Higelin F, Annoni J M
Department de médecine communautaire, Hôpital cantonal universitaire de Genève.
Schweiz Med Wochenschr. 1998 Mar 7;128(10):374-83.
Management of migraine patients with or without aura must include appropriate medication to treat the attack and long-term preventive therapy, especially if the frequency of the attacks is greater than 2-4 per month. In both cases the choice of treatment depends on its efficacy and side effects. With regard to acute drug therapy, group studies do not suggest that ergot derivatives and sumatriptan are superior to simple analgesics and anti-inflammatory drugs, particularly if a prokinetic agent is added. These new substances are indicated for severe attacks refractory to more conventional therapy. Chronic drug abuse may induce drug-induced or rebound headaches. As regards long-term prophylaxis, group studies suggest that calcium antagonists and 5-HT-influencing drugs are superior concerning attacks frequency to beta-blocking agents, but involve very frequent side effects (weight gain and somnolence). Interesting preliminary results have also been reported with valproate and enalapril, which will confirmation by controlled studies. Finally, the choice of drug must take into account the patient's comorbidities (cardiovascular diseases, asthma, diabetes etc).
有先兆或无先兆偏头痛患者的管理必须包括用于治疗发作的适当药物和长期预防性治疗，尤其是当发作频率大于每月2 - 4次时。在这两种情况下，治疗的选择取决于其疗效和副作用。关于急性药物治疗，群体研究并不表明麦角衍生物和舒马曲坦优于单纯的镇痛药和抗炎药，特别是如果添加了促动力剂的话。这些新物质适用于对更传统治疗难治的严重发作。长期药物滥用可能导致药物性或反弹性头痛。关于长期预防，群体研究表明，钙拮抗剂和影响5 - 羟色胺的药物在发作频率方面优于β受体阻滞剂，但副作用非常频繁（体重增加和嗜睡）。丙戊酸盐和依那普利也有有趣的初步结果报道，这将由对照研究予以证实。最后，药物的选择必须考虑患者的合并症（心血管疾病、哮喘、糖尿病等）。
