Göbel Hartmut, Heinze Axel, Heinze-Kuhn Katja, Göbel Carl H H
Migräne- und Kopfschmerzzentrum, Neurologisch-verhaltensmedizinischeSchmerzklinik Kiel, Heikendorfer Weg 9-27, 24149, Kiel, Deutschland.
Internist (Berl). 2020 Mar;61(3):326-332. doi: 10.1007/s00108-020-00757-5.
Migraine has a very high lifetime prevalence with a severe illness-related burden. As a result, extensive long-term and regular treatment is required, which cannot be covered solely by neurologists. This is particularly the case for the long-term monitoring of migraine, which often takes place over several decades. The diagnosis is made using the diagnostic criteria of the International Headache Society (ICHD-3) based on the clinical phenotype. Owing to often complex neurological symptoms, a detailed weighing up of the differential diagnoses is required, which calls for specialist neurological expertise. The same is true for follow-up appointments of more complex therapy issues. Acute therapy with antiemetics, analgesics, and triptans can, so long as it is effective and is administered not longer than 10 days per month, be carried out by the general practitioner or specialist in internal medicine. This is also true for medical prophylactic treatment with dietary supplements, antihypertensive drugs, and tricyclic antidepressants. If this therapy is unsuccessful, prophylactic substances must be used that require more specialized knowledge, which is also reflected in the formal prescription requirements. Neurologists and pain therapists should then be involved in the treatment. This is particularly true for the use of Onabotulinumtoxin A and monoclonal CGRP-(receptor)-antibodies.
偏头痛的终生患病率很高，伴有严重的疾病相关负担。因此，需要进行广泛的长期定期治疗，而这仅靠神经科医生无法完全覆盖。偏头痛的长期监测尤其如此，这种监测通常持续数十年。诊断是根据临床表型，使用国际头痛协会（ICHD-3）的诊断标准进行的。由于神经症状往往复杂，需要对鉴别诊断进行详细权衡，这需要专业的神经学专业知识。对于更复杂治疗问题的随访预约也是如此。只要有效且每月使用不超过10天，全科医生或内科专科医生就可以进行使用止吐药、镇痛药和曲坦类药物的急性治疗。使用膳食补充剂、抗高血压药物和三环类抗抑郁药进行药物预防性治疗也是如此。如果这种治疗不成功，则必须使用需要更专业知识的预防性药物，这也反映在正式的处方要求中。此时神经科医生和疼痛治疗师应参与治疗。使用A型肉毒毒素和单克隆CGRP（受体）抗体时尤其如此。
