Pardutz Arpad, Schoenen Jean
Department of Neurology, University of Szeged, Semmelweis u. 6. Szeged, Hungary H-6720, Hungary.
Headache Research Unit, Department of Neurology & GIGA Neurosciences, Liège University, CHU-Sart Tilman, T4(+1), B36, B-4000 Liège, Belgium.
Pharmaceuticals (Basel). 2010 Jun 17;3(6):1966-1987. doi: 10.3390/ph3061966.
Migraine is a common disabling neurological disorder with a serious socio-economical burden. By blocking cyclooxygenase nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the synthesis of prostaglandins, which are involved in the pathophysiology of migraine headaches. Despite the introduction more than a decade ago of a new class of migraine-specific drugs with superior efficacy, the triptans, NSAIDs remain the most commonly used therapies for the migraine attack. This is in part due to their wide availability as over-the-counter drugs and their pharmaco-economic advantages, but also to a favorable efficacy/side effect profile at least in attacks of mild and moderate intensity. We summarize here both the experimental data showing that NSAIDs are able to influence several pathophysiological facets of the migraine headache and the clinical studies providing evidence for the therapeutic efficacy of various subclasses of NSAIDs in migraine therapy. Taken together these data indicate that there are several targets for NSAIDs in migraine pathophysiology and that on the spectrum of clinical potency acetaminophen is at the lower end while ibuprofen is among the most effective drugs. Acetaminophen and aspirin excluded, comparative trials between the other NSAIDs are missing. Since evidence-based criteria are scarce, the selection of an NSAID should take into account proof and degree of efficacy, rapid GI absorption, gastric ulcer risk and previous experience of each individual patient. If selected and prescribed wisely, NSAIDs are precious, safe and cost-efficient drugs for the treatment of migraine attacks.
偏头痛是一种常见的致残性神经疾病，会造成严重的社会经济负担。通过阻断环氧化酶，非甾体抗炎药（NSAIDs）可减少前列腺素的合成，而前列腺素参与偏头痛性头痛的病理生理过程。尽管十多年前就已推出一类疗效更佳的新型偏头痛特异性药物——曲坦类药物，但NSAIDs仍然是偏头痛发作最常用的治疗方法。这部分是由于它们作为非处方药广泛可得及其药物经济学优势，还因为至少在轻度和中度强度发作中具有良好的疗效/副作用概况。我们在此总结了表明NSAIDs能够影响偏头痛性头痛多个病理生理方面的实验数据，以及为NSAIDs各亚类在偏头痛治疗中的疗效提供证据的临床研究。综合这些数据表明，NSAIDs在偏头痛病理生理学中有多个靶点，在临床效力谱上，对乙酰氨基酚处于较低端，而布洛芬是最有效的药物之一。排除对乙酰氨基酚和阿司匹林，其他NSAIDs之间的对比试验缺失。由于缺乏循证标准，NSAIDs的选择应考虑疗效的证据和程度、胃肠道快速吸收、胃溃疡风险以及每个患者的既往经验。如果明智地选择和开处方，NSAIDs是治疗偏头痛发作的宝贵、安全且经济高效的药物。
