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ημικρανία

ημικρανία

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Published by burnhut
Ημικρανια:
Μηχανισμοί και σύγχρονοι τρόποι αντιμετώπισης
Κλινική εικόνα - ταξινόμηση ημικρανιών
Εργαστηριακά ευρήματα ημικρανίας
Παθοφυσιολογικoς μηχανισμoς ημικρανίας
Θεραπευτικη προσεγγιση ημικρανιας
Θεραπεία κρίσεων ημικρανίας
Νεώτερες θεραπείες της ημικρανίας



Ημικρανια:
Μηχανισμοί και σύγχρονοι τρόποι αντιμετώπισης
Κλινική εικόνα - ταξινόμηση ημικρανιών
Εργαστηριακά ευρήματα ημικρανίας
Παθοφυσιολογικoς μηχανισμoς ημικρανίας
Θεραπευτικη προσεγγιση ημικρανιας
Θεραπεία κρίσεων ημικρανίας
Νεώτερες θεραπείες της ημικρανίας



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Published by: burnhut on Mar 22, 2009
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D I V A L P R O E X
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3*-54,1D: *7/446H(-(:.
17
• O Wilkinson *+FH848 65, 61% 5;+ *-A8+9+ 5/E 80)*+ 7>D4( D
-(.*+5,1D *+*1/2H,-( *76 5(+ (.,14*+0* *1/>/EA9+5*: F+* -)D.*
7/E 784,8><.?*+8 F+*+ *+5*3;+,-5D 5(: +5/7*.0+(:, F+* *7>6
*+*>3(5,16 1*, .,* 74/-7<A8,* 3,* 27+/ *76 5/+ *-A8+D. J5/E:
E76>/,7/E: *-A8+80: ( 74/-AD1( 8+6: 7*4*393/E 843/5*.0+(: -5/
-)D.* *+F?*-8 5/ 7/-/-56 *7/58>8-.*5,165(5*: -5/ 91%.
• O -E+GE*-.6: 5(: G,VG4/843/5*.0+(: .8 74/)>;4784*I0+( -8
8+G/H>F?,* )/4D3(-( *7/G80)A(18 F+* 7/>2 *7/58>8-.*5,16 -)D.*
3,* 8H*4./3D -5/ M.D.* @78,36+5;+ (Callaham and Raskin).
• O -E+GE*-.6: -/E.*54,75<+(: .*I0 .8 F+* .( -584/8,GF:
*+5,H>83./+9G8: 67;: 5/ 5/>H*,+*.,16 /L2 D ( +*54,/2)/: +*74/LF+(
8>*559+8, 5(+ E7/54/7D -5(+ 1>,+,1D 74<L(.
• ! )4D-( 100 mg -/E.*54,75<+(: 1*, 550 mg +*54,/2)/E +*74/LF+(:
8><55;-8 5/ 7/-/-56 5(: E7/54/7D: *76 59% -8 25,5% (p < 0.0003) -8
-2314,-( .8 5( )4D-( -/E.*54,75<+(: .*I0 .8 placebo.
• ! 34D3/4* G49-* 4,I*54,75<+( -8 -E+GE*-.6 .8 F+* COX-2
*+*-5/>F* .8 .*142 )46+/ (.,I;D: -5/ 7><-.* 67;: ( 4/H81/L0.7(
8><55;-8 5(+ E7/54/7D, 7F5E)8 1*>2584* 7/-/-5< G,*5D4(-(: )46+/E
8>82A84/E *76 76+/ 1*, 7*4/E-0*-8 1*>2584* 7/-/-5<
*7/58>8-.*5,165(5*: *+*H/4,1< .8 5(+ *+*1/2H,-( *76 5(+
18H*>*>30* 1*, 5( +*E50* -8 -)F-( .8 5( .8./+;.F+( )4D-( 5(:
4,I*54,75<+(:.
