全新偏头痛诊疗专家共识,3分钟读懂!

2021-07-27 MedSci原创 MedSci原创

本共识所有建议都基于已发表的证据和专家意见,旨在为偏头痛诊疗提供普遍适用的建议。

 

偏头痛是一种普遍的原发性头痛疾病,直接影响着全球超过10亿人。尽管偏头痛发病率高,但目前仍没有较好的诊疗方法。为支持临床决策,Anna K. Eigenbrodt及其团队召集了一个欧洲专家小组制定了诊疗偏头痛方法,形成专家共识发布在Nature Reviews Neurology 6月刊上。每一步都由专家共识确认,并得到文献分析的支持,该共识声明已得到欧洲头痛联合会(EHF)和欧洲神经病学会(EAN)的认可。

共识内容包括偏头痛的典型临床特征、诊断标准、鉴别诊断,概述了不同人群的最佳治疗方法,包括成人、儿童、青少年、孕妇、哺乳期女性和老人。此外,声明还提供了治疗失败后如何进行评估的建议。

 

第一步:何时怀疑为偏头痛?

偏头痛主要分为三种主要类型:有先兆偏头痛、无先兆偏头痛和慢性头痛。

对于反复出现中度至重度头痛并伴有畏光、畏声、恶心和/或呕吐等症状的患者怀疑为无先兆偏头痛,尤其是头痛出现在单侧和/或具有搏动性时。

对于已出现上述症状,同时反复出现短暂的视觉和/或单侧感觉障碍的患者,怀疑为有先兆的偏头痛。

对于一个月内出现头痛超过15天的患者,怀疑为慢性偏头痛。尤其是对于有偏头痛家族史的,如确有慢性偏头痛,一般于青春期或青春期前后出现症状。

 

第二步:偏头痛的诊断

病史是偏头痛诊断的主要依据,一个完整的病史记录提供的信息应足以让医生根据ICHD-3标准作出诊断。记录病史时可运用有效的诊断辅助工具和筛查工具,如头痛日记,偏头痛鉴别问卷(ID-Migraine)和偏头痛筛查问卷。头痛日记是辅助诊疗的有效手段,用以记录有关头痛的模式、频率、症状和用药情况。请勿混淆头痛日历与头痛日记,头痛日历仅记录发病的频率、程度及头痛相关事件,用作疗效的评估(详见第七步)。

诊断时应注意与其他原发性、继发性头痛的鉴别区分,特别是一些继发性头痛严重时可能危及生命(如脑膜炎)。

神经影像学手段因为电离辐射的危害,应仅在怀疑为继发性头痛时使用。而MRI优于CT,因为MRI能提供更高的分辨率且能避免暴露于电离辐射。

 

第三步:教育和以患者为中心

以患者为中心和教育在偏头痛治疗中起到重要作用。医生应向每位患者解释何为偏头痛以及应对原则,包括解释偏头痛难以被治愈,降低患者不切实际的期望,指导患者如何正确地使用药物,应对不良反应。

尽管偏头痛的诱发和触发因素的重要性有限,但如果能正确识别和避免它们,无需过多干预即可实现一定的头痛控制。注意勿将加重症状的因素与诱发因素混淆,如体力活动为前者,睡眠质量差、身体素质差或压力大为后者。

 

第四步:急性治疗

建议为所有的偏头痛患者提供急性药物。药物的有效性与正确的时机和剂量相关,最好在头痛发作的早期使用。急性治疗可分为一线、二线、三线和辅助治疗,应采用阶梯式治疗方法。

使用非甾体抗炎药(乙酰水杨酸、布洛芬或双氯芬酸钾)作为一线药物。

使用曲坦类药物作为二线药物。如出现症状复发,可以重复使用曲坦类药物,或同时使用非甾体药物。但应告诫患者,频繁、重复地使用急性药物有发生MOH(因过度使用药物而导致的头痛)的风险。

