.

: 1014-1-000-003-07-2560
: 12 2560
: 11 2561
: 2

23-26
7.8-101-3

2
vascular theory4,5 inflammation
hypothesis4,5 calcitonin gene related peptide (CGRP)
substance P (SP) neurogenic inflammation cortical
spreading depression (CSD) CSD occipital lobe
CSD migraine center trigeminal nerve (CN V)
CSD
prefrontal cortex aura4
1

1 6,7

stress food containing

emotion MSG (monosodium glutamate)
hypoglycemia tyramine (e.g., red wine, ripened cheese)
altered sleep pattern nitriles (e.g., cured meat products)
menses phenylethylamine (e.g., chocolate, cheese)
exercise aspatame
alcohol drugs
carbon Monoxide excessive use or withdrawal (ergot, triptan,
excess caffeine use or withdrawal analgesic)
environmental estrogen (oral contraception)
- light, changes in barometric pressure, strong cocaine
odors, computer screens, rapid temperature nitroglycerin
change

The International Headache Society (IHS) 2

migraine without aura migraine with aura 2

2 2 IHS8

migraine without aura8 migraine with aura8

A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or
unsuccessfully treated)
C. Headache has at least two of the following
characteristics:
- unilateral location
- pulsating quality
- moderate or severe pain intensity
- aggravation by or causing avoidance of
routine physical activity (e.g., walking or climbing
stairs)
D. During headache, at least one of the following is
present;
- nausea and / or vomiting
- photophobia and phonophobia
E. Not attributed to another disorder
A. At least 2 attacks fulfilling criteria B-D
B. Aura consisting of at least one of the following,
but no motor weakness:
1. fully reversible visual symptoms including
positive features (e.g., flickering lights, spots or lines)
and/or negative features (i.e., loss of vision)
2. fully reversible sensory symptoms including
positive features (i.e., pins and needles) and/or
negative features (i.e., numbness)
3. fully reversible dysphasic speech disturbance
C. At least two of the following:
1. homonymous visual symptoms and/or
unilateral sensory symptoms
2. at least one aura symptom develops
gradually over 5 minutes
3. each symptom lasts 5 and 60 minutes
D. Headache fulfilling criteria B-D for migraine
 without aura begins during the aura or follows aura
within 60 minutes
E. Not attributed to another disorder

migraine with aura migraine without

aura aura 3
migraine without aura migraine
with aura8

1. (prodrome phase)

aura
2. (headache phase)


3. (postdrome)

2 (abortive
treatment) (prophylactic treatment)
Canadian Headache Society guideline
2013 AHS/AAN guideline 2012

1. (abortive treatment)

abortive treatment
central sensitization9
2 9
abortive treatment 3 9
 1.1 acetaminophen 1000
9
1.2 (nonsteroidal anti-inflammatory drugs; NSAIDs)

triptans NSAIDs 9
NSAIDs 3

3 NSAIDs 10,11,12,13

NNT (2-h pain free) (mg) (mg)

aspirin10 8.1 975-1,000 5,400
ibuprofen11 7.2 400 2,400
naproxen sodium12 15.0 500-825 1,375
diclofenac potassium (tablet)13 8.9 50 150
ketorolac - 10 40

ibuprofen 400 mg 2
9
aspirin 9
ibuprofen ibuprofen 9
NSAIDs (enteric coated tablet)
9

1.3 triptans 5HT1B 5HT1D 9

ergotamine/caffeine9
triptans
NSAIDs
9

medication overuse headache (MOH)9 4
 4 triptans 14,15,16

Onset NNT (2-h pain comments

free) (mg) (mg)
sumatriptan (tablet) 30 min 6.1 25-50 200 - 9
sumatriptan (SC) 15 min 2.3 6 12
zolmitriptan (tablet) 45 min 5.9 1-2.5 10 MOH
almotriptan (tablet) 0.5-2 h 4.3 6.25-12.5 25 -
eletriptan (tablet) 0.5-1 h 10 (20 mg) / 20-40 40 mg in cardiovascular,
4.5 (40 mg) Canada/ 80 peripheral vascular
mg in US disorder,
frovatriptan (tablet) N/A 8.5 2.5 5
naratriptan (tablet) 1-3 h 8.2 1-2.5 5
rizatriptan (tablet) 0.5-1 h 3.1 5-10 20

triptans 9 almotriptan
12.5 rizatriptan 10 24
sumatriptan14,17 sumatriptan
9
CYP P450 enzyme
monoamine oxidase (MAO) enzyme propranolol
rizatriptan rizatriptan 5 9

3
domperidone metoclopramide 9
extrapyramidal symptom (EPS) metoclopramide QTc interval
prolongation domperidone 60 domperidone
30 9
opioids, D2 antagonist corticosteroids

abortive treatment 7 9
 19 mild-moderate attack strategy (
) acetaminophen NSAIDs

2 9 moderate-severe attack or NSAIDs failure strategy

NSAIDs
NSAIDs NSAIDs triptans
NSAIDs triptans triptans
9 MOH

39 refractory migraine strategy 2

triptans NSAIDs
D2 antagonist prochloperazine, chlorpromazine opioids tramadol, codeine
systemic corticosteroids
ergotamine/caffeine 0.5-2 6 10
ergotamine/caffeine 9 MOH

49 vasoconstrictor unresponsive-contraindicated strategy

triptans ergotamine/caffeine
acetaminophen NSAIDs
prochloperazine, chlorpromazine, tramadol, codeine systemic corticosteroids

59 menstrual migraine strategy

1 2

frovatriptan 2.5 2
naratriptan, zolmitriptan

6 9 migraine during pregnancy strategy

ergotamine/caffeine
domperidone metoclopramide
dimenhydrinate sumatriptan NSAIDs
NSAIDs spontaneous abortion
32 acetaminophen codeine

7 9 migraine during lactation strategy 6

NSAIDs
ibuprofen sumatriptan
opioids morphine codeine genetic
polymorphism ultra-rapid metabolizer

2. (prophylactic treatment)

AHS/AAN 201218 3
6
4 3
18


18
propranolol 5

(level A: established as effective)18

valproic acid 400-1,000
metoprolol 47.5-200
propranolol 120-240
timolol 10-15
topiramate 25-200

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