Tratamento preventivo e abortivo da migrânea com medicamentos tradicionais. O estado da arte
DOI:
https://doi.org/10.48208/HeadacheMed.2023.27Palavras-chave:
Enxaqueca, Tratamento, Tratamento preventivo, Tratamento abortivoResumo
Introdução
A migrânea é uma doença neurológica crônica, com prevalência de 15,2% no Brasil. É 2,2 vezes mais prevalente em mulheres, predominantemente na faixa etária de 18 a 50 anos. Seu mecanismo fisiopatológico ainda não está completamente esclarecido. Possivelmente, os ataques e sintomas de dor de cabeça estão associados à depressão alastrante cortical, ao sistema trigeminovascular, à inflamação neurogênica, à vasodilatação e à vulnerabilidade genética.
Objetivo
Esta é uma revisão narrativa do tratamento preventivo e abortivo da migrânea.
Comentários
O tratamento da migrânea baseia-se em três pilares: educação do paciente, tratamento da própria doença ou prevenção de crises e tratamento agudo das crises de cefaleia. As classes terapêuticas de medicamentos tradicionais utilizados na prevenção da enxaqueca são betabloqueadores, antidepressivos tricíclicos, antagonistas ou bloqueadores dos canais de cálcio e neuromoduladores anticonvulsivantes. Os medicamentos específicos utilizados no tratamento de crises de dor de cabeça são triptanos ou agonistas do receptor serotoninérgico 5-HT1B/1D, ditans ou agonistas do receptor 5-HT1F e gepants ou antagonistas do receptor CGRP.
Conclusão
Os medicamentos tradicionais utilizados no tratamento preventivo ou abortivo da migrânea são considerados eficazes. Através da modulação dos mecanismos da doença, há redução na frequência, intensidade e duração das crises de cefaleia, e também na incapacidade causada pela cefaleia. Tudo isso para melhorar a qualidade de vida dos pacientes. As classes terapêuticas de medicamentos tradicionais utilizados na prevenção da migrânea são betabloqueadores, antidepressivos tricíclicos, antagonistas ou bloqueadores dos canais de cálcio e neuromoduladores anticonvulsivantes. Os medicamentos específicos utilizados no tratamento de crises de cefaleia são triptanos ou agonistas do receptor serotoninérgico 5-HT1B/1D, ditans ou agonistas do receptor 5-HT1F e gepants ou antagonistas do receptor CGRP.
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Referências
Queiroz LP, Peres MFP, Piovesan EJ, Kowacs F, Ciciarelli MC, Souza JA, ... and Zukerman E. A nationwide population-based study of migraine in Brazil. Cephalalgia 2009;29(6):642-649 Doi:10.1111/j.1468-2982.2008.01782.x. DOI: https://doi.org/10.1111/j.1468-2982.2008.01782.x
Sanvito WL and Monzillo PH. O livro das cefaleias. São Paulo: Atheneu, 2001.
Headache Classification Subcommittee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211 Doi:10.1177/0333102417738202. DOI: https://doi.org/10.1177/0333102417738202
Affaitati G, Costantini R, Tana C, Cipollone F and Giamberardino MA. Co-occurrence of pain syndromes. J Neural Transm (Vienna) 2020;127(4):625-646 Doi:10.1007/s00702-019-02107-8. DOI: https://doi.org/10.1007/s00702-019-02107-8
Katsarava Z, Buse DC, Manack AN and Lipton RB. Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep 2012;16(1):86-92 Doi:10.1007/s11916-011-0233-z. DOI: https://doi.org/10.1007/s11916-011-0233-z
Onder H, Hamamci M, Alpua M and Ulusoy EK. Comorbid fibromyalgia in migraine patients: Clinical significance and impact on daily life. Neurol Res 2019;41(10):909-915 Doi:10.1080/01616412.2019.1630164. DOI: https://doi.org/10.1080/01616412.2019.1630164