• K46-H*5* *7/G80)A(18 65, 10 mg 4,I*54,75<+(: -8 -E+GE*-.6 .8 50
mg 4/H81/L0.7(: D5*+ 7,/ *7/58>8-.*5,16 -)D.* -8 -)F-( .8 5(+
4,I*54,75<+( .6+( 5(: 1*, 5/ -E+GE*-.6 5(: 4,I*54,75<+(: .*I0 .8 200
mg 5/>H8+*.,1/2 /LF/:, ;: 74/: 5/ 7/-/-56 5;+ *-A8+9+ 8>82A84;+
76+/E -5,: 2 948: 1*, ;: 74/: 5(+ 81GD>;-( H;5/H/?0*: -5,: 2 1*,
-5,: 4 948: .85< 5(+ F+*4L( 5(: 140-(:(7).
18
?$(!$'$2 9$'&+$.$2 !12 1)03'&*.&2
?-.#9-6# &+().#"6#7 +- -"0/2$>@(# )#( #9; '/= ,';+#'/7 A/.1%&,&
"(#,6"&7
",* 1*,+/24,*, *>>< 6), 74*3.*5,1< +F* A84*780* 80+*, ( )/4D3(-(
+,*-0+(: (+,1/5,+,1/2 /LF/:) 8+G/H>8?0;: D/1*, *76 5/E -56.*5/:. !
+,*-0+( 80+*, 3+;-56 G,*,5(5,16 -E.7>D4;.*, )4(-,./7/,/2.8+/ 1E40;:
3,* 5(+ ,1*+65(5< 5(: +* 87(48<I8, A85,1< 5* 87078G* )/>(-5840+(:.
K46-H*5* 8.H*+0-5(1*+ 74/-;7,1F: 5/7/A85D-8,: 7/E E7/G8,1+2/E+
5(+ *7/58>8-.*5,165(5* 5(: +,*-0+(: -5(+ 8L<>8,=( 5;+ /LF;+
74/-?/>9+ (.,14*+0*: 1*, -5(+ 746>(=( 5(: 18H*>*>30*: 5(:
(.,14*+0*:
! -E-5(.*5,1D *+*-167(-( *E59+ 5;+ <4A4;+ G80)+8, 65, ( +,*-0+(
7,A*+9: +* F)8, 1<7/,/ A84*78E5,16 *7/5F>8-.* -5(+ 18H*>*>30* 5(:
(.,14*+0*:, 5(+ 18H*>*>30* 5<-(: 1*, 18H*>*>308: <>>(: *,5,/>/30*:. !
7/,65(5* 5;+ -5/,)80;+ 80+*, 5F5/,*, 7/E +* 87*4180 .6+/ 3,* 5(
G,*527;-( E7/AF-8;+. @0+*, *7*4*05(58: /, 5E)*,/7/,(.F+8: .8>F58:
3,* 5/+ 1*A/4,-.6 5;+ 1>,+,19+ 8+G80L8;+ *E5D: 5(: A84*780*:.
M* *05,* 5(: *7/58>8-.*5,165(5*: 5(: +,*-0+(: .7/4/2.8 +* 5*
74/-8330-/E.8 .6+/ E7/A85,1<. U5*+ >*.?<+85*, 8+G/H>8?0;: D *76 5/
-56.* ( +,*-0+( 74/1*>80 84EA40*-( 5/E GF4.*5/:, 1<5, 7/E .7/480 +*
8L*>80H8, 5* /LF* -E.759.*5* 5(: (.,14*+0*: 74/1*>9+5*: G,*-5/>D
5;+ 14*+,*19+ *3380;+ 1*, 1*5, 87F15*-( 74/>*.?<+/+5*: 5(+
*338,/-2-7*-( 5;+ 8L;14*+,*19+ *3380;+. M/ 383/+6: *E56 *7/58>80
-5/,)80/ 65, ( +,*-0+( 80+*, *7/58>8-.*5,16: 784,H848,*16:
*338,/G,*-5/>F*:, *>>< ( ,1*+65(5< 5/E +* 87(48<I8, 18+54,1/2:
.()*+,-./2: (7.). *,.*5,1D 4/D 5;+ (.,-H*,40;+, 1*, *,./GE+*.,1D 5/E
14*+0/E) 7/E 8+F)/+5*, -5(+ 18H*>*>30* 5(: (.,14*+0*: G8+ F)8,
.8>85(A80 87*419:. ! +,*-0+( 74/1*>80 784,H84,1D *338,/G,*-5/>D 1*,
19
84EA40*-( 87<3/+5*: 5(+ 7*4*3;3D 5(: 74/-5*3>*+G0+(: D2 (PGD2)
