Ranganathan Lakshmi N, Ramamurthy Guhan, Kanthimathinathan Shunmugasundaram
Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India.
Neurol India. 2021 Mar-Apr;69(Supplement):S51-S58. doi: 10.4103/0028-3886.315985.
Migraine is a common primary headache disorder and Episodic migraine is characterized by the occurrence of up to 14 headache days in a month. The preventive treatment of migraine is useful in patients with frequent migraine attacks, impaired activities of daily living, failure of acute pain management, disabling aura and limitations in the use of acute treatment. It is aimed at reducing headache frequency and intensity, improve response to acute treatment of migraine and improve the quality of life.
To analyze the evidence for the efficacy and tolerability of preventive oral drugs used in the management of episodic migraine.
A narrative review of the references were reviewed by searching the literature for the articles published in PubMed in English language using all the following MeSH keywords "preventive treatment", "preventive oral treatment", AND "episodic migraine", "migraine".
Out of articles identified in the search, 38 articles were reviewed for evidence and summarized. The various oral drugs used in the prevention of episodic migraine are antihypertensives (beta-blockers, calcium channel blockers and Angiotensin-converting enzyme inhibitors/Angiotensin receptor blockers), antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors), antiepileptic drugs (valproic acid, topiramate, lamotrigine) and other miscellaneous agents. HURT questionnaire and HALT 30 index are useful in assessing response to treatment in the follow up of migraine patients.
An appropriately chosen oral drug is useful in the preventive treatment of episodic migraine. In patients, who fail to respond to the preventive treatment, it is essential to review the diagnosis of migraine, titrate the dosage and duration of preventive treatment and ensure patient compliance. In those patients who fail to respond to monotherapy, polytherapy is a useful option to be considered.
偏头痛是一种常见的原发性头痛疾病，发作性偏头痛的特征是每月头痛天数多达14天。偏头痛的预防性治疗对偏头痛发作频繁、日常生活活动受损、急性疼痛管理失败、致残性先兆以及急性治疗使用受限的患者有用。其目的是减少头痛频率和强度，改善对偏头痛急性治疗的反应并提高生活质量。
分析用于发作性偏头痛管理的预防性口服药物的疗效和耐受性证据。
通过使用以下所有MeSH关键词“预防性治疗”“预防性口服治疗”以及“发作性偏头痛”“偏头痛”在PubMed上搜索英文发表的文章，对参考文献进行叙述性综述。
在搜索中确定的文章中，对38篇文章进行了证据审查和总结。用于预防发作性偏头痛的各种口服药物有抗高血压药（β受体阻滞剂、钙通道阻滞剂和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂）、抗抑郁药（三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂）、抗癫痫药（丙戊酸、托吡酯、拉莫三嗪）和其他杂类药物。HURT问卷和HALT 30指数有助于评估偏头痛患者随访中的治疗反应。
适当选择的口服药物对发作性偏头痛的预防性治疗有用。对于预防性治疗无反应的患者，必须重新审视偏头痛的诊断，调整预防性治疗的剂量和持续时间，并确保患者的依从性。对于单一疗法无反应的患者，联合疗法是一个值得考虑的有用选择。
