预防性偏头痛治疗
Preventive Migraine Treatment.
作者信息
Silberstein Stephen D
出版信息
Continuum (Minneap Minn). 2015 Aug;21(4 Headache):973-89. doi: 10.1212/CON.0000000000000199.
Abstract
PURPOSE OF REVIEW
This article reviews the evidence base for the preventive treatment of migraine.
RECENT FINDINGS
Evidence-based guidelines for the preventive treatment of migraine have recently been published by the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS), providing valuable guidance for clinicians. Strong evidence exists to support the use of metoprolol, timolol, propranolol, divalproex sodium, sodium valproate, and topiramate for migraine prevention, according to the AAN. Based on best available evidence, adverse event profile, and expert consensus, topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, Petasites (butterbur), riboflavin, coenzyme Q10, and magnesium citrate received a strong recommendation for use from the CHS.
SUMMARY
Migraine preventive drug treatments are underutilized in clinical practice. Principles of preventive treatment are important to improve compliance, minimize side effects, and improve patient outcomes. Choice of preventive treatment of migraine should be based on the presence of comorbid and coexistent illness, patient preference, reproductive potential and planning, and best available evidence.
摘要
综述目的
本文综述偏头痛预防性治疗的证据基础。
最新发现
美国神经病学学会（AAN）和加拿大头痛协会（CHS）最近发布了偏头痛预防性治疗的循证指南，为临床医生提供了有价值的指导。根据AAN的说法，有强有力的证据支持使用美托洛尔、噻吗洛尔、普萘洛尔、丙戊酸二钠、丙戊酸钠和托吡酯预防偏头痛。基于现有最佳证据、不良事件概况和专家共识，托吡酯、普萘洛尔、纳多洛尔、美托洛尔、阿米替林、加巴喷丁、坎地沙坦、蜂斗菜属植物（款冬）、核黄素、辅酶Q10和柠檬酸镁获得了CHS的强烈使用推荐。
总结
偏头痛预防性药物治疗在临床实践中未得到充分利用。预防性治疗原则对于提高依从性、最小化副作用和改善患者预后很重要。偏头痛预防性治疗的选择应基于合并症和并存疾病的存在、患者偏好、生育潜力和计划以及现有最佳证据。
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