-5/ GF4.*, /G(39+5*: -8 .,* *L,/-(.80;5( *2L(-( 5/E .85*?/>05( 5(:
9*,11?-PGF2 -5/ 7><-.*. U5*+ ( +,*-0+( )/4(3805*, -8 G6-( 500 mg *76
5/ -56.* D 5/7,1< -8 ./4HD *E5/16>>(5/E .8 EG*5,16 G,<>E.* 10-1
methylnicotinate -5(+ ;>F+(, ( PGD2 *78>8EA849+85*, -8 .83<>/ ?*A.6
-5/ GF4.* 1*, / .85*?/>05(: 5(: 8.H*+0I85*, -8 E=(>F: -E318+549-8,:
-5/ 7><-.*. P8+ 80+*, 3+;-56 *+ ( PGD2 74/1*>80 *338,/G,*-5/>D -5,:
14*+,*1F: *45(408:, *>>< ( ,1*+65(5* 5(: +,*-0+(: +* 8L*>80H8, 5(+
/L80* 18H*>*>30* 5(: (.,14*+0*: G80)+8, 65, 1<5, 5F5/,/ 80+*, *E56 7/E
7,A*+9: -E.?*0+8,. K*>,F: *+*H/4F: 7/E )4(-,./7/,DA(1*+ *76 5/E:
Bicknell 1*, Prescott *7/G8,1+2/E+ 65, ( +,*-0+( 74<3.*5, 74/1*>80
*338,/G,*-5/>D 5;+ 8318H*>,19+ 1*, -7/+GE>,19+ *3380;+, 1*, (
8+G/H>F?,* )/4D3(3(-D 5(: *EL<+8, 5(+ 8+G/14<+,* *,.*5,1D 4/D -5/E:
*+A497/E: 3,* 20-60 >875<, );40: +* .85*?<>>85*, -(.*+5,1< (
*45(4,*1D 708-(. PE-5E)9: G8+ E7<4)/E+ 7,/ 746-H*58: *+*H/4F: 7/E
+* 8L85<I/E+ 5( G4<-( 5(: +,*-0+(: 870 5(: *,.*5,1D: 4/D: -5/+
831FH*>/ 5/E *+A497/E (5).
!"'#%5"(,'>7 '5" CGRP =9/0/A>5"
O, -(.84,+F: A8;408: 74/580+/E+ 65, 5* 8,G,1< 848A0-.*5* 7/E
7E4/G/5/2+ 5(+ (.,14*+0*, 74/1*>/2+ 5(+ 74;5/7*AD 8318H*>,1D
GE->8,5/E430*, ( /7/0* L81,+< *>>*3F: -5( G,*-5/>D 5;+ .(+,33,19+
*3380;+ 1*, 5(+ 8+843/7/0(-( 5;+ 784,*338,*19+ 1><G;+ 5/E 54,G2./E.
M* +824* *E5< 74/-<3/E+ *,-A(5(4,*1< 848A0-.*5* *76 5* .83<>*
*,./H64* *3380* 7/E 80+*, E782AE+* 3,* 5( 42A.,-( 5(: 8318H*>,1D:
*,.*5,1D: 4/D:, 1*, *76 .,146584* *3380* 7/E ?40-1/+5*, -5,:
8E*0-A(58: -5/+ 76+/ .D+,338:. O, *7/>DL8,: 5/E 8+843/7/,(.F+/E
54,G2./E *78>8EA849+/E+ *338,/G4*-5,1< +8E4/78750G,* .F-* -5,:
.D+,338:, 5* /7/0* .8-/>*?/2+ -5(+ +8E4/38+D H>83./+D, ( /7/0*
)*4*15(40I85*, *76 *338,/G,*-5/>D, *338,*1D G,*HE3D 1*,
*7/11/10;-( 5;+ ,-5,/1E55<4;+. @7,746-A85*, 5* +8E4/78750G,*
*+*.85*G0G/E+ G,83F4-8,: 74/: 5/ 18+54,16 +8E4,16 -2-5(.*
20
74/1*>9+5*: F5-, -/?*46 76+/, 18+54,1D G,F384-( 7/E 8>*559+8, 5/+
/EG6 *+5*7614,-(: 5/E 76+/E, 1*, *>>/GE+0* 7/E .85*54F78, *+9GE+*
848A0-.*5*, 67;: 5/ GF-,./ 5;+ .*>>,9+ -8 195-/ D 5/+ 75*4.6 -8
879GE+*.