Silberstein S, Loder E, Diamond S, Reed ML, Bigal ME, Lipton RB, … and AMPP Advisory Group. Probable migraine in the United States: results of the American Migraine Prevalence and Prevention (AMPP) study. Cephalalgia 2007;27(3):220-229 Doi:10.1111/j.1468-2982.2006.01275.x. DOI: https://doi.org/10.1111/j.1468-2982.2006.01275.x
Steiner TJ, Stovner LJ, Vos T, Jensen R and Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain 2018;19(1):17 Doi:10.1186/s10194-018-0846-2. DOI: https://doi.org/10.1186/s10194-018-0846-2
Diamond S, Bigal ME, Silbertein S, Loder E, Reed M and Lipton RB. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: Results from the American Migraine Prevalence and Prevention study. Headache 2007;47(3):355-363 Doi:10.1111/j.1526-4610.2006.00631.x. DOI: https://doi.org/10.1111/j.1526-4610.2006.00631.x
Silberstein SD. Migraine. Lancet 2004;363(9406):381-391 Doi:10.1016/S0140-6736(04)15440-8. DOI: https://doi.org/10.1016/S0140-6736(04)15440-8
Shaik MM, Hassan NB, Tan HL and Gan SH. Quality of life and migraine disability among female migraine patients in a tertiary hospital in Malaysia. Biomed Res Int 2015;2015:523717 Doi: 0.1155/2015/523717. DOI: https://doi.org/10.1155/2015/523717
Bussone G. Pathophysiology of migraine. Neurol Sci 2004;25(Suppl 3):239-241 Doi:10.1007/s10072-004-0295-3. DOI: https://doi.org/10.1007/s10072-004-0295-3
Recober A. Pathophysiology of migraine. Continuum (Minneap Minn) 2021;27(3):586-596 Doi:10.1212/CON.0000000000000983. DOI: https://doi.org/10.1212/CON.0000000000000983
Mathew AN and Panonnummal R. Cortical spreading depression: culprits and mechanisms. Exp Brain Res 2022;240(3):733-749 Doi:10.1007/s00221-022-06307-9. DOI: https://doi.org/10.1007/s00221-022-06307-9
Close LN, Eftekhari S, Wang M, Charles AC and Russo AF. Cortical spreading depression as a site of origin for migraine: Role of CGRP. Cephalalgia 2019;39(30):428-434 Doi:10.1177/0333102418774299. DOI: https://doi.org/10.1177/0333102418774299
Russell MB and Olesen J. Increased familial risk and evidence of genetic factor in migraine. BMJ 1995;311(7004):541-544 Doi:10.1136/bmj.311.7004.541. DOI: https://doi.org/10.1136/bmj.311.7004.541
Krymchantowski AV. Condutas em cefaleia: Avaliação e tratamento. São Paulo: Lippincott Williams & Wilkins, 2008:32-87.
Eigenbrodt AK, Ashina H, Khan S, Diener HC, Mitsikostas DD, Sinclair AJ, ... and Ashina M. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021;17(8):501-514 Doi:10.1038/s41582-021-00509-5. DOI: https://doi.org/10.1038/s41582-021-00509-5
Lipton RB and Bigal ME. Migraine: epidemiology, impact and risk factors for progression. Headache 2005;45(Suppl 1):S3-S13 Doi:10.1111/j.1526-4610.2005.4501001.x. DOI: https://doi.org/10.1111/j.1526-4610.2005.4501001.x
Harpe J, Bernstein C and Harriott A. Migraine and infertility, merging concepts in women's reproductive health: A narrative review. Headache 2022;62(10):1247-1255 Doi:10.1111/head.14402. DOI: https://doi.org/10.1111/head.14402
Spierings EL. Preventive pharmacological treatment. In: Management of migraine. Butterworth-Heinemann, 1996:65-104.
Souza WPO, Fortes YML, Soares AA and Silva-Néto RP. Propranolol: A migraine prophylactic since the 1960s. Headache Medicine 2023;14(1):00-00. DOI: https://doi.org/10.48208/HeadacheMed.2023.2
Saper JR, Silberstein SD, Gordon D and Hamel R. Handbook of headache management. Baltimore: Williams & Wilkins, 1993;53-82.
