Мигрень и цереброваскулярная патология: обзор литературы и опыт использования кандесартана для профилактики мигрени у пациентов с артериальной гипертензией

Азимова Ю.Э., Скоробогатых К.В., Ищенко К.А., Климов Е.А. Мигрень и цереброваскулярная патология: обзор литературы и опыт использования кандесартана для профилактики мигрени у пациентов с артериальной гипертензией. Consilium Medicum. 2017; 19 (9): 55–58. DOI: 10.26442/2075-1753_19.9.55-58

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Azimova Yu.E., Skorobogatykh K.V., Ishchenko K.A., Klimov E.A. Migraine and cerebrovascular pathology: a review of the literature and experience overview of using candesartan for the prevention of migraine in patients with arterial hypertension. Consilium Medicum. 2017; 19 (9): 55–58. DOI: 10.26442/2075-1753_19.9.55-58

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Аннотация

Актуальность. Согласно современным рекомендациям лечение мигрени должно продолжаться не менее 12 мес. В связи с этим приверженность пациента терапии является основным условием ее успешности. Тем не менее среди пациентов, получающих b-адреноблокаторы, антиконвульсанты, антидепрессанты, 40% пациентов отказываются от терапии в течение 1 мес, 24–25% остаются на лечении через 6 мес, 13–16% принимают препараты до 12 мес. Основная причина отказа от терапии, в особенности в первые недели, – плохая переносимость этих препаратов (психотропные эффекты, седация, брадикардия).
Цель работы – изучение эффективности и безопасности назначения кандесартана (Ордисс) пациентам с хронической мигренью (согласно критериям Международной классификации головной боли III, 2013 г.) и артериальной гипертензией (повышение систолического артериального давления – АД>40, диастолического – 90 мм рт. ст.).
Материалы и методы. Лечение проводилось 72 пациентам с хронической мигренью и артериальной гипертензией (9 мужчин, 63 женщины, средний возраст 46,4±9,7 года). Оценка эффективности проводилась при помощи анализа данных дневника головной боли (показатели количества дней с головной болью, дней с мигренью). На каждом из визитов фиксировалось АД. Оценка проводилась до начала лечения, через 1, 3 и 6 мес.
Результаты. Происходило статистически значимое снижение дней с головной болью: от 22,3±6,0 дня до 10,4±3,5 дня через 1 мес, 8,8±3,1 дня через 3 мес и 6,2±2,7 дня через 6 мес терапии (везде р<0,01). Статистически значимое снижение происходило и по динамике показателя дней с мигренью: от 16,9±5,4 дня до лечения до 7,3±2,9 дня через 1 мес, 6,5±2,7 дня – через 3 мес, 4,9±1,8 дня – через 6 мес. Лечение кандесартаном (Ордисс) также приводило к нормализации АД у 92,8% пациентов. Два пациента прервали лечение в силу развития общей слабости и повышенной утомляемости. У 5 (6,9%) пациентов также отмечались общая слабость и повышенная утомляемость, но эти явления были транзиторными.
Выводы. Кандесартан (Ордисс) может быть рекомендован для лечения пациентов с хронической мигренью и артериальной гипертензией.

Ключевые слова: мигрень, хроническая мигрень, лечение мигрени, артериальная гипертензия, кандесартан, Ордисс.

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Relevance. According to modern recommendations, migraine treatment should last at least 12 months. In this regard, adherence to patient therapy is the main condition for its success. Nevertheless, among patients receiving b-adrenoblockers, anticonvulsants, antidepressants, 40% of patients refuse therapy within 1 month, 24–25% remain on treatment after 6 months, 13–16% take drugs for up to 12 months. The main reason for refusing therapy, especially in the first weeks, is the poor tolerance of these drugs (psychotropic effects, sedation, bradycardia).
The aim of the study lies in examining the efficacy and safety of the appointment of candesartan (Ordiss) to patients with chronic migraine (according to the criteria of the International Classification of Headache III, 2013) and arterial hypertension (increase in systolic blood pressure – BP of above 140, diastolic – 90 mm Hg).
Materials and methods. Treatment was conducted in 72 patients with chronic migraine and hypertension (9 men, 63 women, mean age 46.4±9.7 years). Evaluation of the effectiveness was carried out by analyzing the data of the diary of a headache (indicators of the number of days with a headache, days with migraine). At each of the visits BP was recorded. Evaluation was carried out before the start of treatment, after 1, 3 and 6 months.
Results. There was a statistically significant decrease in days with headache: from 22.3±6.0 days to 10.4±3.5 days after 1 month, 8.8±3.1 days after 3 months and 6.2±2.7 day after 6 months of therapy (everywhere p<0.01). A statistically significant decrease was also observed in the dynamics of the indicator of days with migraine: from 16.9±5.4 days before treatment to 7.3±2.9 days after 1 month, 6.5±2.7 days – after 3 months, 4.9±1.8 days – after 6 months. Treatment with candesartan (Ordiss) also led to the normalization of BP in 92.8% of patients. 2 patients interrupted treatment due to the development of general weakness and increased fatigue. 5 (6.9%) patients also had general weakness and increased fatigue, but these phenomena were transient.
Conclusions. Candesartan (Ordiss) can be recommended for the treatment of patients with chronic migraine and hypertension.

Key words: migraine, chronic migraine, treatment of migraine, arterial hypertension, candesartan, Ordiss.

