偏头痛的治疗和预防

偏头疼(Migraine)

1。终身发病率：妇女43%，男人18%，儿童4-5%

2。经常是单侧搏动性头痛

3。双侧头痛：成年人：40%, 儿童：60%

4。短暂发作性的头痛：每月少于15天

5。慢性头痛：每月大于15天

6。相关症状：畏光，恐声，惧气味，恶心和呕吐

7。20%的病人有预兆：最多的是视觉症状，少数人有感觉和偏瘫症状

8。有一定的家属史

9。月经期间可能加重。

急性治疗：在24小时内，恢复功能，减轻病痛，减少复发。

A: 家中非特效治疗：

Aspirin (650-1000 mg),

Ibuprofen (400-800 mg),

Naproxen (125-550 mg),

Diclofenac (50 mg),

Ketoprofen (50-75 mg)

Ketorolac (10 mg),

Etodolac (200-500 mg),

Mecofenamate (50-100 mg) 

B: 特效治疗-1： Triptans

Almotriptan (Axert, 6.25,12.5 mg, onset 1-2hr, t1/2 3-4hr),

Eletriptan (Relpax, 20, 40 mg, onset <1hr, t1/2 4 hr),

Rizatriptan (Maxalt, 5, 10 mg, onset 30 min, t1/2 2-3hr),

Sumatriptan (Imitrex, 25, 50, 100 mg, onset oral 1-2hr, t1/2-3hr),

Zolmitriptan (Zomig, 2.5, 5 mg, onset <1hr, t1/2 -3hr),

Frovatriptan (Frova, 2.5 mg, onset 2hr, t1/2 26hr),

Naratriptan (Aerge, 1, 2.5 mg, onset 1hr, t1/2 6hr).

C: 特效治疗-2: Ergots

Dihydroergotamine (DHE, 0.5, 1 mg nasal spray or IV injection)

D: 急诊室治疗:

Sumatriptan: 4-6 mg subcutaneously

 OR

Headache cocktail:

 Valproate 500 mg intra-venously

 Dexamethasone 10 mg intra-venously

 Magnesium solfate 1-2 gram intra-venously

 Metoclopramide 10-20 mg intra-venously 

预防性治疗

减少复发频率，严重性，延迟疾病进展，增强对急性治疗的反应性

A: 改变生活方式：

要有足够的睡眠，有氧运动，少量多餐，避免咖啡因，巧克力， 喝酒，和奶酪等发
酵食品。 

B: 特效预防性药品：

1. Beta-adrenergic blockers:

Metoprolol 50-150 mg twice a day

Propranolol 80-240 mg daily

Timolol 10-20 mg twice a day

2. Antiepileptic drugs

Topiramate 25-150 mg twice a day

Divaproex 250-1500 mg twice a day

3. Antidepressants

Amitriptyline 25-150 mg bedtime

Venlafaxine 37.5-150 mg daily

C: 非主流的预防性药品和方法：

Magnesium 400 mg 1-2 times a day

Coznzyme Q10 300 mg daily

Riboflavin (Vit B2) 400 mg daily

Butterbur 150 mg daily

Feverfew: 50-100 mg 1-2 times a day

Folic acid 2 mg, Vit B12 400 ug, and Vit B6 25 mg, daily

Acupuncture 45% reduction of headache

Oxygen 10-12 Liter/min for cluster headache