Becker Werner J
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
The Hotchkiss Brain Institute, Calgary, Alberta, Canada.
Headache. 2015 Jun;55(6):778-93. doi: 10.1111/head.12550. Epub 2015 Apr 15.
There are many options for acute migraine attack treatment, but none is ideal for all patients. This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment. NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics (acetaminophen, ASA, and caffeine), and several anti-emetics (metoclopramide, domperidone, and prochlorperazine) are additional evidence-based options. Opioid containing combination analgesics may be helpful in specific patients, but should not be used routinely. Clinical features to be considered when choosing an acute migraine medication include usual headache intensity, usual rapidity of pain intensity increase, nausea, vomiting, degree of disability, patient response to previously used medications, history of headache recurrence with previous attacks, and the presence of contraindications to specific acute medications. Available acute medications can be organized into 4 treatment strategies, including a strategy for attacks of mild to moderate severity (strategy one: acetaminophen and/or NSAIDs), a triptan strategy for patients with severe attacks and for attacks not responding to strategy one, a refractory attack strategy, and a strategy for patients with contraindications to vasoconstricting drugs. Acute treatment of migraine attacks during pregnancy, lactation, and for patients with chronic migraine is also discussed. In chronic migraine, it is particularly important that medication overuse is eliminated or avoided. Migraine treatment is complex, and treatment must be individualized and tailored to the patient's clinical features. Clinicians should make full use of available medications and formulations in an organized approach.
急性偏头痛发作的治疗方法有很多，但没有一种对所有患者都理想。本研究旨在回顾目前基于医疗办公室的成人急性偏头痛治疗方法，并为读者提供一种有条理的方法来应对偏头痛治疗的这一重要方面。一般性文献综述包括对近期发布的几项指南的回顾。对乙酰氨基酚、4种非甾体抗炎药（布洛芬、乙酰水杨酸[ASA]、萘普生钠和双氯芬酸钾）以及7种曲坦类药物（阿莫曲坦、依立曲坦、夫罗曲坦、那拉曲坦、利扎曲坦、舒马曲坦和佐米曲坦）有充分的疗效证据，构成了急性偏头痛治疗的核心。非甾体抗炎药-曲坦类药物联合使用、双氢麦角胺、非阿片类复方镇痛药（对乙酰氨基酚、ASA和咖啡因）以及几种止吐药（甲氧氯普胺、多潘立酮和丙氯拉嗪）是其他基于证据的选择。含阿片类的复方镇痛药可能对特定患者有帮助，但不应常规使用。选择急性偏头痛药物时应考虑的临床特征包括通常的头痛强度、疼痛强度增加的通常速度、恶心、呕吐、残疾程度、患者对先前使用药物的反应、既往发作时头痛复发的病史以及特定急性药物的禁忌证。现有的急性药物可分为4种治疗策略，包括轻度至中度严重程度发作的策略（策略一：对乙酰氨基酚和/或非甾体抗炎药）、针对重度发作患者以及对策略一无反应发作患者的曲坦类药物策略、难治性发作策略以及对血管收缩药物有禁忌证患者的策略。还讨论了妊娠、哺乳期偏头痛发作的急性治疗以及慢性偏头痛患者的治疗。在慢性偏头痛中，消除或避免药物过度使用尤为重要。偏头痛治疗很复杂，治疗必须个体化并根据患者的临床特征进行调整。临床医生应以有条理的方式充分利用现有的药物和制剂。
