medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»medalphabet-346Research ArticleСтатьиТеоретические и практические аспекты применения ацетазоламида в лечении посттравматической головной болиTheoretical and practical aspects of acetazolamide use in post-traumatic headache treatmentИскраД. А.IskraD. A.noemail@neicon.ruФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» Минобороны РоссииРоссияMilitary Medical Academy n.a. S. M. KirovRussian Federation201716102017332Неврология и психиатрия3740Copyright © Искра Д.А., 20172017Искра Д.А.Iskra D.A.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/346

В статье рассматриваются современные представления об этиопатогенезе посттравматической головной боли, освещается алгоритм ее диагностики и лечения. Установлено, что ведущими факторами возникновения и развития этой цефалгии являются структурно-функциональные и психопатологические изменения, играющие разную роль в зависимости от тяжести травмы и ее стадии. Уточнено значение гидроцефалии и сенситизации церебральных нейронов в патогенезе посттравматической головной боли, в том числе при легкой черепномозговой травме. Раскрыты механизмы действия ацетазоламида как лекарственного средства, ингибирующего продукцию ликвора и подавляющего активность клеток головного мозга. Обсуждены практический опыт применения и перспективы использования препарата в рамках патогенетической терапии и альтернативной анальгезии при посттравматической головной боли.

The article deals with the modern understanding of etiopathogenesis of post-traumatic headache. It describes the algorithm of its diagnosis and treatment. It is established that structural, functional and psychopathological changes, which play a different role depending on the severity of the trauma and its stage, are the leading factors in the onset and the development of this cephalalgia. The role of hydrocephalus and sensitization of cerebral neurons in the pathogenesis of post-traumatic headache, including a mild traumatic brain injury, has been clarified. The mechanisms of the action of acetazolamide as a drug inhibiting the production of cerebrospinal fluid and suppressing the activity of brain cells are disclosed. Practical experience and the prospects of using this drug within the framework of pathogenetic therapy and alternative analgesia in post-traumatic headache are discussed.

