List of migraine preventive treatment drugs, quickly collect!

*For medical professionals' reference only, this article lists 4 types of migraine preventive treatment drugs, with 3 types of drug recommendations for special groups
.

Migraine is a common disorder, usually occurring in young and middle-aged women, and is a chronic neurovascular disorder characterized by recurrent, severe, pulsating headaches on one or both sides, mostly on one side of the head , can cause cognitive decline, white matter lesions, asymptomatic cerebral infarction in the posterior circulation, etc.
, and can also be combined with autonomic nervous system dysfunction such as nausea, photophobia, vomiting, sound fear, etc.
, and can also be associated with anxiety and depression.
, is extremely dangerous
.

Treatment drugs usually include acute treatment drugs and preventive treatment drugs.
There are many kinds of drugs, and the precautions are complicated.
The author combines his own clinical experience and collects relevant literature.
Summarize the matter, in order to give readers some help
.

The pathogenesis of migraine may be related to meningeal vasodilation, neurogenic inflammation, central sensitization, and cortical spreading inhibition.
Its preventive drug treatment can reduce the frequency, severity and duration of migraine attacks, and can improve acute Many of these migraine prophylactic drugs work by inhibiting central sensitization and improve quality of life
.

The types of preventive drugs mainly include non-steroidal anti-inflammatory drugs (NSAIDs), non-specific calcium ion antagonists (flunarizine), antiepileptic drugs, beta-receptor antagonists, antidepressants, magnesium-containing drugs, calcium-lowering drugs Gene-related peptide (CGRP) monoclonal antibody, injection of botulinum toxin type A,
etc.

How are the guidelines recommended? "China Migraine Prevention and Control Guidelines" (2016) pointed out that the class A recommended migraine preventive treatment drugs are flunarizine, valproic acid, topiramate, metoprolol, propranolol, and class B recommended gabapentin , bisoprolol, amitriptyline, naproxen, aspirin, candesartan, lisinopril, magnesium salts, riboflavin, coenzyme Q10
.

The "Chinese Expert Consensus on Diagnosis and Treatment of Migraine and Depressive Disorders" (2020) pointed out that the class A recommended preventive treatment drugs for migraine are flunarizine, valproic acid, topiramate, metoprolol, propranolol ; Grade B recommended gabapentin, bisoprolol, venlafaxine, amitriptyline, candesartan, lisinopril
.

(Level A: highly recommended, with definite efficacy, and balanced efficacy and safety; level B: recommended, with poor balance of efficacy/efficacy and safety) Table 1.
Inventory of preventive treatment drugs for migraine recommended by the guideline Most drugs need to be taken 3- 4 weeks to get a specific dose of treatment response
.

▌ ①Non-specific calcium ion antagonists are commonly used preventive treatment drugs for migraine, such as flunarizine, which have a selective relaxation effect on cerebral blood vessels, which can significantly reduce the degree of headache and the frequency of headache
.

It can cause drowsiness, weight gain, depression, extrapyramidal symptoms, etc.
It is forbidden for those with depressive disorder and extrapyramidal symptoms
.

▌ ②Anti-epileptic drugs are common preventive treatments for migraine, which mainly exert analgesic effect by blocking cortical spreading inhibition and reducing central sensitivity
.

Topiramate and valproic acid are the only antiepileptic drugs approved by the US FDA for the treatment of migraine
.

■ Topiramate is effective for episodic and chronic migraine, and may also be effective for drug overdose headache, which can cause drowsiness, ataxia, balance disturbance, weight loss, paresthesia, cognitive and language impairment, etc.
It is contraindicated for those allergic to sulfa
.

■ Valproic acid is effective in migraine prevention without increasing the risk of depression, and can cause nausea, lethargy, sedation, weight gain, hair loss, fatigue, tremor, ovarian dysfunction (eg, polycystic ovary syndrome), hyperammonemia, Abnormal liver function, etc.
, liver disease is prohibited
.

■ Gabapentin calcium channel regulator, has the effect of blocking calcium channels, can reduce membrane potential changes, can relieve pain, and inhibit hyperalgesia and central sensitization, and can also improve sleep and emotional disorders
.

It can cause nausea, vomiting, drowsiness, dizziness, convulsions, ataxia, etc.
It is contraindicated in patients with acute pancreatitis and severe heart failure
.

▌ ③The effect of beta-blockers in the preventive treatment of migraine is clear, and the evidence is relatively sufficient for propranolol and metoprolol, which have a direct impact on cerebrovascular and can reduce the severity and frequency of headaches
.

It should be noted that the use of beta-blockers in people with affective disorders may cause depression and even suicidal tendencies, and caution should be used when using depressive disorders
.

■ Propranolol can cause diarrhea, constipation, vomiting, insomnia, nightmares, hypotension, slow heart rate such as bradycardia, depression, cold hands and feet, asthma attack, respiratory tract infection, hypoglycemia, changes in myocardial enzymes, etc.
Hypotension, heart failure, II-III degree atrioventricular block, sick sinus syndrome, bradycardia, cardiogenic shock, hypoglycemia tendency or family history, Raynaud's syndrome, pheochromocytoma are contraindicated
.

