成人：エピソード片頭痛薬物治療ガイドライン update

ミグシス（ lomerizine）なんて記載すらないのだが・・・

デパケンは、“片頭痛発作の発症抑制”の適応あり、それ以外のlevel A推奨薬剤は健保適応に注意必要だろう。フロバトリプタンは、“月経に伴う片頭痛予防”として意義があると思うのだが・・・

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults
Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society
Neurology April 24, 2012 vol. 78 no. 17 1337-1345 

http://www.neurology.org/content/78/17/1337.full

２８４の要約をレビューし、２９の class I あるいは class II　のレビュー作成

片頭痛予防に有効で、片頭痛頻度・重症度減少目的のため使用すべき：Divalproex sodium、 sodium valproate（デパケンなど）、 topiramate（商品名：トピナ錠）、 metoprolol（セロケン、ロプレソールなど）、 propranolol（インデラルなど）、 timolol (level A)

Frovatriptanは、月経関連片頭痛予防2有効 (level A)

Lamotrigine は片頭痛予防に効果ない (level A)

表をそのまま転載

RECOMMENDATIONS

Level A.

The following medications are established as effective and should be offered for migraine prevention:

Antiepileptic drugs (AEDs): divalproex sodium, sodium valproate, topiramate

β-Blockers: metoprolol, propranolol, timolol

Triptans: frovatriptan for short-term MAMs prevention

Level B.

The following medications are probably effective and should be considered for migraine prevention:

Antidepressants: amitriptyline, venlafaxine

β-Blockers: atenolol, nadolol

Triptans: naratriptan, zolmitriptan for short-term MAMs prevention

Level C.

The following medications are possibly effective and may be considered for migraine prevention:

ACE inhibitors: lisinopril

Angiotensin receptor blockers: candesartan

α-Agonists: clonidine, guanfacine

AEDs: carbamazepine

β-Blockers: nebivolol, pindolol

Level U.

Evidence is conflicting or inadequate to support or refute the use of the following medications for migraine prevention:

AEDs: gabapentin

Antidepressants

Selective serotonin reuptake inhibitor/selective serotonin-norepinephrine reuptake inhibitors: fluoxetine, fluvoxamine

Tricyclics: protriptyline

Antithrombotics: acenocoumarol, Coumadin, picotamide

β-Blockers: bisoprolol

Calcium-channel blockers: nicardipine, nifedipine, nimodipine, verapamil

Acetazolamide

Cyclandelate

Level A negative.

The following medication is established as ineffective and should not be offered for migraine prevention:

Lamotrigine

Level B negative.

The following medication is probably ineffective and should not be considered for migraine prevention:

Clomipramine

Level C negative.

The following medications are possibly ineffective and may not be considered for migraine prevention:

Acebutolol

Clonazepam

Nabumetone

Oxcarbazepine

Telmisartan