Доказательная терапия приступа мигрени

Сергеев А.В. Доказательная терапия приступа мигрени. Consilium Medicum. Неврология и Ревматология (Прил.). 2015; 1: 34–37.

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Sergeev A.V. Evidence-based treatment of a migraine attack. Consilium Medicum. Neurology and Rheumatology (Suppl.). 2015; 1: 34–37.

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Аннотация

Около 15% общей популяции и до 20% женщин страдают мигренью. Тяжесть приступов мигрени и распространенность преимущественно среди людей молодого и среднего возраста (20–59 лет) ведут к огромным социально-экономическим затратам. Нерациональное использование лекарственных средств приводит к тому, что успешно купируются лишь два приступа из трех. На данный момент новые противомигренозные лекарственные препараты (ингибиторы CGRP, селективные агонисты 5-HT1F-рецепторов, лекарственные средства, воздействующие на TRPV-рецепторы и оксид азота) находятся в стадии исследований и не выходят в клиническую практику. Таким образом, ключом к успешной терапии мигренозного приступа по-прежнему является рациональное использование уже имеющихся препаратов как в виде монотерапии, так и в составе комбинированного подхода. В статье представлены современный обзор имеющихся лекарственных средств для купирования мигренозного приступа, а также основные доказательные и эффективные терапевтические стратегии.

Ключевые слова: приступ мигрени, нестероидные противовоспалительные препараты, напроксен, триптаны, суматриптан, антиэметики, стратификационный подход.

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About 15% of the general population and up to 20% of women suffer from migraine. The severity of migraine attacks and its prevalence mainly among young and middle-aged (20–59 years) people, results in huge economic and social costs. An irrational use of drugs leads to the fact that only two cropped successfully attack of three. At data point anti-migraine new drugs (inhibitors of CGRP, selective agonists at the 5-HT1F-receptors, drugs that act on the TRPV receptors and NO) are under investigation and are locatedin clinical practice. Thus, the key to successful therapy migraineattack is still the rational use of existing drugs as a monotherapy, as part of a combined approach. The paper presents an overview of the available modern drugs for the relief of migraine attack, as well as the main evidence and effective therapeutic strategies.

Key words: migraine, NSAIDs, naproxen, triptans, sumatriptan, antiemetics, stratification approach.

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Список литературы

1. Lipton RB, Bigal ME, Steiner TJ et al. Classiﬁcation of primary headaches. Neurology 2004; 63: 427–35.
2. Leonardi M, Steiner TJ, Scher AT, Lipton RB. The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF). J Headache Pain 2005; 6 (6): 429–40.
3. Steiner TJ, Gururaj G, Andrée C et al. Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 2014; 15: 3.
4. Ayzenberg I, Katsarava Z, Sborowski A et al. Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed. Eur J Neurol 2014; 21 (5): 758–65.
5. Табеева Г.Р. Рациональная комбинированная терапия приступа мигрени. Consilium Medicum. 2013; 9: 18–23. / Tabeeva G.R. Ratsional'naia kombinirovannaia terapiia pristupa migreni. Consilium Medicum. 2013; 9: 18–23. [in Russian]
6. Acute migraine treatment in emergency settings. Comparative Effectiveness Review Summary Guides for Clinicians. Agency for Healthcare Research and Quality. www.ncbi.nlm.nih.gov/books/NBK164542/
7. Lipton RB, Stewart WF, Stone AM et al. Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study: A randomized trial. JAMA 2000; 284: 2599.
8. Evers S, Afra J, Frese A et al. EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. Eur J Neurol 2009; 16 (9): 968–81.
9. Suthisisang CC, Poolsup N, Suksomboon N et al. Meta-analysis of the efficacy and safety of naproxen sodium in the acute treatment of migraine. Headache 2010; 50 (5): 808–18.
10. Pringsheim T, Becker WJ. Triptans for symptomatic treatment of migraine headache. BMJ 2014; 348: g2285.
11. The Oral Sumatriptan and Aspirin plus Metoclopramide Comparative Study Group. A study to compare oral sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. Eur Neurol 1992; 32: 177–84.
12. Geraud G, Compagnon A, Rossi A. Zolmitriptan versu a combination of acetylsalicylic acid and metoclopramide in the acute oral treatment of migraine: a double-blind, randomised, three-attack study. Eur Neurol 2002; 47: 88–98.
13. Hall G, Brown M, Mo J, MacRae KD. Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology 2004; 62: 563–8.
14. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001; 358: 1668.
15. Brandes JL, Kudrow D, Stark SR et al. Sumatriptan-naproxen for acute treatment of migraine: A randomized trial. JAMA 2007; 297: 1443–54.
16. Ellis GL, Delaney J, DeHart DA, Owens A. The efficacy of metoclopramide in the treatment of migraine headache. Ann Emerg Med 1993; 22: 191–5.
17. Tfelt-Hansen P, Saxena PR, Dahlöf C et al. Ergotamine in the acute treatment of migraine: a review and European consensus. Brain 2000; 123 (Pt 1): 9.
18. Colman I, Friedman BW, Brown MD et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008; 336: 359.

