MEDIX, God. 24 Br. 133/134 Supplement 2  •  Pregledni članak  •  Neurologija HR ENG

Medikamentna terapija migrene: abortivna i profilaktičkaMedicamentous therapy of migraine: abortive and prophylactic

Damir Petravić

Migrena je kronični poremećaj karakteriziran rekurirajućim napadajima onesposobljavajuće glavobolje. Klinički razlikujemo migrenu s aurom i bez aure te epizodnu s <15 i kroničnu migrenu s ≥15 dana glavobolje mjesečno. Liječenje migrene usmjereno je na prekidanje napadaja abortivnom terapijom te u bolesnika s ≥2 napadaja mjesečno na smanjenje broja napadaja profilaktičkom terapijom. Abortivna terapija se, ovisno o težini napadaja (stratificirani pristup), odnosno terapijskom odgovoru provodi nespecifičnim (paracetamol, acetilsalicilna kiselina, ibuprofen, diklofenak, naproksen) ili specifičnim lijekovima (triptanima). Nespecifična profilaktička terapija provodi se β-blokatorima (propranolol, metoprolol), antiepilepticima (topiramat) i antidepresivima (amitriptilin). U kroničnoj migreni neučinkovitost nespecifične profilaktičke terapije implicira terapijski pokušaj botulinskim toksinom tipa A. Uvođenjem u kliničku praksu monoklonskih protutijela na calcitonin gene-related peptide započinje era specifične profilaktičke terapije migrene. Različitost kliničke prezentacije migrene nameće potrebu maksimalne individualizacije terapijskoga pristupa pojedinom bolesniku, za što je preduvjet poznavanje navedenih terapijskih opcija.

Ključne riječi:
abortivna terapija; calcitonim gene-realated peptide; botulinski toksin tipa A; migrena; profilaktička terapija

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 24 Br. 133/134 Supplement 2

Migraine is a chronic disorder characterized by recurrent episodes of disabling headache. Clinically, there is migraine with and without aura, episodic migraine with <15 days and chronic migraine with >15 days of headache per month. Treatment is aimed at terminating migraine attacks by abortive therapy or reducing the number of attacks by prophylactic therapy in patients with ≥2 episodes per month. Depending on the severity of migraine attacks (stratified approach) and therapeutic response, abortive therapy is performed with nonspecific (paracetamol, acetylsalicylic acid, ibuprofen, diclofenac, naproxen) or specific (triptans) drugs. Nonspecific prophylactic therapy includes the use of beta-blockers (propranolol, metoprolol), antiepileptics (topiramate) and antidepressants (amitriptyline). In the case of non specific prophylactic therapy failure in chronic migraine, therapy with botulinum toxin type A can be attempted. With the introduction of monoclonal antibodies to calcitonin gene-related peptide in clinical practice, the era of specific prophylactic therapy of migraine has begun. The variable clinical presentation of migraine has imposed the need of maximal individualization of therapeutic approach to each patient, which requires familiarity with all the therapeutic options mentioned above.

Key words:
abortive therapy; calcitonin gene-related peptide; botulinum toxin type A; migraine; prophylactic therapy