偏头痛的合理用药

Pharmacological management of migraine

偏头痛的治疗应遵循个体化治疗,同时结合对患者的宣教和其他非药物干预措施。急性期治疗包括普通止痛剂(非甾体抗炎药)和偏头痛特异性药物(麦角胺和曲坦类),药物使用应遵循阶梯法或分层法原则。对需要进行预防治疗的患者,可按照个体情况选择氟桂利嗪、抗抑郁剂(阿米替林)、抗癫痫剂(丙戊酸和托吡酯)及β受体阻滞剂(心得安和美托心安),疗效评估4～8周,疗程3～6个月。

Pharmacological management of migraine should be evidence-based and individualized, combined with patient＇s education and non-pharmacological management. For acute therapy,simple or combination analgesics （non-steroidal anti-inflammatory drugs） or migraine specific drugs （ergotamines and triptans） are recommended and should be administrated following the concept of stratification or stepwise treatment. For preventive therapy, flunarizine, antidepressant （ amitriptyline）, antiepilepties （valproic acids and topiramate）, and beta-blockers （propranolol and metoprolol ） are drugs of first choice and should be chosen individually. Prophylaxis therapy should be evaluated for 4 - 8 weeks and last for 3 --6 months whenever it is effective.