课件：头痛李通.ppt

恶心是偏头痛突出症状, 也是药物常见副作用 ? 合用止吐剂(如胃复胺10mg 肌肉注射) ? 严重呕吐可给予小剂量奋乃静、氯丙嗪 麦角生物碱曲坦类是强力血管收缩剂 严重高血压心脏病患者禁忌 治疗 1. 发作期治疗 ? 适用于频繁发作, 尤其1次/week以上 严重影响正常生活工作 ? 急性期麦角生物碱治疗不能耐受禁忌的患者 治疗 心得安\阿米替林\丙戊酸是治疗的支柱 2. 预防性治疗 β-受体阻滞剂 心得安(propranolol)5~20mg, 2~3次/d; 有效率约50% 小剂量开始逐渐增加, 以心率不60次/min为限 治疗 副反应: 抑郁\低血压\不能耐受活动\阳痿等 禁忌证: 哮喘\房室传导阻滞\心力衰竭病史 2. 预防性治疗 (2) 抗抑郁药 发作频繁偏头痛合并紧张性头痛用 阿米替林(amitriptiline) 丙咪嗪(imipramine) 舍曲林(sertraline) 氟西汀(fluoxetine) 治疗 阿米替林抗胆碱能作用可并发青光眼前列腺疾病 2. 预防性治疗 (3) 抗癫痫药 ? 丙戊酸(valproate)成人400~600mg/d, 小剂量开始 逐渐加量, 妊娠时禁忌 ? 卡马西平(carbamazepine) ? 托吡酯(topiramate) ? 加巴贲丁（gabapendine） 治疗 2. 预防性治疗 (4) 钙通道拮抗剂 ? 普通型典型偏头痛均有效 ? 氟桂利嗪(flunarizine)5mg口服, 每晚1次 ? 尼莫地平(nimodipine)20~40mg口服, 2~3次/d ? 异博定尼卡地平 治疗 硝苯地平无效 2. 预防性治疗 THANK YOU SUCCESS * * 可编辑 数分钟至1小时 These comparative prevalence estimates point to the relative importance of migraine and its impact on health in the United States. Disease prevalence data was found on the Centers for Disease Control and Prevention’s Health Topics Web Site and the Arthritis Foundation Web Site. Current US population statistics were found on the US Census Bureau Web Site. Respondents were asked to self-report the severity of their headaches on this 4-item scale. Eighty percent of these symptom-defined sufferers reported severe or extremely severe headaches. In this question respondents were asked, “How are you usually affected by your severe headaches?” There were 4 response choices : Able to work/function normally Working ability or activity impaired to some degree Working ability or activity severely impaired Bed rest required The severe impairment and bed rest codes were combined for this analysis. In 1999, over half of migraine sufferers reported that they were severely disabled or required bed rest and 92% had some disability. The distribution of impairment scores look similar, but there was a statistically significant (p.05) shift toward higher levels of impairment between 1989 and 1999. This finding is surpr