■ Metoprolol can cause gastrointestinal reactions, bradycardia, heart failure, heart block, hypotension, drowsiness, dizziness, depression, weakness, decreased exercise tolerance, skin itching, rash, etc.
It is contraindicated in sick sinus Nodal syndrome, cardiogenic shock, II-III degree AV block, symptomatic bradycardia or hypotension, unstable decompensated heart failure (pulmonary edema, hypoperfusion, or hypotension), concomitant Severe peripheral vascular disease at risk of gangrene
.

■ Bisoprolol may be effective, it can cause gastrointestinal symptoms, dizziness, headache, bradycardia, hypotension, cold or numb extremities, weakness, fatigue, etc.
It is contraindicated in acute heart failure or in heart failure decompensation Period requiring intravenous inotropes, cardiogenic shock, sick sinus syndrome, II-III degree AV block, sinoatrial block, severe bronchial asthma, Raynaud's syndrome, untreated pheochromocytoma, severe peripheral arterial occlusive disease, metabolic acidosis,
etc.

In older adults with diabetes, glucose tolerance may be impaired and mask hypoglycemia
.

▌ ④The antidepressant drug 5-hydroxytryptamine (5-HT) and the noradrenergic system are involved in the pathogenesis of migraine.
Antidepressant drugs mainly target one or two substances in these systems to prevent migraine.
Therefore, drugs that inhibit the reuptake of norepinephrine and 5-HT at the same time are better than drugs that inhibit the reuptake of 5-HT amine alone in the treatment of migraine
.

The tricyclic antidepressants (TCAs) amitriptyline, 5-HT, and the norepinephrine reuptake inhibitors (SNRIs) venlafaxine are approved for the preventive treatment of migraine
.

■ Amitriptyline is a drug with relatively clear therapeutic effect, which can block the reuptake of norepinephrine and 5-HT by noradrenergic and 5-HT nerve endings at the same time, and has anticholinergic, antihistamine, antagonistic Alpha1 receptors, also block sodium, calcium and potassium channels, relieve pain, and improve mood and sleep
.

Can cause dry mouth, cognitive impairment, somnolence, excessive sedation, weight gain, cardiotoxicity (eg, sinus tachycardia, increased ventricular ectopic beat, orthostatic hypotension, myocardial ischemia, and even sudden cardiac death), gait exception,
etc.

Avoid use by those at risk of ischemic heart disease or sudden cardiac death
.

Glaucoma, urinary retention are disabled
.

Use with caution in high-risk patients such as prostatic hyperplasia or hypertrophy and suicide
.

It is forbidden to use in combination with 5-HT enhancers and monoamine oxidase inhibitors
.

■ Venlafaxine is often used in first-line migraine prophylaxis failures.
It relieves pain by selectively inhibiting reuptake of 5-HT and norepinephrine.
It also improves mood and sleep, and can maintain or lose weight.
Its efficacy is comparable to that of amitriptyline in preventing migraine, but its safety is better than that of amitriptyline
.

Can cause nausea, sweating, dry mouth, headache, tremors, anxiety, increased bleeding risk,
etc.

Use with caution in patients with angle-closure glaucoma, epilepsy, severe heart disease, high blood pressure, and blood disease
.

It is forbidden to use in combination with monoamine oxidase inhibitors and 5-HT enhancers
.

The selection of preventive treatment drugs for migraine in special populations such as migraine with epilepsy, migraine with depression, migraine with abnormal blood sugar
.

▌ ① Migraine with epilepsy Valproic acid and topiramate can be used to treat epilepsy and are also the recommended first-line drugs for migraine prevention.
Therefore, it is recommended to choose these two antiepileptic drugs (AEDs) to treat migraine with epilepsy
.

Tricyclic antidepressants (TCAs) such as amitriptyline may induce epilepsy and should be used with caution in patients with migraine and epilepsy
.

▌ ② Migraine combined with depression The antidepressant drugs amitriptyline and venlafaxine can be used to treat depression and prevent migraine.
Amitriptyline is especially suitable for those with tension headache or depression
.

The non-specific calcium ion antagonist flunarizine can cause depression and is contraindicated in patients with depressive disorder
.

The antiepileptic drug topiramate increases the risk of occurrence and recurrence of depression and should be used with caution in patients with depressive disorders
.

The relationship between beta-blockers and depressive disorders has been controversial and should be used with caution in patients with depressive disorders
.

▌ ③ For migraine patients with abnormal blood sugar, β-blockers can cause hyperglycemia, make blood sugar difficult to control, and increase the incidence of new-onset diabetes
.

Nonselective beta-blockers such as propranolol can aggravate diabetic peripheral vascular disease and are not suitable for diabetic patients
.

α1/β receptor blockers should be used with caution in patients with obstructive diabetic nephropathy, patients with insufficiently controlled diabetes, and contraindicated in patients with diabetic ketosis
.

Beta-blockers can cause hypoglycemia and mask symptoms of hypoglycemia such as palpitations
.

Beta-blockers should be used with caution in patients with recurrent hypoglycemia, so as not to mask the symptoms of hypoglycemia
.

Propranolol is contraindicated in those with a tendency or family history of hypoglycemia
.

Alpha1/beta blockers should be used with caution in idiopathic hypoglycemia
.

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