Kowacs Fernando, Roesler Célia Aparecida de Paula, Piovesan Élcio Juliato, Sarmento Elder Machado, Campos Henrique Carneiro de, Maciel Jayme Antunes, Calia Leandro Cortoni, Barea Liselotte Menke, Ciciarelli Marcelo Cedrinho, Valença Marcelo Moraes, Costa Maria Eduarda Nobre de Magalhães, Peres Mário Fernando Prieto, Kowacs Pedro André, Rocha-Filho Pedro Augusto Sampaio, Silva-Néto Raimundo Pereira da, Villa Thais Rodrigues, Jurno Mauro Eduardo
Departamento Científico de Cefaleia da Academia Brasileira de Neurologia, São Paulo SP, Brasil.
Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia, Serviço de Neurologia, Porto Alegre RS, Brasil.
Arq Neuropsiquiatr. 2019 Jul 29;77(7):509-520. doi: 10.1590/0004-282X20190078.
Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.
慢性偏头痛会带来重大的个人、社会和经济负担，其特征是每月有15天或更多天数出现头痛，持续至少三个月，且每月至少有8天为偏头痛性头痛。它常与镇痛药或急性偏头痛药物过度使用有关，这一点不容忽视。巴西头痛协会的一组成员详细阐述了目前的共识，以描述现有证据，并提供与慢性偏头痛药物和非药物治疗相关的建议。还介绍了药物过度使用性头痛的撤药策略，以及妊娠和哺乳期的治疗风险。口服托吡酯和A型肉毒杆菌毒素注射是仅有的获得A级推荐的治疗方法，而丙戊酸盐、加巴喷丁和替扎尼定获得B级推荐，针灸、生物反馈和正念疗法也获B级推荐。抗降钙素基因相关肽（CGRP）或抗CGRP受体（CGRPr）单克隆抗体在巴西仍无法获得，它们是已在其他地方获批用于偏头痛预防性治疗的有前景的新药，其在慢性偏头痛中的疗效仍有待最终证实。
