Ulwazi olutsha malunga ne-biology emva kokuhlaselwa kwe-migraine luthetha iindlela zokuphucula
I-Migraine isifo esiyinkimbinkimbi yesifo esenza ukuba izazinzulu kunye neurologists zidla ngezinye iintloko. Ngokungafani nezinye iimeko zonyango, i-biology yokuhlaselwa kwe-migraine ayizange ifumaneke.
Iindaba ezilungileyo kukuba abaphandi ekugqibeleni bayasondela ekuqondeni "indlela" emva kokuhlaselwa kwe-migraine-kuthetha intsholongwane yabo, okanye indlela ababonakalisa ngayo.
Yilo lwazi oluye lwaguqula imishanguzo ye-migraine, ukubeka i-barrage yezifundo ezithembisayo kunye neyeza ezitsha ezikhulayo.
Intuthuko emithathu enkulu kwi-migraine yonyango iquka:
- Izindlela eziyingqayizivele zokulawula i-triptans, isisisi se-anti-migraine esele sisekwa
- Iilveli ezichasene ne-anti-migraine imishanguzo yezobisi kunye nokukhusela.
- Izixhobo zonyango ukunyanga nokukhusela migraines.
I-Triptans ihanjiswe ngokukodwa
I-Triptans ibophelela kwi-serotonin receptors kwingqondo kwaye isetyenziswa ngokuqhelekileyo ukuphatha ukuhlaselwa kwe-migraine emodareyitha. Ziye zisetyenziselwa ukunyanga imigraines emancinci ukuya ekumodareyithini engacacisi nge- NSAID .
Ubuhle bama-triptan kukuba banokuhanjiswa inani leendlela ezahlukeneyo-iipilisi, iipilisi ezichithwa ngomlomo (i-spray), i-nasal spray, i-injection engaphantsi (ngaphantsi kwesikhumba), kunye ne-suppository.
Ngazo zonke ezi zikhetho, umntu onemigraines kunye nodokotela wakhe angakhetha i-triptan, ngokusekelwe kwizinto ezikhethiweyo kunye neemfuno zakhe.
Ezi ngqalelo zingaquka:
- Imiphumela
- Ukuqaliswa kwesenzo
- Isibheno kwimimandla ethile ye-migrauneurs-umzekelo, abo banenkcenkceshe kunye nokuhlanza nge-migraines kwaye abanako ukunyamezela amayeza ngomlomo
- Iindleko
- Ukuzonwabisa
Kwakhona kunomdla ukufunda ukuba i-triptans inokulawulwa ngeendlela ezingezona zizodwa kwixesha elizayo.
Ngokomzekelo, i-sumatriptan isicatshulwa esisetyenziswayo njengamanje iphuhliswa, njengokuba i-zolmitriptan inhaler kunye ne-rizatriptan umlomo ukuchithwa kwefilimu.
Gcina ukhumbule ukuba imimiselo emitsha ayisoloko isebenza kakuhle. Ngokomzekelo, i-sumatriptan isetyenziselwa ukuba ifumaneke njengecatshulwa elixhaswe ngebhetri (elibizwa ngokuba yi-Zecuity) eliye lafakwa kwisandla okanye intamo. Kwangena kwesikhumba kusetyenziswa indlela yokusebenzisa umbane, ukuhambisa ama-6.5mg we-sumatriptan ngaphezu kweeyure ezine. Nangona kunjalo, okwangoku ivela kwimarike ngenxa yeengxelo zokutshisa kunye nezikhonkwane ezihambelana nayo.
Umfanekiso omkhulu apha kukuba ngamachiza amasha kunye neziqulatho ziza izithembiso, kodwa ezinye zizingabaza njengoko amanqaku athathwe.
Khumbula kwakhona ukuba ukuqulunqwa okusebenza kumntu omnye kunokungasebenzi kumnye-ngoko uthetha nodokotela wakho ukuba uhlenge i-pluses kunye neendlela zokunciphisa unyango lwe-migraine.
