Современные стратегии лечения приступа мигрени и возможности дифференцированного подхода

Стратегии лечения приступов мигрени включают использование  неспецифических  средств (простых и комбинированных анальгетиков, противорвотных  средств)  и специфических  препаратов  (триптанов, производных  эрготамина, гепантов, дитанов), а также методов  нейромодуляции. Несмотря на расширение  спектра специфических  средств, эффективность купирования приступов головной при мигрени остается неудовлетворительной. Выбор средства для лечения приступов мигрени основывается  на их стратификации по степени нарушения функциональной активности пациентов  и при умеренной и тяжелой дезадаптации предполагает назначение специфических антимигренозных средств. Стратифицированный подход имеет ряд преимуществ по основным параметрам  эффективности анальгезии, сопряжен с более низкими затратами на лечение и несет меньший риск злоупотребления  анальгетиками. Мигренозные приступы характеризуются высоким полиморфизмом и наличием множества клинических проявлений, которые во многом определяют тяжесть состояния пациента и требуют подчас самостоятельного лечения. Специфические препараты для лечения приступов мигрени (триптаны) позволяют купировать не только головную боль, но и симптомы тошноты, рвоты, фото- и фонофобии. Выбор средства основывается на индивидуальных характеристиках пациента, профиле мигренозных атак и предполагает учет фармакологических  свойств  лекарственного  средства. Такие  особенности  мигрени, как высокая  скорость нарастания боли  в  приступе, наличие  быстроразвивающейся   тошноты, необходимость  обеспечения   длительного  обезболивания, требуют использования  быстродействующих форм  лекарственных  препаратов.  Преимущества выбора  этих форм  подтверждают результаты исследований  предпочтений  пациентов. Данные клинических исследований  и результаты исследований  реальной  клинической  практики  позволяют  сформулировать  некоторые  подходы  к  дифференцированному выбору лекарственного  средства.

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