Special Conditions in Migraine Treatment (Status Migrainosus, Menstrual Migraine, Migraine During Pregnancy and Breastfeeding)

Autor: Marijana Bosnar Puretić
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Medicus
Volume 30
Issue 1 Migrena
ISSN: 1848-8315
1330-013X
Popis: Migrenski status je stanje perzistirajućega migrenskog napadaja trajanja dužeg od 72 sata. Liječenje se temelji na parenteralnoj primjeni analgetika, antimigrenika, antiemetika i nadoknadi tekućine. Kortikosteroidi smanjuju rizik od povrata glavobolje. Veća prevalencija migrena u žena objašnjava se povezanošću estrogena i patofizioloških mehanizama migrene. Prava menstrualna migrena javlja se isključivo u danima oko početka ciklusa i nije česta. Migrena povezana s menstruacijom javlja se na početku ciklusa, ali i u drugim danima ciklusa i znatno je češće pojavnosti. U liječenju akutnog napadaja koristi se standardna abortivna terapija. Profilaksa menstrualne migrene i migrene povezane s menstruacijom može biti kratkotrajna (mini-profilaksa) i počinje 2 dana prije i traje obično do 3. ili 4. dana ciklusa, a u tu se svrhu koriste nesteroidni antireumatici (naproksen), triptani ili hormonska terapija. Ako mini-profilaksa nije učinkovita, potrebno je započeti kontinuiranu profilaksu koja može biti klasična ili hormonska. Tijekom trudnoće i dojenja terapijske su mogućnosti ograničene zbog mogućega štetnog utjecaja lijeka na trudnoću i dijete. U akutnoj terapiji sigurni u svim stanjima su paracetamol, sumatriptan te metoklopramid. Profilaksa migrene tijekom trudnoće većinom nije potrebna jer obično nakon prvog tromjesečja dolazi do redukcije broja migrena zbog stabilno visokih razina estrogena, a ako je indicirana, sigurnom se smatra primjena propranolola. Tijekom dojenja moguća je akutna terapija gotovo svim uobičajenim lijekovima za migrenu osim opijatima i ergotaminskim preparatima, a veći je i spektar lijekova koji se mogu primijeniti radi profilakse migrene. Blokatori CGRP-a ili njegovog receptora nisu indicirani za profilaktičku terapiju tijekom trudnoće i dojenja.
Status migrainosus is a condition of prolonged and continuous migraine attack lasting longer than 72 hours. Treatment is based on parenteral use of analgesics, antimigraine agents, antiemetics and intravenous rehydration. Corticosteroids reduce the risk of headache recovery. The higher prevalence of migraines in women is a result of estrogen influence on migraine pathophysiology. A pure menstrual migraine is rare, and it occurs exclusively in the days around the beginning of the menstrual cycle. A menstrually-related migraine occurs at the beginning of the cycle, but also on other days of the cycle and is significantly more common. Standard abortive therapy is used for the treatment of acute attacks. A prophylaxis of menstrual migraine and menstrually-related migraine can be short-term, and mini-prophylaxis and NSAID (naproxen), triptans or hormone therapy from two days before and until the third or fourth day of menstruation are used for this purpose. If mini-prophylaxis is not effective, continuous prophylaxis is needed using standard prophylactic medications or hormonal therapy. During pregnancy and lactation, therapeutic options are limited due to safety concerns of the effect of the medication on pregnancy and the child. In acute therapy, paracetamol, sumatriptan and metoclopramide are safe in all conditions. Migraine prophylaxis during pregnancy is rarely indicated and then the use of propranolol is considered safe. During breastfeeding, the majority of medications for acute therapy are safe for the child, except opiates and ergotamine-based medications. Greater range of preventive drugs are compatible with breastfeeding. CGRP antagonists are not indicated for migraine prophylaxis during pregnancy and breastfeeding.
Databáze: OpenAIRE
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