偏头痛乌灵65 ppt课件.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 这是比较粗略的头痛分类。紧张型头痛属于原发性头痛。 * * * * * * Pathophysiology of Migraine. Migraine involves dysfunction of brain-stem pathways that normally modulate sensory input. The key pathways for the pain are the trigeminovascular input from the meningeal vessels, which passes through the trigeminal ganglion and synapses on secondorder neurons in the trigeminocervical complex. These neurons, in turn, project through the quintothalamic tract, and after decussating in the brain stem, form synapses with neurons in the thalamus. There is a reflex connection between neurons in the pons in the superior salivatory nucleus, which results in a cranial parasympathetic outflow that is mediated through the pterygopalatine, otic, and carotid ganglia. This trigeminal–autonomic reflex is present in normal persons 34 and is expressed most strongly in patients with trigeminal–autonomic cephalgias, such as cluster headache and paroxysmal hemicrania; it may be active in migraine. Brain imaging studies suggest that important modulation of the trigeminovascular nociceptive input comes from the dorsal raphe nucleus, locus ceruleus, and nucleus raphe magnus. * * * * * * * * * * * * * * * * * * 偏头痛急性治疗的分类 一般止痛剂 如：去痛片 非甾体抗炎药物 阿司匹林 300~600mg q6h 扑热息痛 1.0(max) q6h 布洛芬 200~400mg q4~6h 止痛剂与抗焦虑药物联合 麦角制剂 麦角胺咖啡因 双氢麦角胺 特异性5-HT1B/1D激动剂 Triptans”： 英明格 NO合酶抑制剂 L-NMMA 曲坦类药物： 作用在三叉血管神经末端的5－HT 1D/1F受体，使其活化，抑制神经介质释放，减轻痛性颅脑血管扩张。通过颅脑血管的1B受体，引起血管收缩。也有镇吐作用，减轻怕光怕声。 禁用于冠心病、脑血管病和未经治疗的高血压病。 孕妇最好不用。 CGRP受体拮抗剂BIBN4096BS Jes Olesen, et al. N Engl J Med 2004;350:1104-1110 ２.５mg IV　有效率66％ (安慰剂27%) 副作用25% (安慰剂12%) 最常见的副反应是感觉异常，没有严重的副作用。 结论： CGRP受体拮抗剂－－BIBN4096BS是偏头痛 急性发作的有效治疗药物。 1. 逐步治疗 首先采用一线治疗（简单的止痛药物，如非甾体抗炎药物），如果效果不好，再用二线治疗（止痛药物联合治疗），如果仍不能控制，采用三线治疗（偏头痛的特异治疗药物，例如triptan类）。 2.多次发作的阶梯式治疗： 第1～3次发作， ASA类 第4～6次发作， 曲坦类