Тревога и первичные головные боли

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.

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