偏頭育預防性藥物治療譽則

Treatment Guidelines for Preventive Treatment of Migraine

臺灣頭痛學會治療準則小組(Treatment Guideline Subcommittee of the Taiwan Headache Sociey)

《Acta Neurologica Taiwanica》 17卷2期 (2008/06) Pp. 132-148

https://doi.org/10.29819/ANT.200806.0011

摘要

本小組針對國內臨床使用的偏頭痛預防治療藥物，以實證醫學的方式，評估其試驗品質、證據等級並參考歐美國家的治療準則，歷經數次討論與意見整合，對該類藥物用於偏頭痛預防治療之主要角色、推薦等級、臨床療效與不良反應等使用時之注意事項提出共識。
臺灣目前可用於偏頭痛預防性發作治療之藥物可分爲乙型阻斷劑、抗憂鬱劑、鈣離子阻斷劑、抗癲癇藥物、非類固醇抗發炎藥物、肉毒桿菌素與其他藥物。其中，propranolol證據等級最佳，建議做第一線治療。Valproic acid、topiramate、flunarizine和amitriptyline建議爲第二線治療。其他類藥物建議於上述藥物無效後使用。肉毒桿菌素於陣發性偏頭痛並未比安慰劑效果好，但是對於慢性偏頭痛是否有效仍待確定。懷孕婦女非必要不建議使用偏頭痛預防性藥物。月經性偏頭痛可使用非類固醇類抗發炎製劑或是翠普登類藥物於月經期作爲預防治療。兒童、青少年及老年人的偏頭痛預防藥物臨床證據不足。
預防用藥必須由小劑量閉始，並逐漸增至有效劑量，減少不良反應及提高耐受性。預防偏頭痛藥物一般需使用3到4週才能評估療效，治療需持續4-6個月，待頭痛減少後，逐漸減藥與停藥。除使用預防用藥外，應同時注意病人是否有過度使用急性治療藥物。

關鍵字

偏頭痛 ； 治療 ； 準則 ； 預防

並列摘要

The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for preventive therapy of migraine in Taiwan according to the principles of evidence-based medicine. We assessed the quality of clinical trials, levels of evidence, and referred to other treatment guidelines proposed by Western countries. Throughout several panel discussions, we merged opinions from the subcommittee members in order to propose a Taiwan consensus about the major roles, recommended levels, clinical efficacy, adverse events and cautions of clinical practice for these medications in preventive treatment of migraine.
Migraine preventive medications currently available in Taiwan can be categorized into s-blockers, antidepressants, calcium channel blockers, anticonvulsants, nonsteroid anti-inflammatory drugs, botulinum toxin type A and miscellaneous medications. Propranolol has the best level of evidence, and is recommended as the first-line medication for migraine prevention. Valproic acid, topiramate, flunarizine and amitriptyline are suggested as the second-line medications. The rest medications are used when the above medications fail. Botulinum toxin type A did not differ from placebo for episodic migraine prevention but its efficacy in chronic migraine is not determined yet. It is not recommended to use migraine preventive medication during pregnancy. For those women with menstrual migraine, nonsteroid anti-inflammatory drug and triptans can be used for prevention during the menstrual period. The levels of evidence for migraine preventive medications in children/adolescents and elderly population are low.
The preventive medications should follow the ”start low and go slow” doctrine to reach an effective dosage. This can prevent adverse events and increase tolerance. The efficacy of preventive medications can not be evaluated until 3 to 4 weeks after treatment. If the improvement of migraine maintains for 4 to 6 months, physicians can gradually taper down or off the medications. Physicians should notify the patients not to overuse acute medications during migraine prevention treatment.

並列關鍵字

Migraine ； Treatment ； Guideline ； Prophylaxis