! *78>8EAF4;-( 5/E +8E4/7875,G0/E CGRP (78750G,/ 8L*459.8+/ *76 5/
3/+0G,/ 5(: 1*>-,5/+0+(:) *76 5/ 540GE./ 70-58285*, 65, 7*0I8, 18+54,16
46>/ -5(+ ?*-,1D 7*A/HE-,/>/30* 5(: (.,14*+0*:. M* 87078G* -5/+ /46
5/E GCRP -5(+ FL; -H*305,G* H>F?* 80+*, *EL(.F+* -8 *-A8+80: 1*5<
5( G,<418,* 1<A8 80G/E: *338,*1D: 18H*>*>30*:, -E.784,>*.?*+6.8+(:
1*, 5(: (.,14*+0*: (.8 D );40: *24*).M/ CGRP 746-H*5* *7/G80)5(18
65, F)8, *,5,/>/3,16 46>/ -5(+ (.,14*+0*, 67/E ( F3)E-D 5/E 87D3*38 5(+
8.H<+,-( (.,14*+,9+ 1*, 18H*>*>30*: -8 87,4487D <5/.*.
M/ CGRP 8+5/70I85*, -5/ .(+/8,GF: 3<33>,/ 1*, *78>8EA849+85*, .85<
*76 +8E4,1D G,F384-(. BE-,/>/3,1F: .8>F58: *7FG8,L*+ 65, 5/ CGRP 80+*,
,-)E46: *338,/G,*-5/>F*: 5;+ 8318H*>,19+ 1*, .(+,33,19+ *3380;+ 1*,
;: 81 5/25/E 7*0I8, -(.*+5,16 46>/ -5( 42A.,-( 5(: *,.*5,1D: 4/D:
-5/+ 831FH*>/ 1*, -5,: 8E*0-A(58: -5/+ 76+/ .D+,338:. M/ CGRP 870-(:
.7/480 870-(: +* 74/1*>F-8, *7/1/110;-( 1*, *78>8EAF4;-(
7*4*36+5;+ H>83./+D: *76 5* .(+,33,1< ,-5,/1255*4*. @7,746-A85* 5/
CGRP 8+F)85*, -5( .85*?0?*-( 879GE+;+ 848A,-.<5;+ *76
8+G/14*+,*1< *3380* 74/: 5/ 18+54,16 +8E4,16 -2-5(.*. &E5< 5*
8E4D.*5* G80)+/E+ 65, /, *+5*3;+,-5F: 5;+ E7/G/)F;+ 5/E CGRP .7/480
+* 80+*, *7/58>8-.*5,1/0 -5( A84*780* 5(: (.,14*+0*:.