考虑将CGRP受体拮抗剂(Gepants)和地坦作为三线药物。

使用促动力止吐药(多潘立酮或甲氧氯普胺)作为恶心和/或呕吐的辅助口服药物。

避免口服麦角生物碱、阿片类药物和巴比妥类药物。麦角生物碱效果不佳且有潜在毒性,阿片类药物和巴比妥类药物药效不定,且有相当大的副作用和依赖性。

偏头痛用药一览

 

第五步:预防性治疗

对于尽管进行了优化了的急性治疗,但生活仍受偏头痛影响的患者应考虑额外的预防性治疗。一般对每月受到偏头痛影响大于2天的患者考虑预防性治疗,但这标准并不是绝对的,医生还应考虑偏头痛发作的严重程度、持续时间、与偏头痛相关的其他功能障碍和是否已用药过度。

预防性治疗同样可分为一线、二线和三线,实际的药物选择应根据当地的指南、是否可用和报销政策决定。

使用β受体阻滞剂(阿替洛尔、比索洛尔、美托洛尔或普萘洛尔)、托吡酯或坎地沙坦作为一线药物。

使用氟桂利嗪、阿米替林或(男性)丙戊酸钠作为二线药物。

考虑将 CGRP 单克隆抗体作为三线药物。

考虑将神经调节装置、生物行为疗法和针灸作为急性和预防性药物治疗的辅助手段,或用作存在药物禁忌时的独立预防性治疗

预防性治疗起效时间较长,应劝阻患者在治疗早期因效果不明显而放弃治疗。对于口服预防性用药,在2-3个月仍无效后再考虑更换疗法,CRGP或其受体的单克隆药物评估时间为3-6个月后,肉毒杆菌毒A素药物为6-9个月后。

 

第六步:特殊人群偏头痛治疗

继发性头痛的发病率随着年龄增加而增加,对于年龄大于50岁的偏头痛患者,应考虑存在潜在病因,还应考虑已知和未知的合并症和药物的副作用,因为老年人往往对药物的副作用更敏感。例如不建议对老年人使用曲坦药物,因为此类患者患有血管疾病的可能性较高。如果使用,建议定期检测患者血压、评估发生心血管疾病的风险。

偏头痛在青少年和儿童中很常见。诊断与成人一样,主要基于病史,但临床特征略有不同:发作时间同常较短,头痛更常见于双侧,胃肠道紊乱较明显。与孩子相比,父母的描述可能更可靠,也能更好地说明可能存在问题的生活方式。治疗方面,对于发作时间较短的儿童,卧床休息即可。需要时,建议使用布洛芬作为一线药物,剂量随体重调整。

对于孕期女性,需要特别考虑对胎儿的伤害。尽管疗效相对较差,扑热息痛仍应作为一线药物,曲坦类药物仅可在专家的严格监督下使用。对于妊娠期偏头痛相关的恶心,可以使用甲氧普氯胺。由于可能对胎儿造成伤害,怀孕期最好避免使用预防性药物。如实在有必要,应使用安全性最高的普萘洛尔,如有普萘洛尔使用禁忌,则使用阿米替林,二者都应在专家监督下使用。禁用托吡酯、坎地沙坦和丙戊酸钠,皆会对胎儿造成伤害。

产后的偏头痛用药也须谨慎,扑热息痛是首选急性药物,布洛芬和舒马曲坦也是安全的。如果需要预防性治疗,首选安全性最高的普萘洛尔。

大约8%的偏头痛女性患者会出现与月经有关的偏头痛发作。如果急性药物治疗不能满足需要,考虑使用围经期预防性治疗,通常为每日使用长效非甾体抗炎药或曲坦类药物,持续5天,从预期的月经前2天开始。一些无先兆偏头痛女性患者可以从连续的复合激素避孕药中获益,但对有先兆偏头痛的女性患者则会增加中风风险,应禁用复合激素避孕药。

 

第七步:随访、治疗效果和治疗失败时

积极的随访是确定治疗效果的最优手段,应在在开始或更改治疗方案后(2-3个月后)评估治疗效果,并在之后定期进行(每6-12个月)。评估内容包括有效性、不良反应和依从性。有效性的关键指标为发作频率、严重程度和与偏头痛有关的功能障碍。发作频率的衡量标准为每月头痛天数,严重程度为疼痛强度而不是功能性后果。可以要求患者在头痛发作时记录下来形成疼痛日历,可以用较小的投入得到较好的随访效果。当结果未达最优标准时,重新检查诊断、治疗方案、剂量和依从性。

