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題名 | 偏頭痛急性發作藥物治療準則=Treatment Guidelines for Acute Migraine Attacks |
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作者 | 臺灣頭痛學會治療準則小組; | 書刊名 | Acta Neurologica Taiwanica |
卷期 | 16:4 2007.12[民96.12] |
頁次 | 頁251-268 |
分類號 | 418.2133 |
關鍵詞 | 偏頭痛; 翠普登; 治療; 準則; Migraine; Triptan; Treatment; Guideline; |
語文 | 中文(Chinese) |
中文摘要 | 本小組針對國內臨床使用的偏頭痛急性治療藥物,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與日本的治療準則,歷經數次討論與意見整合,對該類藥物用於偏頭痛急性治療之主要角色、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急性發作治療之藥物可分為偏頭痛特定性與非特定性藥物。其中,具特定性的翠普登、麥角胺,或非特定性的非類固醇抗發炎藥物,證據等級最佳,建議優先採用,且應依循「分層治療」之原則。輕中度偏頭痛,先選擇口服非類固醇抗發炎藥物,替代藥物包括口服阿斯匹靈、複方止痛藥、靜脈/肌肉注射非類固醇抗發炎藥物或麥角胺。中度偏頭痛,建議口服或鼻噴翠普登或是麥角胺,宜在頭痛早期使用。非類固醇抗發炎藥物可作為替代藥物。翠普登與非類固醇抗發炎藥物同時使用,效果較單獨使用更好。偏頭痛重積狀態,首先應以靜脈投予類固醇並配合輸液治療。乙醯氨酚對中重度偏頭痛療效不佳,但為兒童及孕婦偏頭痛急性發作之首選用藥。嗎啡類製劑副作用大,現階段不建議用於偏頭痛的治療。使用急性治療藥物,為預防藥物過度使用頭痛,原則上一個月不宜使用超過十天。 |
英文摘要 | The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the medications currently used for acute migraine attacks in Taiwan according to the principles of evidence-based medicine. We have assessed the quality of clinical trials, levels of evidence, and referred to other treatment guidelines proposed by Western countries and Japan. After several panel discussions, we merged opinions from the subcommittee members in order to propose a Taiwan consensus regarding the major roles, recommended levels, clinical efficacy, adverse events and cautions of clinical practice for these medications in treatment of acute migraine attacks. Acute medications currently available in Taiwan can be categorized into “migraine-specific” and “migraine-nonspecific” groups. Migraine-specific triptans and ergotamine, and migraine-nonspecific nonsteroidal anti-inflammatory drugs (NSAIDs) have the best levels of evidence, and are recommended as the first-line medications for acute migraine attacks. The administration should follow the concept of “stratified care”. For mild to moderate migraine attacks, oral NSAIDs are the first choice; with oral aspirin, combination analgesics, intravenous/intramuscular NSAIDs or ergotamine as alternatives. For moderate to severe attacks, oral or nasal spray triptans and ergotamine are recommended and the suggestion is to administer them in the early stage of migraine attacks. NSAIDs can be used as alternatives. Notably, a combination of a triptan and a NSAID yielded a better efficacy compared with either monotherapy. Parenteral steroid and fluid supply are the first choice in treatment of status migrainosus. Acetaminophen showed poor efficacy for moderate to severe migraine attacks but remains the first choice for children and pregnant women. Opiates are not recommended for acute migraine treatment at the present time because of serious adverse events. To prevent medication-overuse headache, the use of acute treatment should be limited to a maximum of ten days a month. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。