Migraine Management in Medically Complex Patients: a Narrative Review.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL ACS Applied Energy Materials Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI:10.1007/s11910-024-01361-y

Megan A Hird, Claire H Sandoe

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Abstract

Purpose of review: The current review aims to provide an overview of migraine treatment strategies in medically complex patients, including those with renal, liver, and cardiovascular disease.

Recent findings: In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.

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复杂病症患者的偏头痛管理：叙述性综述。

综述目的：本综述旨在概述病情复杂的偏头痛患者（包括肾脏、肝脏和心血管疾病患者）的治疗策略：最近的研究结果：对于心血管疾病患者，庚烷类药物可能是安全的急性治疗药物；不推荐使用非甾体抗炎药、麦角胺和三苯氧胺。β-受体阻滞剂、血管紧张素转换酶抑制剂（ACEi/ARB）和维拉帕米除了具有预防偏头痛的作用外，还对心血管有潜在的益处。肾病或轻度至中度肝病患者无需调整氟伐曲普坦的剂量。对于轻度和中度肾病和肝病患者，吉潘类药物是安全的急性和预防性治疗选择。肾病患者无需调整 TCAs 和丙戊酸的剂量。OnabotulinumtoxinA 对心脏、肾脏和肝脏受损的患者可能是安全的。虽然 CGRP 单克隆抗体在肾病和肝病患者中可能是安全的，但在这些情况下以及在心脏病患者中还需要进一步研究，目前还没有剂量建议。对于有复杂并发症的患者来说，可以选择有效的治疗方案。关于新型偏头痛特异性疗法在这些复杂人群中的安全性，还需要进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.