Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
Centre for Headache, Women's College Hospital, 3rd Floor, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
Curr Neurol Neurosci Rep. 2024 Sep;24(9):423-438. doi: 10.1007/s11910-024-01361-y. Epub 2024 Jul 29.
The current review aims to provide an overview of migraine treatment strategies in medically complex patients, including those with renal, liver, and cardiovascular disease.
In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.
本综述旨在概述治疗伴有肾脏、肝脏和心血管疾病等复杂医学合并症的偏头痛患者的策略。
在心血管疾病中， gepants 可能适合急性治疗；不建议使用 NSAIDs、麦角胺和曲坦类药物。β受体阻滞剂、ACEi/ARB 和维拉帕米除了具有偏头痛预防作用外，还有潜在的心血管益处。在肾功能不全或轻度至中度肝功能不全时，frovatriptan 无需调整剂量。在轻度和中度肾脏和肝脏疾病中， gepants 是安全的急性和预防治疗选择。TCAs 和丙戊酸在肾功能不全时无需调整剂量。在心脏、肾脏和肝脏功能障碍时，肉毒毒素 A 可能是安全的。尽管 CGRP 单克隆抗体在肾脏和肝脏疾病中可能是安全的，但在这些情况下以及在心脏病中还需要进一步研究，并且这些情况下没有剂量建议。对于伴有复杂医学合并症的患者，有有效的治疗选择。需要进一步研究这些复杂人群中新型偏头痛特异性治疗的安全性。