Iimveli zoLondolozo lweMigudu ye-Anti-Migraine
Njengoko izazinzulu ziveza i-biology emva kokuhlaselwa kwe-migraine kwintliziyo, bayakwazi ukujolisa kwiindlela ezintsha kunye nama-receptors. Intuthuko emithathu kwizidakamizwa ze-migraine ziquka:
- I-Lasmiditan: Amachiza afana namanye ama-triptan kodwa ngobudlelwane obukhulu kummkeli othile we-serotonin.
- Iimpawu ezijolise ku-Calcitonin-Related Related Peptide (CGRP)
- Amachiza axhomekeke kuGlutamate
I-Lasmiditan: I-Serotonin 5-HT1F Agonist
I-Lasmiditan iphuhliswa njengenye imithi kwi- triptans . Kutheni kukho enye efunekayo? Kukho izizathu ezintathu:
- Uphando lubonisa ukuba malunga neepesenti ezingama-35 zabantu abafumani imiphumo ye-migraine kwi-triptans yomlomo.
- Inani elininzi labantu alikwazi ukuthatha ii-triptan kuba zingabangela i-bloodstriction constraction (vasoconstriction) -njalo, ama-triptans aphikisana nalabo abaneengxaki zesifo senhliziyo, isifo, isifo sesifo se-vascular , ingcinezelo ephezulu yegazi, kunye / okanye iintlobo ezithile i-migraine njenge- hemiplegic okanye i-basilar migraine.
- Abanye abantu abathandi nje ukuba i-triptans ibenza njani bazive, njengoko zinokubangela iziphumo ezibi ezintle njengomhlathi, intamo, kunye nesifuba, ukugada, kunye nokubetha (ikakhulukazi ubuso).
Iindaba ezithembisayo malunga ne-lasmiditan kukuba zibophelela ngokukhethekileyo kwi-receptors ethile ye-serotonin ebuchosheni, ukuba nobudlelwane obungaphantsi kwamanye ama-receioton receptors ukuba xa eboshiweyo, unokukhokelela kwisifo esingavumelekanga se-vasoconstriction.
Iindaba ezilungileyo kukuba kwisifundo sesigaba sesi-2, i-lasmiditan ethathelwe kwiindlela ezahlukeneyo ifunyenwe ukuphucula intlungu esuka kwintloko ye-migraine enomlinganiselo ongathintekiyo okanye onobunzima. Ukuphuculwa kwentlungu kwakuxhomekeke kwintsholongwane, oku kuthetha ukuba phezulu kwe dose, ukukhululeka kwentlungu.
Iziphumo eziphambili ziyizondlo (ezenzeka kuma-38 ekhulwini abathathi-nxaxheba) zilandelwa yi-vertigo kunye nokukhathala.
Ngoko ke, ngokungafani ne-triptans yangoku, ukukhonkxa ngokuchanekileyo kwe-lasmiditan kunokunceda ukuphepha iziphumo ezimbi ze-vasoconstrictive, kodwa kunokukhokelela kwinkqubo eninzi yeentlanzi, ezinokuthi zithintele abanye abantu. Ngokubanzi, izifundo ezikhulu kunye nomfanekiso ocacileyo weendlela ezisemva kwemilingo ziyimfuneko.
I-Calcitonin I-Peptide ehlobene ne-Gene (CGRP)
I-peptide ehlobene ne-calcitonin ye-gene (CGRP) idlala indima ebalulekileyo kwi-migraine pathogenesis. Ngokukodwa, uphando lubonisa ukuba ngexesha lokuhlaselwa kwe-migraine, i-system ye-trigeminal isebenze, ekhokelela ekukhululeni i-CGRP kwiziphelo ze-nerginal. I-CGRP isebenza ngokujongana nemigodi yegazi ejikeleze ingqondo kwaye ibangele into ebizwa ngokuba yi-neurogenic inflammation, kwaye yile nyathelo emibini leyo eyenza intloko ye-migraine.
