Zatsopano zokhudzana ndi sayansi kumbuyo kwa migraine zimatanthawuza njira zabwino zothandizira
Migraine ndi matenda osokoneza ubongo omwe amachoka ngakhale asayansi ochenjera komanso akatswiri a m'maganizo mwa nthawi zina akuwombera mitu yawo. Mosiyana ndi zina zambiri zachipatala, chilengedwe cha kugwidwa kwa migraine sikunakwaniritsidwebe.
Nkhani yabwino ndi yakuti ochita kafukufuku akumaliza kumvetsetsa "momwe" kusinthira kwa migraine-kutanthauza matenda awo, kapena momwe amasonyezera.
Ndi chidziwitso ichi chomwe chasintha njira zochizira matenda, ndikukhazikitsa maphunziro othandiza komanso mankhwala atsopano.
Kupititsa patsogolo kwakukulu katatu mu migraine mankhwala ndi:
- Njira zodabwitsa zogwiritsira ntchito triptans, mankhwala osakanikirana ndi anti-migraine.
- Mankhwala atsopano oletsa anti-migraine omwe amachiza kwambiri komanso kupewa.
- Zipangizo zamankhwala zothandizira ndikuletsa migraines.
Triptans Anapulumutsidwa Mwapadera
Triptans imamangiriza serotonin receptors mu ubongo ndipo amagwiritsidwa ntchito kuti athetse matenda osokoneza bongo. Amagwiritsidwanso ntchito pochita maseŵera olimbitsa thupi omwe samasuka ndi NSAID .
Kukongola kwa triptan ndikuti akhoza kuperekedwa m'njira zingapo-mapiritsi, mapiritsi olekanitsa pamlomo (zakumwa), utsi wamkati, jekeseni (pansi pa khungu), ndi suppository.
Ndi zonsezi, munthu yemwe ali ndi migraines ndi dokotala wake angathe kusankha triptan, malinga ndi zomwe amakonda komanso zosowa zake.
Mfundo izi zingaphatikizepo izi:
- Zotsatira zoyipa
- Kuyamba kuchitapo kanthu
- Kupempha kwa anthu ena a migrauneurs-mwachitsanzo, iwo omwe amamva nkhanza ndi kusanza ndi migraines ndipo sangathe kulekerera mankhwala pamlomo
- Mtengo
- Zosangalatsa
Ndimasangalatsanso kudziwa kuti triptans ingaperekedwe m'njira zosiyanasiyana kwambiri m'tsogolomu.
Mwachitsanzo, pulogalamu ya sumatriptan lingual ikukonzekera, monga zolmitriptan inhaler ndi rizatriptan pakamwa kutaya filimu.
Kumbukirani kuti mawonekedwe atsopano samachita bwino. Mwachitsanzo, sumatriptan ankakonda kupezeka ngati patch transdermal patch (yotchedwa Zecuity) yomwe imagwiritsidwa ntchito pamanja kapena pamphuno. Iyo inalowa mu khungu pogwiritsa ntchito njira yamagetsi, yopereka 6.5mg wa sumatriptan kwa maola anayi. Komabe, pakali pano imachoka pamsika chifukwa cha malipoti a zowonongeka ndi zida zogwirizana nazo.
Chithunzi chachikulu apa ndi chakuti ndi mankhwala atsopano ndi mawonekedwe omwe amabwera lonjezano, komabe ena amawatsutsa ngati maonekedwe amatsitsidwa.
Kumbukiraninso kuti malemba omwe amagwiritsidwa ntchito kwa munthu mmodzi sangagwiritse ntchito wina-choncho kambiranani ndi dokotala wanu kuti mutulutse mayendedwe ndi zosungira zomwe mungachite posankha mankhwala.
Mankhwala a Anti-Migraine Achilendo
Monga asayansi amavumbulutsira zamoyo zomwe zimayambitsa matenda a migraine, amatha kulunjika njira zatsopano ndi zovomerezeka. Kupititsa patsogolo katatu pa mankhwala a migraine ndi:
- Lasmiditan: Mankhwala ofanana ndi ma triptan ena koma ali ndi mgwirizano wapadera wothandizira serotonin.