Lance JW. Migraine Prophylaxis – Indication for drug therapy. In: Diener H-C. (Ed.) Drug treatment of migraine and other headaches. Monograms in Clinical Neuroscience. Basel: Karger, 2000:250-255. DOI: https://doi.org/10.1159/000061595
Couch JR and Hassanein RS. Amitriptyline in migraine prophylaxis. Arch Neurol 1979;36(11):695-699 Doi:10.1001/archneur.1979.00500470065013. DOI: https://doi.org/10.1001/archneur.1979.00500470065013
Punay NC and Couch JR. Antidepressants in the treatment of migraine headache. Curr Pain Headache Rep 2003;7(1):51-54 Doi:10.1007/s11916-003-0010-8. DOI: https://doi.org/10.1007/s11916-003-0010-8
Gomersall JD and Stuart A. Amitriptyline in migraine prophylaxis. Changes in pattern of attacks during a controlled clinical trial. J Neurol Neurosurg Psychiatry 1973;36(4):684-690 Doi:10.1136/jnnp.36.4.684. DOI: https://doi.org/10.1136/jnnp.36.4.684
Ye Q, Yan LY, Xue LJ, Wang Q, Zhou ZK, Xiao H, … and Wan Q. Flunarizine blocks voltage-gated Na+ and Ca2+ currents rat cortical neurons: A possible locus of action in the prevention of migraine. Neurosci Lett 2011;487(3):394-399 Doi:10.1016/j.neulet.2010.10.064. DOI: https://doi.org/10.1016/j.neulet.2010.10.064
Bassi P, Brunati L, Rapuzzi B, Alberti E and Mangioni A. Low-dose flunarizine in the prophylaxis of migraine. Headache 1992;32(8)390-393 Doi:10.1111/j.1526-4610.1992.hed3208390.x. DOI: https://doi.org/10.1111/j.1526-4610.1992.hed3208390.x
Silberstein SD, Saper JR and Freitag FG. Migraine: Diagnosis and Treatment. In: Silberstein SD, Lipton RB and Dalesiio DJ (Eds.). Wolff’s headache and other head pain, 7th Edition. New York: Oxford, 2001:121-237.
Gabai IJ and Spierings EL. Prophylactic treatment of cluster headache with verapamil. Headache 1989;29(3)167-168 Doi:10.1111/j.1526-4610.1989.hed2903167.x. DOI: https://doi.org/10.1111/j.1526-4610.1989.hed2903167.x
Krymchantowski AV and Moreira PF. Atualização no tratamento profilático das enxaquecas. Arq Neuropsiquiatr 1999;57(2B):513-519 Doi:10.1590/S0004-282X1999000300027. DOI: https://doi.org/10.1590/S0004-282X1999000300027
Li F, Qiu E, Dong Z, Liu R, Wu S and Yu S. Protection of flunarizine on cerebral mitochondria injury induced by cortical spreding depression under hypoxic conditions. J Hedache Pain 2011;12(1):47-53 Doi:10.1007/s10194-011-0300-1. DOI: https://doi.org/10.1007/s10194-011-0300-1
Ambrosio C and Stefanini E. Interaction of flunarizine with dopamine D2 and D1 recptors. Eur J Pharmacol 1991;197(2):221-223 Doi:10.1016/0014-2999(91)90526-v. DOI: https://doi.org/10.1016/0014-2999(91)90526-V
Dodick DW. Acute and prophylactic management of migraine. Clin Cornerstone 2004;4(3):36-49 Doi:10.1016/s1098-3597(01)90038-9. DOI: https://doi.org/10.1016/S1098-3597(01)90038-9
Silberstein SD and Collins SD. Safety of divalproex sodium in migraine prophylaxis: an open-label, long-term study. Long-term safety of Depakote in headache prophylaxis study group. Headache 1999;39(9):633-643 Doi:10.1046/j.1526-4610.1999.3909633.x. DOI: https://doi.org/10.1046/j.1526-4610.1999.3909633.x
Mathew NT, Saper JR, Silberstein SD, Rankin L, Markley HG, Solomon S, … and Deaton RL. Migraine prophylaxis with divalproex. Arch Neurol 1995;52(3):281-286 Doi:10.1001/archneur.1995.00540270077022. DOI: https://doi.org/10.1001/archneur.1995.00540270077022
