Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
Synergy Integrative Headache Center, Northfield, IL, USA.
Ann Med. 2021 Dec;53(1):1979-1990. doi: 10.1080/07853890.2021.1995626.
Migraine is a chronic neurologic disease estimated to affect approximately 50 million Americans. It is associated with a range of symptoms, which contribute to disability and substantial negative impacts on quality of life for many patients. Still, migraine continues to be underdiagnosed, undertreated, and optimising treatment for individual patients has proven difficult. As many migraine patients will be seen first in primary care settings, internists and other primary care providers are ideally positioned to improve diagnosis and migraine management for many patients. In this review, we discuss some of the challenges in diagnosing migraine and suggest strategies to overcome them, summarise the current understanding of migraine pathophysiology and clinical evidence on acute and preventive treatment options, and offer practical approaches to diagnosis and contemporary management of migraine in the primary care setting.Key messagesMigraine is a prevalent disease with substantial impact. Primary care providers are ideally positioned to improve care for migraine patients with streamlined approaches to diagnosis and management.A stepwise diagnostic approach to migraine involves taking a thorough headache history, excluding secondary headache, and identifying primary headache disorder using screening tools or ICHD-3 criteria.The FDA approved seven new migraine therapies from 2018 to 2020 (four monoclonal antibodies, two gepants, one ditan), expanding acute and preventive therapeutic options.
偏头痛是一种慢性神经系统疾病，据估计影响约 5000 万美国人。它与一系列症状有关，这些症状导致许多患者残疾，并对其生活质量产生重大负面影响。尽管如此，偏头痛仍未得到充分诊断和治疗，为个体患者优化治疗方案也很困难。由于许多偏头痛患者首先在初级保健环境中就诊，内科医生和其他初级保健提供者是改善许多患者诊断和偏头痛管理的理想人选。在这篇综述中，我们讨论了偏头痛诊断中的一些挑战，并提出了克服这些挑战的策略，总结了目前对偏头痛病理生理学的理解以及急性和预防性治疗选择的临床证据，并提供了在初级保健环境中诊断和管理偏头痛的实用方法。
关键信息偏头痛是一种常见疾病，对患者有重大影响。初级保健提供者通过简化诊断和管理方法，为偏头痛患者提供更好的护理。偏头痛的分步诊断方法包括详细的头痛病史、排除继发性头痛，以及使用筛查工具或 ICHD-3 标准识别原发性头痛障碍。FDA 于 2018 年至 2020 年批准了七种新的偏头痛治疗药物（四种单克隆抗体、两种 gepants、一种 ditan），扩大了急性和预防性治疗选择。