- Mankhwala othandiza Calcitonin Gene-Related Peptide (CGRP)
- Mankhwala othandiza Glutamate
Lasmiditan: Serotonin 5-HT1F Agonist
Lasmiditan ikupangidwa ngati mankhwala ena opangira triptans . Nchifukwa chiyani njira ina ikufunika? Pali zifukwa zitatu:
- Kafukufuku amasonyeza kuti pafupifupi 35 peresenti ya anthu sapeza mpumulo wa migraine ku triptans.
- Anthu ambiri sangathe kutenga triptans chifukwa zingayambitse magazi m'thupi (vasoconstriction) -ndipo, triptans imatsutsana ndi omwe ali ndi mbiri ya matenda a mtima, kupweteka, matenda a mitsempha , kuthamanga kwa magazi, ndi / kapena mitundu ina ya Migraine ngati hemiplegic kapena basilar migraine.
- Anthu ena samangokonda momwe ma triptan amawapangitsa kudzimvera, chifukwa amatha kuwononga zotsatirazi monga msuwa, khosi, ndi chifuwa, chifuwa, ndi kumenyana (makamaka nkhope).
Nkhani yodalirika yokhudzana ndi nkhanza ndi yakuti imasankha kumalo enaake a serotonin mu ubongo, kukhala ndi chiyanjano china kwa zina zotchedwa serotonin receptors zomwe zikagwedezeka, zingapangitse kuti pasoconstriction ikhale yosafunika.
Nkhani yabwino ndi yakuti muphunziro lachiwiri, amitundu omwe amamwa mankhwala osiyanasiyana amapezeka kuti amachititsa kupweteka kwa mutu wa mutu wa migraine mopitirira muyeso (kapena wofatsa) maola awiri. Kupititsa patsogolo kwa ululu kunali kudalira kwa mlingo, kutanthauza kuti msinkhuwu umakhala wapamwamba kwambiri, kupumula kowawa kwambiri.
Zotsatira zoyipa zinali chizungulire (zikuchitika pa 38 peresenti ya ophunzira) motsogozedwa ndi vertigo ndi kutopa.
Choncho, mosiyana ndi ma triptan omwe alipo, zovuta zowonongeka zimatha kupeŵa zotsatira za vasoconstrictive, koma zingayambitse machitidwe ena amanjenje, omwe angalepheretse anthu ena. Zonsezi, maphunziro akuluakulu ndi chithunzi chowonekera bwino cha kayendedwe kake kachisokonezo.
Peptide ya Calcitonin yokhudza Gene (CGRP)
Peptide yokhudzana ndi majeremusi ya calcitonin (CGRP) imathandiza kwambiri pa migraine pathogenesis. Kwenikweni, kafukufuku akusonyeza kuti panthawi ya migraine, masewera a trigeminal amayamba, motsogolere kutulutsidwa kwa CGRP kuchokera kumapeto kwa mitsempha ya trigeminal. CGRP imagwira ntchito yochepetsera mitsempha ya ubongo kuzungulira ubongo ndikuyambitsa chochitika chotchedwa neurogenic kutupa, ndipo ndi njira ziwiri izi zomwe zimachititsa mutu wa mutu wa migraine.
Choncho, mankhwala omwe angathe kuletsa CGRP yokha kapena receptors (malo opangira malo mu ubongo) a CGRP akuwerengedwa. Mwamwayi, kafukufuku wina wofufuza a CGRP-receptor antagonists (mankhwala omwe amachititsa kuti ntchito ya CGRP) asakhalenso ndi zifukwa zingapo, kuphatikizapo kudera nkhawa za chiwindi cha chiwindi. Koma mankhwala amodzi, ogwira ntchito, anali olekerera ndi othandiza mu phunziro lachiwiri.
Mankhwala atatu oletsa anti-CGRP (mankhwala omwe amamanga mapuloteni CGRP ndi kuwaletsa kapena kuwaletsa) awonetsedwanso kuti asatengere migraines, ndi lingaliro lochotsa owonjezera CGRP otulutsidwa ndi trigeminal nerve mapeto pa migraine kuukira. Mankhwalawa amasonyeza zotsatira zowonjezera kumayesero oyambirira 1 ndi 2.
