Vol. 10, No 3, 2003 pp. 106 - 110
UC 616-084:616.857
PROPHYLACTIC TREATMENT OF MIGRAINE BY
VALPROATE
Mirjana Spasić, Miroslava Živković, Stevo Lukić
Clinic of Neurology, Clinical centre, Faculty of Medicine, Niš, Serbia
and Montenegro
E-mail: stevol@junis.ni.ac.yu
Summary. Migraine is a common episodic headache disorder. A comprenhensive
headache treatment plan includes acute attack treatment to releive pain
and impairment and long-term preventive therapy to reduce attack frequency,
severity and duration. Circumstances that might warrant preventive treatment
include very frequent and severe migraine that interferes with the patient's
daily routine, failure to acute treatment, special circumstances
such as hemiplegic migraine or patient preference. The drug has to be started
at a low dose and each treatment has to be given an adequate trial with
avoiding interfering overused and contraindicated drugs. Co-morbidity has
to be considered. Drugs that have documented high efficacy and mild to
moderate adverse events include beta-blockers, amitiriptyline and valproates.
Valproate has been shown to be an effective prophylactic teratment
in migraine. Investigation of the mechanism of its antimigraine action
is difficult due to the broad range of its biochemical effects and the
complex nature of migraine pathophysiology. Valptoate increases brain GABA
levels and may suppress migraine related events in the cortex, perivascular
parasympathetics or trigeminal nucleus caudalis. There is experimental
evidence that it suppresses neurogenic inflamation and directly attenuates
nociceptive neurotransmission. In addiion, valproate reportedly alters
levels of excitatory and inhibitory neurotransmitters and exerts direct
effects on neuronal membranes in vitro. Valproate's observed effects may
ultimately result from a combination of actions at different loci.
Key words: Migraine, prophylaxis, valproate
PROFILAKTIČKI TRETMAN MIGRENE VALPROATIMA
Kratak sadržaj: Migrena je epizodična glavobolja. Plan lečenja glavobolje
uključuje akutni tretman sa ciljem prekidanja bola i neurološke oštete
i dugotrajni preventivni tretman sa ciljem smanjivanja učestalosti, jačine
i trajanja bola. Okolnosti koje zahtevaju preventivnu terapiju uključuju
vrlo česte i snažne migrene koje remete pacijentove svakodnevne aktivnosti,
neuspešnost akutnog tretmana, specijalne okolnosti kao što je hemiplegična
migrena ili je to želja pacijenta. Lečenje treba započeti malom dozom,
a svako lečenje treba da traje adekvatno dugo uz izbegavanje interakcija,
predoziranja i kontraindikovanih lekova. Treba razmotiti i komorbiditet.
Među lekovima koji imaju dokazanu visoku efikasnost a blage ili umerene
sporedne efekte spadaju beta blokatori, amitriptilin i valproati.
Valproati su se pokazali kao efikasan lek u profilaktičnom tretmanu
migrene. Istraživanje mehanizma njihovog antimigrenskog dejstva je teško
zbog širokog spektra njihove biohemijske aktivnosti i komplikovane patofiziologije
migrene. Valproati povećevaju nivo GABA i mogu suprimirati migrenske događaje
u korteksu, perivaskularnoj parasimpatičkoj mreži ili u kaudalnom jedru
trigeminusa. Postoji eksperimentalni dokaz da suprimiraju neurogenu inflamaciju
i direktno slabe nociceptivnu neurotransmisiju. Takođe, valproati menjaju
nivoe ekscitatornih i inhibitornih neurotransmitera i pokazuju direktne
efekte na membranu neurona in vitro. Efekti valproata rezultiraju iz kombinacije
aktivnosti na različitim mestima.
Ključne reči: Migrena, profilaktički tretman, valproati