Raskin N H
Department of Neurology, University of California School of Medicine, San Francisco 94143.
Neurology. 1993 Jun;43(6 Suppl 3):S39-42.
The antimigraine efficacy of many drugs may be mediated less through their primary modes of action than through the common pathway of serotonergic transmission stabilization. Migraine treatment may be symptomatic, acute/abortive, or prophylactic. Because oral drug absorption is impaired during attacks, parenteral agents are more appropriate for acute therapy. Acute agents include ergots and ergotamine derivatives, narcotics, and sumatriptan succinate. Agents that activate the 5-HT3 receptors must be administered with an antiemetic. Sumatriptan succinate, a specific 5-HT1 receptor agonist, does not necessitate adjunctive antiemetics. Stabilization regimens, such as those using valproate, may favorably alter the natural history of migraine. Sumatriptan succinate is appropriate both for acute attacks and for symptomatic management during stabilization. beta-Blockers, tricyclic antidepressants, and calcium antagonists may be used prophylactically.
许多药物的抗偏头痛疗效可能较少通过其主要作用方式，而是通过血清素能传递稳定这一共同途径来介导。偏头痛治疗可以是对症治疗、急性/终止发作治疗或预防性治疗。由于发作期间口服药物吸收受损，胃肠外给药制剂更适合急性治疗。急性治疗药物包括麦角和麦角胺衍生物、麻醉药以及琥珀酸舒马曲坦。激活5-HT3受体的药物必须与止吐药一起使用。琥珀酸舒马曲坦是一种特异性5-HT1受体激动剂，无需辅助使用止吐药。稳定治疗方案，如使用丙戊酸盐的方案，可能会有利地改变偏头痛的自然病程。琥珀酸舒马曲坦既适用于急性发作，也适用于稳定治疗期间的症状管理。β受体阻滞剂、三环类抗抑郁药和钙拮抗剂可用于预防性治疗。