Potsirizira pake, erenumab ndi anti-monoclonal antibody yomwe imamangiriza osati ku CGRP, koma kumalo ake, ndipo imaperekedwa pansi pa khungu (jekeseni yapansi). Mwa kumangiriza kwa receptor, erenumab imatseka izo pozizindikiro. Aphunzira ngati mankhwala othandiza kuti asamangodziwa mankhwalawa ndipo akuwoneka bwino mu phunziro lachiwiri.
Zonsezi, kuyang'ana njira za CGRP kumawoneka ngati njira yothandizira odwala omwe ali ndi matenda osokoneza bongo kapena odwala matenda a migraine.
Glutamate Receptor Antagonists
Glutamate ndi mitsempha ya ubongo, kapena mankhwala mu ubongo, kuti malinga ndi zinyama ndi maphunziro aumunthu, zikuwoneka kuti zimathandiza kwambiri momwe migraines imawonekera. Mankhwala amodzi okhudzana ndi kuteteza kapena kusintha mapiritsi a glutamate awerengedwa, ena pofuna kuchiza matenda oopsa a migraine ndi ena pofuna kuteteza migraines.
Mwinanso mukhoza kutenga kapena kudziŵa mankhwala odziteteza monga topamax (topiramate) ndi botulinum poizoni A yomwe imaletsa kutulutsa glutamate, pamodzi ndi mankhwala ena.
Chochititsa chidwi ndi chakuti ketamine (mankhwala osokoneza bongo), omwe amachititsa kuti pakhale ubongo wa glutamate mu ubongo wotchedwa NMDA receptor, wapezeka kuti amachiza migraine aura- mwachidziwitso pogonjetsa kupweteka kwa cortical, phokoso lachisokonezo cha mitsempha yomwe imadutsa pamtunda ubongo.
Phunziro laling'ono la anthu omwe ali ndi migraine aura yaitali, 25mg ya intranasal ketamine (yoperekedwa kupyolera m'mphuno) inafanizidwa ndi midazolam (intraaslam), yomwe imakhala ngati sedative. Kafukufukuyu anapeza kuti ketamine inachepetsera kuuma koma osati nthawi ya aura. Zotsatira zoyipa zinaphatikizapo:
- Maganizo a zenizeni
- Euphoria
- Giddiness Yachisoni
Zotsatirazi zadutsa mkati mwa mphindi 30 mpaka 45. Kwenikweni, udindo wa glutamate ndi njira zake zosagwiritsira ntchito migraine ndi migraine aura zikupitiriza kukhala magwero ofufuzira, ndipo ndizo, chiyembekezo cha mankhwala atsopano.
Zipangizo za Revolutionary FDA-Approved for Migraine Treatment
Kulengedwa kwa zipangizo zochizira komanso kuchepetsa migraines kwasintha kusintha kwa migraine. Zida zimenezi ndizosavuta kugwiritsira ntchito, zosavuta, komanso zogwirizana ndi zotsatira zochepa. Kuwonongeka ndizofunika komanso kuti zipangizo zina sizigwira ntchito kwa aliyense.
Komabe, kutenga ndalama mu chipangizochi kungakhale chinthu choyenera kwa ena ogwira ntchito, makamaka ngati mankhwala sakugwira ntchito, kapena kwa anthu omwe amamwa mankhwala osokoneza mutu .
Chipangizo chimodzi choteteza ku migraine chomwe chimatchedwa Cefaly chimalimbikitsa mitsempha ya supraorbital (tSNS) yomwe imateteza mbali ya pamphumi, khungu ndi chikopa chachikulu. Imeneyi ndi chipangizo chopangidwa ndi batri, chovala ngati tsamba lomwe limagwiritsidwa ntchito tsiku lililonse kwa magawo makumi awiri.