应慎重地得出治疗失败的结论,并在之后对可能的原因进行彻底的审查。有些失败是可以补救的,比如依从性较差或剂量不合适。有些人适合大剂量,也有些人需要减少剂量来减少副作用。如果所有治疗方案均失败,应考虑诊断是否错位并咨询专家意见。

 

第八步:治疗并发症

应尽早提醒患者用药过度可能引发MOH。药物过度使用引起的头痛(MOH)是一种慢性头痛疾病,特征为每月头痛15天及以上。停止用药是必要且唯一的补救措施。专家共识是突然戒断比缓慢戒断更可取,阿片类等有成瘾性的药物除外。由于康复前还会经历一段恶化过程,所以应特别注意患者教育。

注意间歇性偏头痛转变为慢性偏头痛的风险。一些评估数据表明,每年有3%的间歇性头痛会转变为慢性偏头痛,治疗也随之更困难,治疗时可寻求专家意见。排除MOH的可能后,开始预防性治疗。有效的药物包括托吡酯、肉毒杆菌毒素A和 CGRP 单克隆抗体。托吡酯成本较低可作为首选。具体用药应根据当地的指南、成本和报销政策决定。

 

第九步:识别和治疗合并症

确保识别出偏头痛的合并症,并根据不同药之间可能产生的不良反应和并发症情况调整治疗策略。

偏头痛常常与焦虑、抑郁、睡眠障碍和慢性疼痛(如颈部和下背部疼痛)相关联。肥胖则是间歇性偏头痛转变为慢性偏头痛的危险因素。对于肥胖患者,可首选托吡酯,因为它与体重减轻有关。对于抑郁或睡眠障碍的患者,可优先选择阿米替林。

 

第十步:长期随访

当进行至多6个月的预防性治疗,已可见持续效果且无不良反应,制订好全面的治疗计划后即可转至一级医院,由一级医院负责偏头痛患者的长期健康管理,任务包括保障疗效的稳定和应对病情变化。

 

以上所有建议都基于已发表的证据和专家意见,旨在为偏头痛诊疗提供普遍适用的建议,但在临床实践时注意结合当地情况对治疗策略进行调整。

 

原始出处:

Harrison, S.A., Ruane, P.J., Freilich, B.L. et al. Efruxifermin in non-alcoholic steatohepatitis: a randomized, double-blind, placebo-controlled, phase 2a trial. Nat Med 27, 1262–1271 (2021). https://doi.org/10.1038/s41591-021-01425-3

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    学习了

    0

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1066346, encodeId=0be1106634648, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=870e5601349, createdName=ms9000001971570488, createdTime=Tue Nov 02 20:09:12 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845862, encodeId=0ff81845862ad, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jul 29 06:51:17 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003223, encodeId=d15b100322303, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/938039c6a8dd44da88f12057ac560714/12320b429ac14066810455a5a10e4aa9.jpg, createdBy=4dea2051957, createdName=189****1979, createdTime=Wed Jul 28 07:35:34 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003091, encodeId=84831003091ec, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=34c15557901, createdName=司师傅, createdTime=Tue Jul 27 19:32:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003004, encodeId=fcaf1003004d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c0585383684, createdName=ms1000001573815791, createdTime=Tue Jul 27 14:37:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002987, encodeId=5b94100298e02, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210727/d027545c5fe24e5abcd4a88d24ae6cb7/24ea01514ea54b3e9cbbcbe6c40524c7.jpg, createdBy=c3ad5476755, createdName=西红柿子首富, createdTime=Tue Jul 27 13:04:53 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002985, encodeId=3b991002985cf, content=谢谢分享,好文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Tue Jul 27 12:40:34 CST 2021, time=2021-07-27, status=1, ipAttribution=)]
    2021-07-28 189****1979

