Miller Sarah, Matharu Manjit S
National Hospital for Neurology and Neurosurgery, London, UK.
Practitioner. 2014 Sep;258(1774):19-24, 2-3.
Migraine is a common neurovascular disorder characterised by attacks of head pain that are typically unilateral and often described as severe and throbbing in association with nausea and sensitivity to sensory input, i.e. light, sound and head movement. The headaches typically last 4-72 hours, up to 31% of migraineurs have aura on some occasions. Migraine is commonly episodic. With an increasing intake of painkillers, patients often complain of an escalation of migraine attacks or a transformation to a chronic daily background pain with exacerbations. Acute painkiller use, both prescription and OTC, should be enquired about in all cases and medication overuse headache suspected and managed if patients are taking any acute painkiller excessively. Migraineurs should be encouraged to have regular habits. Regular sleep, exercise, meals, work habits and relaxation will be rewarded by a reduction in headache frequency. NICE guidelines recommend adopting the stepped-down approach to management. They suggest a combination of a triptan, NSAID or paracetamol, and an anti-emetic taken as early as possible during the headache. The decision to commence a preventative agent should depend on a combination of attack frequency, duration and severity, as well as response to abortive therapy and patient preference.
偏头痛是一种常见的神经血管性疾病，其特征为发作性头痛，通常为单侧，常被描述为严重的搏动性疼痛，并伴有恶心以及对感觉输入（如光线、声音和头部运动）敏感。头痛通常持续4 - 72小时，高达31%的偏头痛患者在某些情况下会出现先兆。偏头痛通常是发作性的。随着止痛药摄入量的增加，患者常抱怨偏头痛发作加剧或转变为伴有加重发作的慢性每日背景性疼痛。在所有病例中都应询问急性止痛药的使用情况，包括处方药和非处方药，如果患者过度使用任何急性止痛药，应怀疑并处理药物过量使用性头痛。应鼓励偏头痛患者养成规律的习惯。规律的睡眠、锻炼、饮食、工作习惯和放松将有助于减少头痛频率。英国国家卫生与临床优化研究所（NICE）指南建议采用逐步减量的管理方法。他们建议在头痛发作时尽早联合使用曲坦类药物、非甾体抗炎药或对乙酰氨基酚以及一种止吐药。开始使用预防性药物的决定应取决于发作频率、持续时间和严重程度的综合情况，以及对发作期治疗的反应和患者的偏好。