Ndilo chipangizo chotetezeka, chosamalidwa bwino, komanso chogwiritsira ntchito pogwiritsa ntchito kuphunzira kwakukulu mu Journal of Headache and Pain, omwe ali ndi anthu osachepera asanu pa asanu alionse omwe amafotokoza zotsatira zochepa zoyipa. Kungakhale njira yabwino kwa anthu omwe sangathe kulekerera kapena sakufuna kumwa mankhwala ochepetsa mankhwala a migraine.
Chipangizo chinanso chimachititsa chidwi kwambiri (nVNS), chomwe chimatchedwa GammaCore, chomwe chingagwiritsidwe ntchito potsata ndi kuchiza matenda a migraine. Zimagwira ntchito polimbikitsa mitsempha ya vagus-imagwiritsidwa ntchito kumbali ya khosi kwa pafupi mphindi ziwiri mutatha kugwiritsa ntchito gel osakaniza. Amakhulupirira kuti amagwira ntchito popondereza kwambiri magulu a glutamate mu trigeminal system.
Mu kafukufuku wa Journal of Headache and Pain, zotsatira zawonetsetsa kuti chiwerengero cha mitu imatha pa mwezi, komanso kupweteka kwambiri, mwa odwala omwe ali ndi matenda osokoneza maganizo omwe amatha kupweteka kwambiri. Zopweteka zochepa chabe zinafotokozedwa ndipo palibe zomwe zinali zovuta. Zotsatirapo izi zimaphatikizapo kukwiya kwa khungu ndi kupindika khosi.
Chipangizo chachitatu chotchedwa Spring transcranial magnetic stimulator (sTMS) ndi FDA-chovomerezedwa kuti chithandizo cha migraine chikhale ndi aura. Amagwiritsiridwa ntchito pogwiritsa ntchito chipangizo kumbuyo kwa mutu wanu ndikukankhira batani, yomwe imatulutsa mphamvu zamaginito mu ubongo. Ikhoza kugwiritsidwa ntchito kamodzi pa maola 24 ngati mankhwala. Amakhulupirira kuti amagwira ntchito pogwiritsa ntchito kachipangizo kowonongeka kwa magetsi, ntchito yamagetsi yomwe imafalikira kudutsa ubongo.
Mawu Ochokera
Pamene mapeto a mankhwala atsopano ndi othandiza ndi othandiza komanso odalirika, kumbukirani kuti kusamalira ndi kupewa kuthamanga kwa migraine kungakhale kovuta komanso kosasinthika. Mmodzi mwa mayesero omwe angasinthe monga momwe migraines, moyo wanu, ndi / kapena zosinthira zimasinthira.
Pitirizani kuchita zinthu mwakhama mwa kutsata katswiri wanu wa m'maganizo nthawi zonse ndikukhalabe ndi chidwi pa nkhani za migraine, popanda kugwiritsidwa ntchito pazinthu zamakono. Tiyeni tikhale ndi chiyembekezo kuti matenda opweteka awa akhoza kulemedwa pang'ono posachedwa kwa inu kapena wokondedwa wanu.
> Zotsatira:
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> Chan K, MaassenVanDenBrink A. Atsitsi a Glutamate omwe amatsutsana ndi migraine. Mankhwala . 2014 Jul; 74 (11): 1165-76.
> Färkkilä M et al. Kuchita bwino ndi kulekerera kwa chilakolako chogonana, chamlomo chodziwika bwino cha 5-HT (1F) receptor agonist, chifukwa cha mankhwala ovuta a migraine: gawo lachiwiri lopangidwa ndi malo, lofanana, gulu lophunzirira. Lancet Neurol . 2012 May; 11 (5): 405-13.
> Magis D, Sava S, d / Elia TS, Baschi R, Schoenen J. Chitetezo ndi odwala kukhutira ndi transcutaneous supraorbital neurostimulation (tSNS) ndi chipangizo cha Cefaly kuchipatala: kufufuza kwa anthu 2,313 omwe akudwala mutu. J Mutu wa Mutu . 2013 Dec 1; 14: 95.
> Sun H et al. Kutetezeka ndi kuthandizira kwa AMG 334 pofuna kupewa matenda osokoneza bongo. Lancet Neurol. 2016; 15 (4): 382-90.