Cutrer FM and Moskowitz MA. Wolff Award 1996. The actions of valproate and neurosteroids in a model of trigeminal pain. Headache 1996;36(10):579-585 Doi:10.1046/j.1526-4610.1996.3610579.x. DOI: https://doi.org/10.1046/j.1526-4610.1996.3610579.x
Pelloch JM and Willmore LJ. A rational guide to routine blood monitoring in patients receiving antiepileptic drugs. Neurology 1991;41(7):961-964 Doi:10.1212/wnl.41.7.961. DOI: https://doi.org/10.1212/WNL.41.7.961
Krymchantowski AV, Jevoux C and Krymchantowski AG. Sodium divalproate in low alternating daily doses for migraine prevention: A retrospective study. Headache 2019;59(7):1080-1083 Doi:10.1111/head.13579. DOI: https://doi.org/10.1111/head.13579
Dodgson SJ, Shank RP and Maryanoff BE. Topiramate as an inhibitor of carbonic anhydrase isoenzymes. Epilepsia 2000;41(S1):35-39 Doi:10.1111/j.1528-1157.2000.tb06047.x. DOI: https://doi.org/10.1111/j.1528-1157.2000.tb02169.x
Silberstein SD. Topiramate in migraine prevention. Headache 2005;45(Suppl 1):S57-S65 Doi:10.1111/j.1526-4610.2005.4501005.x. DOI: https://doi.org/10.1111/j.1526-4610.2005.4501005.x
Shachter SC. Epilepsy. Neurol Clin 2001;19(1):57-78 Doi:10.1016/s0733-8619(05)70005-0. DOI: https://doi.org/10.1016/S0733-8619(05)70005-0
Edwards KR, Glautz MJ and Shea P. Topiramate for migraine prophylaxis: a double-blind, randomized, placebo controlled study. Headache 2000,40(5):407-411 Doi:10.1046/j.1526-4610.2000.000065.x. DOI: https://doi.org/10.1046/j.1526-4610.2000.000065.x
Silberstein SD, Neto W, Schmitt J, Jacobs and D. MIGR-001 Study Group. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol 2004;61(4):490-495 Doi:10.1001/archneur.61.4.490. DOI: https://doi.org/10.1001/archneur.61.4.490
Brandes JL, Saper JR., Diamond M, Couch JR, Lewis DW, Schmitt J, … and MIGR-002 Study Group. Topiramate for migraine prevention: a randomized controlled trial. JAMA 2004;291(8):965-973 Doi:10.1001/jama.291.8.965. DOI: https://doi.org/10.1001/jama.291.8.965
Lainez MJ, Freitag F, Pfeil J and Schwalen S. Characterizing the time course of adverse events associated with the use of topiramate for migraine prevention. In: Proceedings of 8th Congress of European Headache Federation, 2006 Apr 26-29, Valencia, Spain. J Headache Pain 2006;7(Suppl 1):44 Doi:10.1007/s10194-006-0279-1. DOI: https://doi.org/10.1007/s10194-006-0279-1
Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C and Akerman S. Pathophysiology of migraine: A disorder of sensory processing. Physiol Rev 2017;97(2):553-622 Doi:10.1152/physrev.00034.2015. DOI: https://doi.org/10.1152/physrev.00034.2015
Ferrari MD and Haan J. Drug treatment of migraine attacks. In: Headache. Blue Books of Practical Neurology. Goadsby P, Silberstein SD (eds) Newton: Butterworth-Heinemann, 1997:117-130.
Vanderpluym JH, Singh RBH, Urtecho M, Morrow AS, Nayfeh T, Roldan VDT, … and Wang Z. Acute treatments for episodic migraine in adults: A systematic review and meta-analysis. JAMA 2021;325(23):2357-2369 Doi:10.1001/jama.2021.7939. DOI: https://doi.org/10.1001/jama.2021.7939
Tfelt-Hansen P and Mcewen J. Nonsteroidal antiinflammatory drugs in the acute treatment of migraine. In: Olesen J, Tfelt-Hansen P and Welch KMA (eds). The Headaches. 2nd Edition. Philadelphia: Lippincott-Raven, 2000:391-397.
