慢性偏头痛的管理。

Management of chronic migraine.

机构信息

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA.

出版信息

BMJ. 2022 Oct 10;379:e067670. doi: 10.1136/bmj-2021-067670.

DOI:10.1136/bmj-2021-067670

PMID:36216384

Abstract

Chronic migraine is a neurologic disorder associated with considerable disability, lost productivity, and a profound economic burden worldwide. The past five years have seen a dramatic expansion in new treatments for this often challenging condition, among them calcitonin gene related peptide antagonists and neuromodulatory devices. This review outlines the epidemiology of and diagnostic criteria and risk factors for chronic migraine. It discusses evidence based drug and non-drug treatments, their advantages and disadvantages, and the principles of patient centered care for adults with chronic migraine, with attention to differential diagnosis and comorbidities, clinical reasoning, initiation and monitoring, cost, and availability. It discusses the international guidelines on drug treatment for chronic migraine and evaluates non-drug treatments including behavioral and complementary therapies and lifestyle modifications. Finally, it discusses the management of chronic migraine in special populations, including pediatrics, pregnancy, and older people, and considers future questions and emerging research in the field.

摘要

慢性偏头痛是一种与严重残疾、生产力丧失和全球巨大经济负担相关的神经系统疾病。在过去五年中，针对这种具有挑战性的疾病，出现了许多新的治疗方法，包括降钙素基因相关肽拮抗剂和神经调节装置。本文概述了慢性偏头痛的流行病学、诊断标准和危险因素。讨论了循证药物和非药物治疗方法，及其优缺点，以及针对慢性偏头痛成人患者的以患者为中心的护理原则，包括鉴别诊断和合并症、临床推理、起始和监测、成本和可及性。还讨论了慢性偏头痛药物治疗的国际指南，并评估了非药物治疗方法，包括行为和补充疗法以及生活方式的改变。最后，讨论了特殊人群（包括儿科、妊娠和老年人）中的慢性偏头痛管理，并考虑了该领域未来的问题和新兴研究。