    学习了!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1066346, encodeId=0be1106634648, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=870e5601349, createdName=ms9000001971570488, createdTime=Tue Nov 02 20:09:12 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845862, encodeId=0ff81845862ad, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jul 29 06:51:17 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003223, encodeId=d15b100322303, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/938039c6a8dd44da88f12057ac560714/12320b429ac14066810455a5a10e4aa9.jpg, createdBy=4dea2051957, createdName=189****1979, createdTime=Wed Jul 28 07:35:34 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003091, encodeId=84831003091ec, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=34c15557901, createdName=司师傅, createdTime=Tue Jul 27 19:32:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003004, encodeId=fcaf1003004d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c0585383684, createdName=ms1000001573815791, createdTime=Tue Jul 27 14:37:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002987, encodeId=5b94100298e02, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210727/d027545c5fe24e5abcd4a88d24ae6cb7/24ea01514ea54b3e9cbbcbe6c40524c7.jpg, createdBy=c3ad5476755, createdName=西红柿子首富, createdTime=Tue Jul 27 13:04:53 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002985, encodeId=3b991002985cf, content=谢谢分享,好文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Tue Jul 27 12:40:34 CST 2021, time=2021-07-27, status=1, ipAttribution=)]
    2021-07-27 司师傅

    厉害

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1066346, encodeId=0be1106634648, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=870e5601349, createdName=ms9000001971570488, createdTime=Tue Nov 02 20:09:12 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845862, encodeId=0ff81845862ad, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jul 29 06:51:17 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003223, encodeId=d15b100322303, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/938039c6a8dd44da88f12057ac560714/12320b429ac14066810455a5a10e4aa9.jpg, createdBy=4dea2051957, createdName=189****1979, createdTime=Wed Jul 28 07:35:34 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003091, encodeId=84831003091ec, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=34c15557901, createdName=司师傅, createdTime=Tue Jul 27 19:32:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003004, encodeId=fcaf1003004d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c0585383684, createdName=ms1000001573815791, createdTime=Tue Jul 27 14:37:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002987, encodeId=5b94100298e02, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210727/d027545c5fe24e5abcd4a88d24ae6cb7/24ea01514ea54b3e9cbbcbe6c40524c7.jpg, createdBy=c3ad5476755, createdName=西红柿子首富, createdTime=Tue Jul 27 13:04:53 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002985, encodeId=3b991002985cf, content=谢谢分享,好文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Tue Jul 27 12:40:34 CST 2021, time=2021-07-27, status=1, ipAttribution=)]
    2021-07-27 ms1000001573815791

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1066346, encodeId=0be1106634648, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=870e5601349, createdName=ms9000001971570488, createdTime=Tue Nov 02 20:09:12 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845862, encodeId=0ff81845862ad, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jul 29 06:51:17 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003223, encodeId=d15b100322303, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/938039c6a8dd44da88f12057ac560714/12320b429ac14066810455a5a10e4aa9.jpg, createdBy=4dea2051957, createdName=189****1979, createdTime=Wed Jul 28 07:35:34 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003091, encodeId=84831003091ec, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=34c15557901, createdName=司师傅, createdTime=Tue Jul 27 19:32:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003004, encodeId=fcaf1003004d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c0585383684, createdName=ms1000001573815791, createdTime=Tue Jul 27 14:37:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002987, encodeId=5b94100298e02, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210727/d027545c5fe24e5abcd4a88d24ae6cb7/24ea01514ea54b3e9cbbcbe6c40524c7.jpg, createdBy=c3ad5476755, createdName=西红柿子首富, createdTime=Tue Jul 27 13:04:53 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002985, encodeId=3b991002985cf, content=谢谢分享,好文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Tue Jul 27 12:40:34 CST 2021, time=2021-07-27, status=1, ipAttribution=)]
    2021-07-27 西红柿子首富

