medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2019-3-24(399)-5-9medalphabet-1171Research ArticleСтатьиЛечение хронической головной боли: всегда ли мы можем следовать международным рекомендациям?Chronic headache treatment: can we always follow international guidelines?ЛатышеваН. В.LatyshevaN. V.

к. м. н., доцент кафедры нервных болезней

г. Москва

Moscow

ФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова (Сеченовский университет)» Минздрава России; ООО «Цефалголог» — Клиника головной боли и вегетативных расстройств имени академика Александра Вейна — клиническая база Первого Московского государственного медицинского университета имени И. М. Сеченова (Сеченовский университет)РоссияI. M. Sechenov First Moscow State Medical University (Sechenov University); Alexander Vein Headache ClinicRussian Federation201919112019324Неврология и психиатрия59Copyright © Латышева Н.В., 20192019Латышева Н.В.Latysheva N.V.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-alphabet.com/jour/article/view/1171

Международные рекомендации по профилактическому лечению мигрени предписывают использование пяти основных классов препаратов: бетаблокаторов, антиконвульсантов, антидепрессантов (амитриптилина и венлафаксина), ингибитора ангиотензиновых рецепторов и ботулотоксина типа А. Рекомендации по лечению хронической головной боли напряжения (ХГБН) ограничивают врача в еще большей степени и содержат только амитриптилин, венлафаксин и миртазапин. В то же время возможность длительного приема большего числа рекомендованных препаратов сильно осложнена в связи с их недостаточно хорошей переносимостью. Кроме того, большая часть рекомендованных препаратов не позволяет контролировать наиболее часто встречаемые коморбидные заболевания, среди которых наибольшее значение для выбора и прогноза эффективности терапии имеет депрессия. В статье представлен обзор текущих рекомендаций по лечению мигрени и ХГБН и связанных с их использованием практических сложностей. Также представлена серия случаев использования нового мультимодального антидепрессанта вортиоксетина в лечении хронической головной боли.

International guidelines on the prevention of migraine recommend the use of five main classes of medications: beta-blockers, antiepileptics, antidepressants (amitriptyline and venlafaxine), angiotensin receptor antagonists and botulinum toxin type A. Chronic tension-type headache (CTTH) guidelines are even more limiting and contain only amitriptyline, venlafaxine and mirtazapine. However, long-term intake of these medications is substantially limited by their tolerability issues. Moreover, most recommended medications cannot control the most frequently observed comorbidities, where depression plays the most important role in treatment selection, efficacy and long-term prognosis. This paper reviews the current migraine and CTTH prevention guidelines and complexities that physicians encounter with their use. The paper also includes a case series of treating chronic headache with a new multimodal antidepressant vortioxetine.

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