Bigal ME, Krymchantowski AV and Hargreaves R. The triptans. Expert Rev Neurother 2009;9(5);649-659 Doi:10.1586/ern.09.15. DOI: https://doi.org/10.1586/ern.09.15
Bigal ME, Lipton RB and Krymchantowski AV. The medical management of migraine. Am J Ther 2004;11(2):130-140 Doi:10.1097/00045391-200403000-00008. DOI: https://doi.org/10.1097/00045391-200403000-00008
Hughes AM, Dixon R, Dane A, Kemp J, Cummings L and Yates RA. Effects of zolmitriptan (Zomig) on central serotonergic transmission as assessed by active oddball auditory event-related potentials in volunteers without migraine. Cephalalgia 1999;19(2):100-106 Doi:10.1046/j.1468-2982.1999.019002100.x DOI: https://doi.org/10.1046/j.1468-2982.1999.019002100.x
Goadsby PJ. Treatment of acute migraine attacks with naratriptan. In: Diener HC (ed). Drug treatment of migraine and other headaches. Mongr Clin Neurosci. Basel: Karger, 2000:134-140 Doi:10.1159/000061583. DOI: https://doi.org/10.1159/000061583
Mathew NT, Asgharnejad M, Peykamian M and Laurenza A. Naratriptan is effective and well tolerated in the acute treatment of migraine. Results of a double blind, placebo-controlled, crossover study. The Naratriptan S2WA3003 Study Group. Neurology 1997;49(6):1485-1490 Doi:10.1212/WNL.49.6.1485. DOI: https://doi.org/10.1212/WNL.49.6.1485
Krymchantowski AV and Bigal ME. Rizatriptan in migraine. Expert Rev Neurother 2005;5(5):597-603 Doi:10.1586/14737175.5.5.597. DOI: https://doi.org/10.1586/14737175.5.5.597
Krymchantowski AV and Jevoux CC. Low-dose topiramate plus sodium divalproate for positive responders intolerant to full-dose monotherapy. Headache 2012;52(1):129-132 Doi:10.1111/j.1526-4610.2011.02035.x. DOI: https://doi.org/10.1111/j.1526-4610.2011.02035.x
Krymchantowski AV, Jevoux CC and Bigal ME. Topiramate plus nortriptyline in the preventive treatment of migraine: a controlled study for nonresponders. J Headache Pain 2012;13(1):53-59 Doi:10.1007/s10194-011-0395-4. DOI: https://doi.org/10.1007/s10194-011-0395-4
Krymchantowski AV and Jevoux CC. The experience of combining agents, specially triptans and non steroidal anti-inflammatory drugs, for the acute treatment of migraine - a review. Recent Pat CNS Drug Discov 2007;2(2):141-144 Doi:10.2174/157488907780832733. DOI: https://doi.org/10.2174/157488907780832733
Krymchantowski AV. The use of combination therapies in the acute management of migraine. Neuropsychiatr Dis Treat 2006;2(3):293-297 Doi:10.2147/nedt.2006.2.3.293. DOI: https://doi.org/10.2147/nedt.2006.2.3.293
Krymchantowski AV, Moreira Filho PF and Bigal ME. Rizatriptan vs. rizatriptan plus trimebutine for the acute treatment of migraine: a double-blind, randomized, cross-over, placebo-controlled study. Cephalalgia 2006;26(7):871-874 Doi:10.1111/j.1468-2982.2006.01136.x. DOI: https://doi.org/10.1111/j.1468-2982.2006.01136.x
Krymchantowski AV and Bigal ME. Polytherapy in the preventive and acute treatment of migraine: fundamentals for changing the approach. Expert Rev Neurother 2006;6(3);283-289 Doi:10.1586/14737175.6.3.283. DOI: https://doi.org/10.1586/14737175.6.3.283
Krymchantowski AV. Acute treatment of migraine. Breaking the paradigm of monotherapy. BMC Neurol 2004;28(4):4 Doi:10.1186/1471-2377-4-4. DOI: https://doi.org/10.1186/1471-2377-4-4
Krymchantowski AV and Moreira PF. Subcutaneous sumatriptan 3mg + rectal indomethacin 50mg for severe refractory migraine attacks: an open pilot study. J Headache Pain 2006;7(Suppl 1):S60 Doi:10.1111/j.1526-4610.2006.00490.
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