻瘫）对曲坦类药物治疗失败的影响。
偏头痛相关的恶心和呕吐以及与偏头痛相关的胃轻瘫似乎很常见，且影响很大，被认为是当今影响偏头痛治疗的最大挑战之一。这些胃肠道症状和体征在偏头痛的管理中尚未得到令人满意的考虑，偏头痛的管理主要依赖于口服治疗。在存在与偏头痛相关的恶心的情况下，口服曲坦类药物不是最佳治疗方法，因为恶心预示着对口服曲坦类药物的反应不佳，并且因为恶心会导致患者延迟口服治疗，从而进一步影响治疗效果。在存在与偏头痛相关的胃轻瘫的情况下，口服曲坦类药物不是最佳治疗方法，因为这些药物依赖于胃动力和胃肠道吸收，并且在胃轻瘫的情况下可能无效、起效缓慢或效果不一致。医疗保健提供者需要与患者合作，解决偏头痛治疗失败这一仍然普遍存在的问题。首先，医疗保健提供者需要更加重视恶心、呕吐和胃轻瘫作为影响偏头痛预后和治疗成功的因素的重要性。其次，医疗保健提供者需要系统地评估偏头痛患者的胃肠道症状。最后，患者和医疗保健提供者需要愿意实践定制化的偏头痛护理，即患者根据个体偏头痛发作的特点和背景调整治疗和配方。