    好文章,谢谢分享

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1066346, encodeId=0be1106634648, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=870e5601349, createdName=ms9000001971570488, createdTime=Tue Nov 02 20:09:12 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1845862, encodeId=0ff81845862ad, content=<a href='/topic/show?id=5d2f206482e' target=_blank style='color:#2F92EE;'>#专家共识#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20648, encryptionId=5d2f206482e, topicName=专家共识)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Thu Jul 29 06:51:17 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003223, encodeId=d15b100322303, content=学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/938039c6a8dd44da88f12057ac560714/12320b429ac14066810455a5a10e4aa9.jpg, createdBy=4dea2051957, createdName=189****1979, createdTime=Wed Jul 28 07:35:34 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003091, encodeId=84831003091ec, content=厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=34c15557901, createdName=司师傅, createdTime=Tue Jul 27 19:32:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003004, encodeId=fcaf1003004d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c0585383684, createdName=ms1000001573815791, createdTime=Tue Jul 27 14:37:01 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002987, encodeId=5b94100298e02, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210727/d027545c5fe24e5abcd4a88d24ae6cb7/24ea01514ea54b3e9cbbcbe6c40524c7.jpg, createdBy=c3ad5476755, createdName=西红柿子首富, createdTime=Tue Jul 27 13:04:53 CST 2021, time=2021-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1002985, encodeId=3b991002985cf, content=谢谢分享,好文章。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Tue Jul 27 12:40:34 CST 2021, time=2021-07-27, status=1, ipAttribution=)]
    2021-07-27 yangchou

    谢谢分享,好文章。

    0

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J Headache Pain:依普奈珠单抗预防慢性偏头痛的有效性和安全性:PROMISE-2 III期研究结果

PROMISE-2是一项3期、随机、双盲、安慰剂对照研究,评估降钙素基因相关肽靶向单克隆抗体依普奈珠单抗(ALD403)重复静脉注射(IV)剂量对慢性偏头痛成人患者预防偏头痛的有效性和安全性。近日,研

BMJ:增加omega-3或减少 omega-6脂肪酸摄入,可以缓解偏头痛

降低饮食中的亚油酸会带来额外的好处。

Neurology:埃克汀珠单抗可有效减少慢性偏头痛患者每月偏头痛的天数

偏头痛是一种常见的致残性神经系统疾病,最棘手的是慢性偏头痛(CM)。人源化抗降钙素基因相关肽单克隆抗体--埃汀珠单抗是唯一被批准用于预防CM的药物,一项3期、多中心、随机、双盲、安慰剂对照、平行组研究

拓展阅读

干货 I 偏头痛筛查评估工具与热点解读汇总篇,收藏起来慢慢用!

偏头痛筛查评估工具、热点解读、研究进展汇总篇,收藏起来慢慢用!

专治“偏头痛”!这种口服疗法,使超50%人发作天数减少至少一半

一项研究(ELEVATE试验)结果显示,对于既往接受2~4类预防偏头痛的常规口服治疗无效、患有阵发性偏头痛的成人患者来说,atogepant 60 mg每天一次治疗有效且安全。

偏头痛评估量表:筛查、诊断、严重程度评估、偏头痛特异性生活质量量表、偏头痛失能程度评估问卷

偏头痛是一种常见的慢性发作性脑功能障碍性疾病,长期反复发作会导致严重的健康损失、生活质量下降和生产力的损耗,现已成为全球公共卫生的主要问题之一。《柳叶刀》杂志发布的“2019年全球疾病负担

解剖学分析:头痛

虽然头痛有使得大脑爆炸的感觉,但是脑组织本身没有产生疼痛的组织,这就意味着头痛是外周组织损伤将疼痛信号传递给大脑。因此,除外脑肿瘤,中风导致的头痛,大部分情况下,我们要关注脑外组织。

好文推荐 | 偏头痛与CVD的研究进展:复杂的生物学联系

本文将对现有的偏头痛和CVD相关联的证据以及可能的潜在机制进行简要综述。

2023 NICE 技术鉴定指南:瑞美吉泮治疗偏头痛【TA919】

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2023-10-18

2023 循证临床实践指南:偏头痛治疗性运动处方

国外神经内科相关专家小组(统称) · 2023-07-07

2023 NICE 技术鉴定指南:瑞美吉泮预防偏头痛[TA906]

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2023-07-05

FDA 指南:偏头痛的开发用于预防性治疗的药物

美国食品和药品监督管理局(FDA,Food and Drug Administration) · 2023-06-01