посттравматическая головная больчерепно-мозговая травмалегкая черепно-мозговая травмагидроцефалияотек мозгацентральная сенситизацияацетазоламидpost-traumatic headache(traumatic) brain injurymild (traumatic) brain injuryhydrocephaluscerebral edemacentral sensitizationacetazolamideReferencesFormisano R., Bivona U., Catani S. et al. Post-traumatic headache: facts and doubts // J. Headache Pain.- 2009.- Vol. 10, N3.- P. J45-J52.Formisano R., Bivona U., Catani S. et al. Post-traumatic headache: facts and doubts // J. Headache Pain.- 2009.- Vol. 10, N3.- P. J45-J52.Martins H. A., Ribas V. R., Martins B. B. et al. Post-traumatic headache // Arq. Neuropsiquiatr. - 2009.- Vol. 67, N J.- P. 43-45.Martins H. A., Ribas V. R., Martins B. B. et al. Post-traumatic headache // Arq. Neuropsiquiatr. - 2009.- Vol. 67, N J.- P. 43-45.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version) // Cephalalgia.- 20J3.- Vol. 33, N 9.- P. 629-808.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version) // Cephalalgia.- 20J3.- Vol. 33, N 9.- P. 629-808.Nampiaparampil D. E. Prevalence of chronic pain after traumatic brain injury: a systematic review // JAMA. - 2008.- Vol. 300, N6.- P. 7JJ-7J9.Nampiaparampil D. E. Prevalence of chronic pain after traumatic brain injury: a systematic review // JAMA. - 2008.- Vol. 300, N6.- P. 7JJ-7J9.Yang C. C., Hua M. S., Tu Y. K., Huang S. J. Early clinical characteristics of patients with persistent post-concussion symptoms: A prospective study // Brain Inj.- 2009.- Vol. 23, N 4.- P. 299-306.Yang C. C., Hua M. S., Tu Y. K., Huang S. J. Early clinical characteristics of patients with persistent post-concussion symptoms: A prospective study // Brain Inj.- 2009.- Vol. 23, N 4.- P. 299-306.Ruff R. L., Ruff S.S., Wang X.F. Headaches among operation Iraqi freedom/operation enduring freedom veterans with mild traumatic brain injury associated with exposures to explosions // J. Rehabil. Res. Dev.- 2008.- Vol. 45.- P. 94J-952.Ruff R. L., Ruff S.S., Wang X.F. Headaches among operation Iraqi freedom/operation enduring freedom veterans with mild traumatic brain injury associated with exposures to explosions // J. Rehabil. Res. Dev.- 2008.- Vol. 45.- P. 94J-952.Theeler B. J., Erickson J, C. Mild head trauma and chronic headaches in returning US soldiers // Headache. - 2009. - Vol. 49.- P. 529-334.Theeler B. J., Erickson J, C. Mild head trauma and chronic headaches in returning US soldiers // Headache. - 2009. - Vol. 49.- P. 529-334.Lenaerts M.E. Post-traumatic headache: from classification challenges to biological underpinnings // Cephalalgia. - 2008. - Vol. 28, Suppl. J.- P. J2-J5.Lenaerts M.E. Post-traumatic headache: from classification challenges to biological underpinnings // Cephalalgia. - 2008. - Vol. 28, Suppl. J.- P. J2-J5.Couch J. R., Bearss C. Chronic daily headache in the posttrauma syndrome: relation to extent of head injury // Headache. - 200J.- Vol. 4J, N6.- P. 559-564.Couch J. R., Bearss C. Chronic daily headache in the posttrauma syndrome: relation to extent of head injury // Headache. - 200J.- Vol. 4J, N6.- P. 559-564.Sheftell F. D., Tepper S. J., Lay C. L., Bigal M. E. Post-traumatic headache: Emphasis on chronic types following mild closed head injury // Neurol. Sci-2007.-Vol. 28, S2. - P. 203-207.Sheftell F. D., Tepper S. J., Lay C. L., Bigal M. E. Post-traumatic headache: Emphasis on chronic types following mild closed head injury // Neurol. Sci-2007.-Vol. 28, S2. - P. 203-207.Evans R. W. Post-traumatic headaches // Neurol. Clin. - 2004. - Vol. 22, N 1. - P. 237-249.Evans R. W. Post-traumatic headaches // Neurol. Clin. - 2004. - Vol. 22, N 1. - P. 237-249.Alfano D. P. Emotional and pain-related factors in neuropsychological assessment following mild traumatic brain injury // Brain Cogn.- 2006.- Vol. 60, N 2.- P. 194-196.Alfano D. P. Emotional and pain-related factors in neuropsychological assessment following mild traumatic brain injury // Brain Cogn.- 2006.- Vol. 60, N 2.- P. 194-196.Михайленко А. А., Одинак М. М., Литвиненко И. В. и др. Неврологическая симптоматика в остром периоде сотрясения головного мозга // Неврологический журн. - 2015.- Т. 20, № 3.- С. 29-36.Михайленко А. А., Одинак М. М., Литвиненко И. В. и др. Неврологическая симптоматика в остром периоде сотрясения головного мозга // Неврологический журн. - 2015.- Т. 20, № 3.- С. 29-36.Solomon S. Post-traumatic headache: Commentary: An overview//Headache.- 2009.- Vol. 49.- P. 1112-1115.Solomon S. Post-traumatic headache: Commentary: An overview//Headache.- 2009.- Vol. 49.- P. 1112-1115.Lun M. P., Monuki E. S., Lehtinen M. K. Development and functions of the choroid plexus-cerebrospinal fluid system // Nat. Rev. Neurosci.-2015. - Vol. 16, N8. - P. 445-457.Lun M. P., Monuki E. S., Lehtinen M. K. Development and functions of the choroid plexus-cerebrospinal fluid system // Nat. Rev. Neurosci.-2015. - Vol. 16, N8. - P. 445-457.Gao F., Zheng M., Hua Y. et al. Acetazolamide attenuates thrombin-induced hy drocephalus // Acta Neurochir. Suppl.- 2016.- Vol. 121.- P. 373-377.Gao F., Zheng M., Hua Y. et al. Acetazolamide attenuates thrombin-induced hy drocephalus // Acta Neurochir. Suppl.- 2016.- Vol. 121.- P. 373-377.Alperin N., Oliu C.J., Bagci A.M. et al. Lowdose acetazolamide reverses periventricular white matter hyperintensities in iNPH // Neurology.- 2014.- Vol. 82, N 15.- P. 1347-1351.Alperin N., Oliu C.J., Bagci A.M. et al. Lowdose acetazolamide reverses periventricular white matter hyperintensities in iNPH // Neurology.- 2014.- Vol. 82, N 15.- P. 1347-1351.Ivkovic M., Reiss-Zimmermann M., Katzen H. et al. MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic normal pressure hydrocephalus // Fluids Barriers CNS.-2015. Vol. 12: 9.Ivkovic M., Reiss-Zimmermann M., Katzen H. et al. MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic normal pressure hydrocephalus // Fluids Barriers CNS.-2015. Vol. 12: 9.Halperin J. J., Kurlan R., Schwalb J.M. et al. Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology // Neurology. - 2015.- Vol. 85, N23. - P. 2063-2071.Halperin J. J., Kurlan R., Schwalb J.M. et al. Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology // Neurology. - 2015.- Vol. 85, N23. - P. 2063-2071.Benfenati V., Caprini M., Dovizio M. et al. An aquaporin-4/transient receptor potential vanilloid 4 (AQP4/TRPV4) complex is essential for cell-volume control in astrocytes // Proc. Natl. Acad. Sci. USA.-2011.- Vol. 108, N6.- P. 2563-2568.Benfenati V., Caprini M., Dovizio M. et al. An aquaporin-4/transient receptor potential vanilloid 4 (AQP4/TRPV4) complex is essential for cell-volume control in astrocytes // Proc. Natl. Acad. Sci. USA.-2011.- Vol. 108, N6.- P. 2563-2568.Sturdivant N. M., Smith S. G., Ali S. F. et al. Acetazolamide mitigates astrocyte cellular edema following mild traumatic brain injury // Scientific Reports. - 2016. - Vol. 6: 33330. - P. 1-11.Sturdivant N. M., Smith S. G., Ali S. F. et al. Acetazolamide mitigates astrocyte cellular edema following mild traumatic brain injury // Scientific Reports. - 2016. - Vol. 6: 33330. - P. 1-11.Chaaban M. R., Illing E., Riley K. O., Woodworth B. A. Acetazolamide for high intracranial pressure cerebrospinal fluid leaks // Int. Forum Allergy Rhinol.- 2013.- Vol. 9.- P. 718-721.Chaaban M. R., Illing E., Riley K. O., Woodworth B. A. Acetazolamide for high intracranial pressure cerebrospinal fluid leaks // Int. Forum Allergy Rhinol.- 2013.- Vol. 9.- P. 718-721.

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