O, 7495/, *+5*3;+,-5F: 5;+ E7/G/)F;+ 5/E CGRP D5*+ ?4*)2584*
1><-.*5* 5/E CGRP. M/ CGRP(8–37), 7/E 784,>*.?<+8, .6+/ 5* 7 7495*
78750G,* 5/E CGRP >8,5/E4380 ;: ,-)E46: *+5*3;+,-5D: 5/E E7/G/)F*
.7>/1<4/+5*: 5( -2+G8-( 5/E 8+G/38+/2: CGRP. K*46>/ 7/E 5/
CGRP(8–37) *+*-5F>>8, 87,5E)9: 5(+ *338,/G,*-5/>D 1*, 5( +8E4/38+D
H>83./+D, F)8, ?4*)2 )46+/ (.,I;D: 1*, G8+ 80+*, 1>,+,1<
*7/58>8-.*5,16. K46-H*5* *+*752)A(18 F+*: .( 7875,G,16:
*+5*3;+,-5D:, / BIBN 4096 BS, / /7/0/: 87,G8,1+28, E=(>D -E33F+8,*
21
3,* 5/E: *+A497,+/E: E7/G/)80: GCRP. O BIBN 4096 BS *7/G80)A(18
65, 80+*, 5/E><),-5/+ 8L0-/E *7/58>8-.*5,16: .8 5,: 54,75<+8: -5(
G,*1/7D D 5(+ *+*-54/HD 5(: *338,/G,*-5/>D: 5;+ 8+G/14*+,*19+
+824;+ 1*, -5(+ *+*-5/>D 5(: +8E4/38+/2: H>83./+D: 7/E *1/>/EA80
5( G,F384-( 5/E 54,G2./E.
O, Olesen 1*, -E+843<58: 7*4/E-,<I/E+ -5/,)80* 7/E G80)+/E+ 65, /
BIBN 4096 BS 80+*, .,* *7/58>8-.*5,1D 1*, 1*>< *+815D A84*780* 5(:
(.,14*+0*:. *+*HF4/E+ 7/-/-56 *+5*7614,-(: 60% 2 948: .85< 5(+
A84*780*, 7/E 80+*, 7*46./,/ .8 5/ 7/-/-56 *7/58>8-.*5,165(5*: 5;+
54,75*+9+. @7,7>F/+, -8 *E5D+ 5( .8>F5( / BIBN 4096 BS D5*+
*7/58>8-.*5,16: -5( A84*780* 74/-?/>9+ (.,14*+0*: 7/E
1*5*5<)5(1*+ ;: .F54,8: F;: -/?*4F: 1*, G8+ 80)*+ E7/);4D-8, 6 948:
.85< 5(+ F+*4L( 5(: 74/-?/>D:. U7;: -(.8,9+/E+ /, Olesen 1*,
-E+843<58: 7*4/E-,<I8, 8+G,*HF4/+ +* 1*A/4,-580 *+ /, *-A8+80: 7/E
G8+ *+5*7/140+/+5*, -5,: 54,75<+8: A* .7/4/2-*+ +* A84*78E5/2+
*7/58>8-.*5,1< .8 5/+ BIBN 4096 BS. X8>5,;.F+( *+5*7614,-( H*0+85*,
*70A*+(, *+ ( G4<-( 5;+ 54,75*+9+ 870 5(: (.,14*+0*: 87,5E3)<+85*,
74;50-5;: G,*.F-; 5(: *+*-5/>D: F114,-(: 5/E CGRP 1*, / BIBN 4096
BS .7>/1<48, 5( >8,5/E430* 5/E E7/G/)F* 5/E CGRP. ! ,1*+65(5* 56-/
5;+ 54,75*+9+, 6-/ 1*, 5;+ *+5*3;+,-59+ 5;+ E7/G/)F;+ 5/E CGRP +*
8>*559+/E+ 5/+ 76+/ 5(: (.,14*+0*: .7/480 +* 87,5E3)<+/+5*, *76 5/E:
0G,/E: ./4,*1/2: -56)/E:, G(>*GD *76 ./4,*1< ./+/7<5,* 7/E
8+843/7/,/2+5*, *1/>/2A;: 74/: 5(+ 8+843/7/0(-( 5;+ E7/G/)F;+ 5/E
CGRP.