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1. Lipton RB, Bigal ME, Steiner TJ et al. Classiﬁcation of primary headaches. Neurology 2004; 63: 427–35.
2. Leonardi M, Steiner TJ, Scher AT, Lipton RB. The global burden of migraine: measuring disability in headache disorders with WHO's Classification of Functioning, Disability and Health (ICF). J Headache Pain 2005; 6 (6): 429–40.
3. Steiner TJ, Gururaj G, Andrée C et al. Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 2014; 15: 3.
4. Ayzenberg I, Katsarava Z, Sborowski A et al. Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed. Eur J Neurol 2014; 21 (5): 758–65.
5. Tabeeva G.R. Ratsional'naia kombinirovannaia terapiia pristupa migreni. Consilium Medicum. 2013; 9: 18–23. [in Russian]
6. Acute migraine treatment in emergency settings. Comparative Effectiveness Review Summary Guides for Clinicians. Agency for Healthcare Research and Quality. www.ncbi.nlm.nih.gov/books/NBK164542/
7. Lipton RB, Stewart WF, Stone AM et al. Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) Study: A randomized trial. JAMA 2000; 284: 2599.
8. Evers S, Afra J, Frese A et al. EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. Eur J Neurol 2009; 16 (9): 968–81.
9. Suthisisang CC, Poolsup N, Suksomboon N et al. Meta-analysis of the efficacy and safety of naproxen sodium in the acute treatment of migraine. Headache 2010; 50 (5): 808–18.
10. Pringsheim T, Becker WJ. Triptans for symptomatic treatment of migraine headache. BMJ 2014; 348: g2285.
11. The Oral Sumatriptan and Aspirin plus Metoclopramide Comparative Study Group. A study to compare oral sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. Eur Neurol 1992; 32: 177–84.
12. Geraud G, Compagnon A, Rossi A. Zolmitriptan versu a combination of acetylsalicylic acid and metoclopramide in the acute oral treatment of migraine: a double-blind, randomised, three-attack study. Eur Neurol 2002; 47: 88–98.
13. Hall G, Brown M, Mo J, MacRae KD. Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology 2004; 62: 563–8.
14. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001; 358: 1668.
15. Brandes JL, Kudrow D, Stark SR et al. Sumatriptan-naproxen for acute treatment of migraine: A randomized trial. JAMA 2007; 297: 1443–54.
16. Ellis GL, Delaney J, DeHart DA, Owens A. The efficacy of metoclopramide in the treatment of migraine headache. Ann Emerg Med 1993; 22: 191–5.
17. Tfelt-Hansen P, Saxena PR, Dahlöf C et al. Ergotamine in the acute treatment of migraine: a review and European consensus. Brain 2000; 123 (Pt 1): 9.
18. Colman I, Friedman BW, Brown MD et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008; 336: 359.

Авторы

А.В.Сергеев*

ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Москва, ул. Трубецкая, д. 8, стр. 2
*sergeev.neuro@gmail.com

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A.V.Sergeev*

I.M.Sechenov First Moscow State Medical University. 119991, Russian Federation, Moscow, ul. Trubetskaya, d. 8, str. 2
*sergeev.neuro@gmail.com

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