片頭痛の予防療法のオーバービュー

An Overview of Prophylactic Therapy for Migraine

はじめに

　2000年に片頭痛の頓挫薬として，片頭痛の病態生理に基づき開発されたトリプタン製剤が本邦で上市されて以来，片頭痛治療における選択肢は頓挫薬による急性期治療が前面に置かれるようになった（Table）。しかしながら片頭痛の発生機序をさらに深く追求していくと，治療における，生活指導や投薬加療を含めた予防的加療の重要性が浮き彫りにされてくる。本項では，このような現状を踏まえて，片頭痛の予防療法の重要性と投薬加療法について述べていくこととする。

Abstract

　The launch of triptans has significantly changed the treatment of migraine,leading to great improvement in the quality of life (QOL) of migraine patients.　In routine clinical settings,few patients present with migraine attacks that clearly deviate from the typical frequency and severity of migraine,and migraine that is difficult to control with acute-phase treatment alone is frequently encountered.　Under these circumstances,the importance of prophylactic therapy,including lifestyle guidance and drug treatment,has attracted attention.　However,in Japan,only a small number of prophylactics are currently indicated for migraine,and the available options are insufficient.　In this study,I have outlined the prophylactic strategies for migraine,including lifestyle guidance,on the basis of literature published in Europe and North America.　In addition,I have presented my clinical experiences and research reports to introduce cases of migraine for which prophylactic therapy was indicated,to hypothesize the mechanisms of the prophylatic activity of specific drugs (e.g.,anti-convulsants,anti-depressants,β-blockers,AII antagonists,Ca channel blockers,leukotriene receptor antagonists,statins,anti-herpes zoster virus drugs) for their prophylactic effect on migraine,and to determine drug regimens.