O BIBN 4096 BS 80+*, / 7495/: *+5*3;+,-5D: 5;+ E7/G/)8;+ 5/E CGRP
3,* 5/+ /7/0/ *+*HF485*, -(.*+5,1D *7/58>8-.*5,165(5* -5( A84*780*
5(: (.,14*+0*:. "8 G8G/.F+( 5(+ *76>E5( *7/E-0* *338,/-E-7*-5,1D:
G4<-(: *E5/2 5/E 7*4<3/+5*, / BIBN 4096 BS 1*, 7,A*+9: 1*, <>>/,
*+5*3;+,-5F: 5;+ E7/G/)F;+ 5/E CGRP .7/480 +* *7/58>/2+ .,*
8+*>>*15,1D >2-( 3,* 5( A84*780* 5(: (.,14*+0*: 7/E *+5*3;+0I85*, 5,:
22
54,75<+8:, 7*46>/ 7/E 74F78, 7495* +* *+*75E)A80 F+* -182*-.* 7/E
+* )/4(3805*, 56-/ 821/>* 6-/ /, 54,75<+8:.
@,16+* 5: K,A*+F: AF-8,: G4<-(: 5/E .( 7875,G,1/2 *+5*3;+,-5D 5/E E7/G/)F* 5/E CGRP BIBN 4096
BS
23
4* 4P* '1#"!* "
1. P7F7ICA=@ *KM::=@, $L;K:M@
*KM::=@, "+?L67;7FG9 P7F7ICA=#,
H?;.315$317, -?HH9;7:GJ=
2004,?JN<H?E@ University Studio Press
2. Peter J. Goadsby, M.D., D.Sc., Richard
B. Lipton, M.D., and Michel D. Ferrari,
M.D., Ph.D., "Migraine % Current
Understanding and Treatment#, New
England Journal of Medicine, Volume
346:257$270 January 24, 2002, Number 4
3. Anne Ducros, M.D., Ph.D., Christian
Denier, M.D., Anne Joutel, M.D., Ph.D.,
Michaelle Cecillon, Christelle Lescoat,
Katayoun Vahedi, M.D., Francoise Darcel,
M.D., Eric Vicaut, M.D., Ph.D.,
Marie$Germaine Bousser, M.D, "The
Clinical Spectrum of Familial Hemiplegic
Migraine Associated with Mutations in a
Neuronal Calcium Channel#, New
England Journal of Medicine, Volume
345:17$24, July 5, 2001, Number 1
4. Jes Olesen, M.D., Hans$Christoph
Diener, M.D., Ingo W. Husstedt, M.D.,
Peter J. Goadsby, M.D., David Hall, Ph.D.,
Ulrich Meier, Ph.D., Stephane Pollentier,
M.D., Lynna M. Lesko, M.D., for the
BIBN 4096 BS Clinical Proof of Concept
Study Group, "Calcitonin Gene&Related
Peptide Receptor Antagonist BIBN 4096
BS for the Acute Treatment of Migraine#,
New England Journal of Medicine,
Volume 350:1104$1110, March 11, 2004,
Number 11
5. Jonathan Prousky and Dugald Seely, "
The treatment of migraines and
tension$type headaches with intravenous
and oral niacin 'nicotinic acid(: systematic
review of the literature#, Nutrition Journal
2005, 4:3, doi:10.1186/1475$2891$4$3
6. Tomoko Morikawa, Yoshiyasu
Matsuzawa, Koshi Makita and Yoshifumi
Katayama, "Antimigraine drug,
zolmitriptan, inhibits high$voltage
activated calcium currents in a population
of acutely dissociated rat trigeminal
sensory neurons#, Molecular Pain 2006,
2:10, doi:10.1186/1744$8069$2$10
7. Abouch Valenty Krymchantowski ,
"Acute treatment of migraine. Breaking
the paradigm of monotherapy,#, BMC
Neurology 2004, 4:4,
doi:10.1186/1471$2377$4$4
8. Paul L. Durham, Ph.D., "CGRP$
Receptor Antagonists % A Fresh
Approach to Migraine Therapy?#, New
England Journal of Medicine,Volume
350:1073$1075, March 11, 2004, Number 11
9. Peter Berlit, "Memorix +?L67;7FG9#,
H?;. 137, "IX:9 2005, *9A6EJC@
)JN<H?E@ ,. Z. ,9HT9;GN=@
10. )I:EJ< (L:A9F7;<FE7, "!M6B9J9
J9AM A=@ =BEJ69:G9@#, A?;?LA9G9
9:9I?D6=H=: 18$07$2001
24

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