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偏头痛是最常见的功能障碍性神经疾病之一,会对患者的生活质量造成严重影响。为了在文献检索和专家组共识基础上对不同类型偏头痛综合征的各种药物治疗方案提供循证或专家推荐,我们从现有的所有医学参考文献系统中筛选出关于有先兆型或无先兆型偏头痛以及偏头痛样综合征等各种类型临床资料进行分析。根据欧洲神经病学学会联盟(European Federation of Neurological Societies.EFNS)制定的推荐意见分级方案对这些研究结果进行评价从而确定A级、B级或C级推荐和良好的临床实践要点。对于偏头痛急性发作期的治疗,推荐口服非甾体消炎药(NSAID)和曲坦类药物。用药方案应遵循分层治疗的观念。在服用NSAID和曲坦类药物之前,推荐口服甲氧氯普胺或多潘立酮。极重度发作的首选药物为静脉注射乙酰水杨酸或皮下注射舒马曲坦。偏头痛持续状态或许可用类固醇治疗。对于偏头痛的预防性治疗,β-受体阻断药(普萘洛尔和美托洛尔)、氟桂利嗪、丙戊酸和托吡酯可作为首选用药,其次可选择阿米替林、萘普生、蜂斗菜烯碱和比索洛尔。
Migraine is one of the most common dysfunctional neurological diseases and can have a serious impact on the patient’s quality of life. In order to provide evidence-based or expert recommendations for various drug treatment regimens for different types of migraine syndromes based on literature search and panel consensus, we screened all available medical reference systems for any evidence of aura with or without aura Migraine-like migraine-like syndrome and other types of clinical data analysis. The results of these studies were evaluated in accordance with the recommendations of the European Federation of Neurological Societies. Efforts to determine the recommended and good clinical practice points for Class A, Class B, or Class C recommendations. For the treatment of acute exacerbation of migraine, oral non-steroidal anti-inflammatory drugs (NSAIDs) and triptans are recommended. Dosage regimen should follow the concept of stratification. Metoclopramide or domperidone is recommended before taking NSAIDs and triptans. Severe seizures of drug of choice for the intravenous injection of acetylsalicylic acid or subcutaneous sumatriptan. Migraine status may be treated with steroids. For preventive treatment of migraine, β-blockers (propranolol and metoprolol), flunarizine, valproic acid and topiramate can be used as the first choice, followed by amitriptyline, naphthalene Probiotics, beetroot and bisoprolol.