Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Lancet. 2021 Apr 17;397(10283):1505-1518. doi: 10.1016/S0140-6736(20)32342-4. Epub 2021 Mar 25.
Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.
偏头痛是一种高度致残的神经系统疾病,直接影响全球超过 10 亿人。现有的治疗选择因国家而异,包括急性、预防性和非药物治疗。由于对偏头痛发病机制的认识取得了重大进展,新型基于机制的药物已经出现,并扩大了治疗手段。我们提供了偏头痛当前护理标准的全面概述,这将有助于进行知情的临床管理。首先,我们讨论了各种用于偏头痛急性和预防性治疗的药物治疗的疗效、耐受性和安全性概况。其次,我们回顾了目前对非药物治疗的认识,例如神经调节和生物行为方法,这些方法可用于对临床管理采取多学科方法。第三,我们强调任何有效的治疗策略都始于制定针对个体临床特征、偏好和需求量身定制的治疗计划。最后,我们探讨了新兴的基于机制的治疗方法的前景,这些方法可能会解决偏头痛临床管理中未满足的挑战。