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Список литературы

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15. Lithell H, Hansson L, Skoog I et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
16. MacClellan LR, Giles W, Cole J et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007; 38 (9): 2438–45.
17. Mancia G, Rosei EA, Ambrosioni E et al. Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence froma large, multicenter, cross-sectional survey in Italy (MIRACLES study). J Hypertens 2011; 29 (2): 309–18.
18. Mawet J. Sensitivity to acute cerebral ischemic injury in migraineurs A retrospective case-control study. Neurology 2015; 85: 1146–53.
19. Scher AI, Terwindt GM, Picavet HS et al. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology 2005; 64: 614–20.
20. Smith DH. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. Drugs 2008; 68: 1207–25.
21. Spector JT. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010; 123: 612–24.
22. Stovner LJ, Linde M, Gravdahl GB et al. A comparative study of candesartan versus propranolol for migraine prophylaxis: A randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia 2013; 10: 1–10.
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24. Tfelt-Hansen P, Agesen FN, Pavbro A et al. Pharmacokinetic Variability of Drugs Used for Prophylactic Treatment of Migraine CNS. Drugs 2017; 31: 389–403.
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1. Osipova V.V., Filatova E.G., Artemenko A.R. i dr. Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ekspertov. Zhurn. nevrologii i psikhiatrii im. S.M.Korsakova. 2017; 1 (Vyp. 2): 28–42. [in Russian]
2. Acer C. Ocular pulse amplitude and retina nerve fiber layer thickness in migraine patients without aura. BMC Ophthalmol 2016; 16: 1.
3. Akiyama H, Hasegawa Y. Migraine Treated Using a Prophylactic Combination of Candesartan and Hydrochlorothiazide (ECARDR Combination Tablets LD). Pain Practice 2013; 13 (7): 566–71.
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: 758–65.
5. Ayzenberg I, Katsarava Z, Sborowski A et al. The prevalence of primary headache disorders in Russia: A countrywide survey. Cephalalgia 2012; 32 (5): 373–81.
6. Cernes R, Mashavi M, Zimlichman R. Differential clinical profile of candesartan compared to other angiotensin receptor blockers. Vasc Health Risk Manag 2011; 7: 749–59.
7. Eikermann-Haerter K. Migraine prophylaxis, ischemic depolarizations and stroke outcomes in mice. Headache 2014; 54 (7): 1146–57.
8. Erdelyi-Botor S. Changes ofmigraine-related white matter hyperintensities after 3 years: a longitudinal MRI study. Headache 2015; 55 (1): 55–70.
9. Gardener H, Monteith T, Rundek T et al. Hypertension and Migraine in the Northern Manhattan Study. Ethn Dis 2016; 26 (3): 323–30.
10. Guidetti D, Rota E, Morelli N et al. Migraine and stroke: “vascular” comorbidity. Frontiers in Neurology 2014; 5: 193.
11. Hepp Z, Dodick DW, Varon SF et al. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia 2017; 37 (5): 470–85.
12. Hu X, Zhou Y, Zhao H, Peng C. Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017; 38 (1): 33–40.
13. Jackson JL, Cogbill E, Santana-Davila R et al. A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache. PLoS ONE 2015; 10: e0130733.
14. Kruit MC. Infarcts in the posterior circulation territory in migraine.The population-based MRI CAMERA study. Brain 2005; 128 (Pt 9): 2068–77.
15. Lithell H, Hansson L, Skoog I et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21: 875–86.
16. MacClellan LR, Giles W, Cole J et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007; 38 (9): 2438–45.
17. Mancia G, Rosei EA, Ambrosioni E et al. Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence froma large, multicenter, cross-sectional survey in Italy (MIRACLES study). J Hypertens 2011; 29 (2): 309–18.
18. Mawet J. Sensitivity to acute cerebral ischemic injury in migraineurs A retrospective case-control study. Neurology 2015; 85: 1146–53.
19. Scher AI, Terwindt GM, Picavet HS et al. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology 2005; 64: 614–20.
20. Smith DH. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. Drugs 2008; 68: 1207–25.
21. Spector JT. Migraine headache and ischemic stroke risk: an updated meta-analysis. Am J Med 2010; 123: 612–24.
22. Stovner LJ, Linde M, Gravdahl GB et al. A comparative study of candesartan versus propranolol for migraine prophylaxis: A randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia 2013; 10: 1–10.
23. Tana C, Tafuri E, Tana M et al. New insights into the cardiovascular risk of migraine and the role of white matter hyperintensities: is gold all that glitters? J Headache Pain 2013; 14 (1): 9.
24. Tfelt-Hansen P, Agesen FN, Pavbro A et al. Pharmacokinetic Variability of Drugs Used for Prophylactic Treatment of Migraine CNS. Drugs 2017; 31: 389–403.
25. Tronvik E, Stovner LJ, Helde G et al. Prophylactic treatment of migraine with an angiotension II receptor blocker: a randomized controlled trial. JAMA 2003; 289: 65–9.
26. Winsvold BS, Hagen K, Aamodt AH et al. Headache, migraine and cardiovascular risk factors: the HUNT study. Eur J Neurol 2011; 18: 504–11.

Авторы

Ю.Э.Азимова*1, К.В.Скоробогатых1, К.А.Ищенко1, Е.А.Климов2

1 ООО «Университетская клиника головной боли». 121467, Россия, Москва, ул. Молодогвардейская, д. 2, корп. 1;
2 ФГБОУ ВО «Московский государственный университет им. М.В.Ломоносова». 119192, Россия, Москва, Ломоносовский пр., д. 31, корп. 5
*azimova.j@mail.ru

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Yu.E.Azimova*1, K.V.Skorobogatykh1, K.A.Ishchenko1, E.A.Klimov2

1 University Headache Clinic. 121467, Russian Federation, Moscow, ul. Molodogvardeiskaia, d. 2, korp. 1;
2 M.V.Lomonosov Moscow State University. 119192, Russian Federation, Moscow, Lomonosovskii pr., d. 31, korp. 5
*azimova.j@mail.ru

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