Rozen Todd D
Continuum (Minneap Minn). 2015 Aug;21(4 Headache):1004-17. doi: 10.1212/CON.0000000000000191.
This article discusses the treatment of status migrainosus in the emergency department and the treatment of intractable migraine in an inpatient setting.
Multiple agents of various drug classes have been tried for the treatment of acute migraine in the emergency department, but few have adequate medical evidence to support their use. Opioids, which are less effective than other medications used for the acute treatment of migraine and also carry the risk of adverse CNS side effects, habituation, and addiction, have been prescribed for migraine in the emergency department at an increasing rate over the last decade, which is a worrisome trend. Very few patients with migraine derive sustained relief from pain after emergency department treatment, and most have a high frequency of headache recurrence.
Treatment of status migrainosus and intractable migraine should focus on adequate fluid hydration and combination IV therapy with multiple nonopioid medications from multiple drug classes. Dopamine receptor antagonists appear to have some of the highest medical evidence for efficacy.
本文讨论了急诊科中偏头痛持续状态的治疗以及住院环境下难治性偏头痛的治疗。
在急诊科，多种不同药物类别的药物已被尝试用于治疗急性偏头痛，但很少有药物有充分的医学证据支持其使用。在过去十年中，急诊科开具用于偏头痛治疗的阿片类药物比例不断增加，这是一个令人担忧的趋势，因为阿片类药物在急性偏头痛治疗中比其他药物效果更差，并且还存在中枢神经系统不良反应、成瘾和依赖的风险。急诊科治疗后，很少有偏头痛患者能从疼痛中获得持续缓解，而且大多数患者头痛复发频率很高。
偏头痛持续状态和难治性偏头痛的治疗应侧重于充分的液体水化以及联合使用多种不同药物类别的非阿片类药物进行静脉治疗。多巴胺受体拮抗剂似乎有一些最高的疗效医学证据。
