Эффективные терапевтические стратегии лечения приступа мигрени

Сергеев А.В. Эффективные терапевтические стратегии лечения приступа мигрени. Справочник поликлинического врача. 2017; 6: 47–51.

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Sergeev A.V. Effective therapeutic strategies for treating a migraine attack. Handbook for Practitioners Doctors. 2017; 6: 47–51.

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Аннотация

Мигрень занимает третье место среди наиболее распространенных заболеваний и седьмое по степени дезадаптации. В России в среднем около 440 тыс. новых приступов мигрени развивается ежедневно. Даже при правильном использовании лекарственной терапии успешно купируется всего два приступа из трех. Распространенные ошибки в назначении препаратов приводят к значительному снижению эффективности терапии. Возможные новые противомигренозные лекарственные препараты (ингибиторы кальцитонин-ген-родственного пептида, селективные агонисты 5-HT1F-рецепторов, лекарственные средства, воздействующие на PACAP и NO) находятся в стадии исследований и не могут помочь в клинической практике. Ключом к успешной терапии мигренозного приступа по-прежнему является рациональное эффективное использование уже имеющихся препаратов. В статье представлены основные эффективные терапевтические стратегии лечения приступа мигрени.

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

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Migraine occupies the third place among the most common diseases and the seventh in the degree of disadaptation. In Russia, on average, about 440 000 new migraine attacks develop daily. Even with the correct use of drug therapy, only two of three outbreaks are successfully stopped. Common errors in prescribing drugs lead to a significant reduction in the effectiveness of therapy. Possible new antimigraine drugs (calcitonin-gene-related peptide inhibitors, selective 5-HT1F receptor agonists, drugs affecting PACAP and NO) are in the research stage and can not help in clinical practice. The key to successful therapy of migraine attack is still the rational effective use of the already available drugs. The article presents the main effective therapeutic strategies for treating a migraine attack.

Key words: migraine attack, triptans, zolmitriptan, nonsteroidal anti-inflammatory drugs, antiemetics, stratification approach.

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Список литературы

1. 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.
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. 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.
4. Табеева Г.Р. Рациональная комбинированная терапия приступа мигрени. Consilium Medicum. 2013; 15 (9): 18–23. / Tabeeva G.R. Ratsional'naia kombinirovannaia terapiia pristupa migreni. Consilium Medicum. 2013; 15 (9): 18–23. [in Russian]
5. 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/ (Accessed on November 25, 2013).
6. 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.
7. 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.
8. Pringsheim T, Becker WJ. Triptans for symptomatic treatment of migraine headache. BMJ 2014; 348: g2285.
9. 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.
10. 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.
11. Thorlund K, Mills EJ, Wu P et al. Comparative efficacy of triptans forthe abortive treatment of migraine: multiple treatment comparison meta-analysis. Cephalalgia 2014; 34 (4): 258–67.
12. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American headache society evidence assessment of migraine pharmacotherapies. Headache 2015; 55 (1): 3–20.
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. Kilit C, Oruc S, Kilit TP, Onrat E. The effect of zolmitriptan on cardiac autonomic modulation in patients with migraine: A double-blind, placebo-controlled, crossover study. Neurol India 2015; 63 (6): 860–5.
15. 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.
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.

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1. 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.
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. 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.
4. Tabeeva G.R. Ratsional'naia kombinirovannaia terapiia pristupa migreni. Consilium Medicum. 2013; 15 (9): 18–23. [in Russian]
5. 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/ (Accessed on November 25, 2013).
6. 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.
7. 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.
8. Pringsheim T, Becker WJ. Triptans for symptomatic treatment of migraine headache. BMJ 2014; 348: g2285.
9. 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.
10. 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.
11. Thorlund K, Mills EJ, Wu P et al. Comparative efficacy of triptans forthe abortive treatment of migraine: multiple treatment comparison meta-analysis. Cephalalgia 2014; 34 (4): 258–67.
12. Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American headache society evidence assessment of migraine pharmacotherapies. Headache 2015; 55 (1): 3–20.
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. Kilit C, Oruc S, Kilit TP, Onrat E. The effect of zolmitriptan on cardiac autonomic modulation in patients with migraine: A double-blind, placebo-controlled, crossover study. Neurol India 2015; 63 (6): 860–5.
15. 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.
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.

Авторы

А.В.Сергеев

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 1
sergeev.neuro@gmail.com

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A.V.Sergeev

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str . 1
sergeev.neuro@gmail.com

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