medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-511medsovet-9720Research ArticleГОЛОВНАЯ БОЛЬ И ГОЛОВОКРУЖЕНИЕHEADACHE AND VERTIGOТревога и первичные головные болиAnxiety and primary headacheshttps://orcid.org/0000-0003-0206-5679ТабееваГ. Р.TabeevaG. R.

Табеева Гюзяль Рафкатовна, д.м.н., профессор кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Gyuzyal R. Tabeeva, Dr. Sci. (Med.), Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

grtabeeva@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2025110120260225565Copyright © Табеева Г.Р., 20262026Табеева Г.Р.Tabeeva G.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9720

Первичные головные боли (ПГБ) являются одними из самых частых расстройств в клинической практике. Несмотря на разработанность принципов их диагностики и лечения, ведение пациентов остается неудовлетворительным. Одной из наиболее значимых причин, усложняющих своевременную диагностику и затрудняющих эффективное лечение пациентов с ПГБ, являются коморбидные психические расстройства. Тревога и депрессия выступают хорошо установленными факторами риска хронификации ПГБ, прежде всего мигрени и головной боли напряжения (ГБН). Наряду с этим они вносят существенный вклад в клиническую картину заболевания, видоизменяя фенотип головной боли, что затрудняет верификацию типа цефалгии. Кроме того, коморбидные психические расстройства предопределяют в значительной мере снижение качества жизни пациентов, приводят к длительному персистированию цефалгического синдрома и требуют самостоятельного лечения. Среди психических расстройств тревога занимает лидируюшее положение не только из-за ее высокой представленности у пациентов с ПГБ, особенно с мигренью и ГБН, но и вследствие формирования особых, подчас специфических для отдельных форм цефалгий клинических проявлений и поведенческих особенностей. К наиболее дезадаптирующим для пациентов феноменам можно отнести цефалалгофобию, которая особенно характерна для пациентов с мигренью и существенно затрудняет их повседневное функционирование. Не менее тяжелыми у больных с ПГБ являются проявления кинезиои когнифобии. Учитывая значимую роль тревожных расстройств в формировании симптомов и течения ПГБ, возникает необходимость использования анксиолитиков у этих больных. Выбор анксиолитика в общеклинической практике, особенно у пациентов с коморбидностью, чаще осуществляется в пользу небензодиазепиновых препаратов, среди которых одним из оптимальных средств является этифоксин (Анкзилера), обладающий полимодальными эффектами, учет которых может дать преимущества для терапии больных с ПГБ и коморбидной тревогой.

Primary headaches (PH) are among the most common disorders in clinical practice. Despite the development of diagnostic and treatment principles, patient management remains unsatisfactory. Comorbid mental disorders are among the most significant factors complicating timely diagnosis and hindering effective treatment of patients with PH. Anxiety and depression are well-established risk factors for the chronicity of PH, particularly migraine and tension-type headache. They also significantly contribute to the clinical presentation of the disease, altering the headache phenotype and complicating the verification of the type of headache. Furthermore, comorbid mental disorders significantly reduce patients’ quality of life, lead to prolonged persistence of the headache syndrome, and require independent treatment. Among mental disorders, anxiety occupies a leading position not only due to its high prevalence in patients with PH, particularly migraine and tension-type headaches, but also due to the development of specific clinical manifestations and behavioral characteristics, sometimes specific to individual forms of headache. Among the most disabling phenomena for patients is cephalalgophobia, which is particularly characteristic of patients with migraine and significantly impairs their daily functioning. Equally severe in patients with PH are manifestations of kinesiophobia and cognitophobia. Given the significance of anxiety disorders in the development of symptoms and the course of PDPH, the use of anxiolytics in these patients is necessary. The choice of anxiolytic in general clinical practice, especially in patients with comorbidity, is often made in favor of nonbenzodiazepine drugs. Among these, one of the optimal agents is etifoxine, which has polymodal effects, which, when taken into account, may provide advantages for the treatment of patients with PH and comorbid anxiety.

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The authors declare that there are no conflicts of interest present.