Woldeamanuel Y W, Rapoport A M, Cowan R P
Stanford Headache Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Room H3160, 300 Pasteur Drive, Stanford, CA, 94305-5235, USA,
Curr Pain Headache Rep. 2014 Dec;18(12):464. doi: 10.1007/s11916-014-0464-x.
Corticosteroids are widely prescribed for the management of migraine attacks. The earliest clinical studies examining the efficacy of corticosteroid monotherapy for managing migraine attacks date back to 1952. Since then, 26 heterogeneous clinical studies and four meta-analyses have been conducted to assess the efficacy of corticosteroids in either aborting acute migraine attacks, prolonged migraine attacks or recurrent headaches. Most of these (86 %) studies employed different comparator arms with corticosteroids monotherapy administration while some studies (14 %) evaluated adjunctive corticosteroid therapy. The majority of these clinical studies revealed the superior efficacy of corticosteroids as mono- or adjunctive-therapy both for recurrent and acute migraine attacks, while the remaining showed non-inferior efficacy. Different forms of oral and parenteral corticosteroids in either single-dose or short-tapering schedules are prescribed; there are clinical studies supporting the efficacy of both methods. Corticosteroids can be administered safely up to six times annually. Corticosteroids are also useful in managing patients who frequent emergency departments with "medication-seeking behavior." Migraine patients with refractory headaches, history of recurrent headaches, severe baseline disability, and status migrainosus were found to have the most beneficial response from corticosteroid therapy.
皮质类固醇被广泛用于偏头痛发作的治疗。最早研究皮质类固醇单药治疗偏头痛发作疗效的临床研究可追溯到1952年。从那时起，已经进行了26项异质性临床研究和四项荟萃分析，以评估皮质类固醇在中止急性偏头痛发作、延长偏头痛发作或复发性头痛方面的疗效。其中大多数（86%）研究采用不同的对照臂进行皮质类固醇单药治疗，而一些研究（14%）评估了皮质类固醇辅助治疗。这些临床研究中的大多数表明，皮质类固醇作为单药或辅助治疗对复发性和急性偏头痛发作均具有卓越疗效，而其余研究显示其疗效不差。目前已开出单剂量或短期递减方案的不同形式的口服和胃肠外皮质类固醇；有临床研究支持这两种方法的疗效。皮质类固醇每年最多可安全使用六次。皮质类固醇在治疗频繁因“药物寻求行为”前往急诊科的患者方面也很有用。发现患有难治性头痛、复发性头痛病史、严重基线残疾和偏头痛持续状态的偏头痛患者对皮质类固醇治疗反应最为有益。