Ngoko ke, imithi enokubamba i-CGRP ngokwayo okanye i-receptors (isayithi lokungena kwindawo yengqondo) ye-CGRP njengangoku ifundiswa. Ngelishwa, ezinye iincwadi ezihlola i-CGRP-receptor antagonists (amayeza avimbela isenzo se-CGRP) ziye zavalwa kwangaphambili ngenxa yezizathu ezininzi, kubandakanywa nokukhathazeka ngenxa yetyhefu yesibindi. Kodwa elinye unyango, olusenyakatho, lwalubekezeleleke kwaye lusetyenziswa kwisifundo sesi-2.
Amanqatha amathathu e-anti-CGRP (iziyobisi ezibophelela kwiprotheyini yeCGRP kunye nokuyivimba okanye zingayisebenzisi) ziye zaphuhliswa ukukhusela imigraines, kunye nombono wokususa i-CGRP eyongezelelweyo ekhutshwe yii-endemic nerve endings ngexesha lokuhlaselwa kwe-migraine. Ezi zi yobisi zibonisa iziphumo ezithembisayo kwisilingo sokuqala se-1 no-2.
Ekugqibeleni, i-erenumab yintsholongwane ye-monoclonal engayibopheli kwi-CGRP, kodwa iya kwi-receptor yayo, kwaye inikwe phantsi kwesikhumba (i-injection subcutaneous). Ngokubopha kwi-receptor, i-erenumab iyayithiya ukusayina. Kuye yafundiswa njengemithi yokukhusela i-migraine kwaye ibonakala ixhomekeke kakuhle kwisifundo sesi-2.
Ngokubanzi, ukujoliswa kweendlela ze-CGRP kubonakala kuyindlela enokuthembisayo yokwelapha kulabo abane-episodic okanye ingxaki engapheliyo ye-migraine.
I-Glutamate Receptor Antagonists
I-Glutamate yintsholongwane, okanye imichiza ebuchosheni, ukuba ngokutsho kwezilwanyana kunye nezifundo zabantu, kubonakala kudlala indima ephambili kwindlela i-migraines ebonakala ngayo. Inani leyeza ezinxulumene nokuvimbela okanye ukuguqula i-glutamate receptors ziye zafundwa, ezinye zonyango ukuhlaselwa kwe-migraine ezimbi kunye nabanye ukukhusela i-migraines.
Unokuthi uthathe okanye uthathe imichiza yokukhusela njenge-topamax (topiramate) kunye ne-botulinum ye-toxin A eyenza ukukhutshwa kwe-glutamate, kunye nezinye iikhemikhali.
Kuyathakazelisa, i-ketamine (isichengisiso sesilwanyana esilumkileyo), esivimbela i-glutamate kwingqondo ebizwa ngokuba yi-receptor ye-NMDA, ifumaneka ukuphatha imfraine -ra- mhlawumbi ngokuthintela uxinzelelo olusasazekayo, i-wave of depress depression. kwengqondo.
Kwisifundo esincinci esincinci esiphakathi kwabantu abane-migraine aura ende, i-25mg ye-intranasal ketamine (enikwe ngeempumlo) yayifaniswa ne-intranasal versed (midazolam), okuyiyo yokuguqula. Uphononongo lufumene ukuba i-ketamine yanciphisa ubunzima kodwa kungengona ixesha le-aura. Iziphumo ezichaphazelekayo zibandakanya:
- Imvakalelo engokoqobo
- Euphoria
- Giddiness yesikhashana
Le miphumo yanikela phantsi kwemizuzu engama-30 ukuya kwe-45. Ngokubanzi, indima ye glutamate kunye neendlela zayo kwi-migraine engapheliyo kunye ne-migraine aura iyaqhubeka iyimvelaphi yophando, kunye naloo nto, ithemba lokuphulukiswa kwintsha.
Izixhobo ezivunyiweyo ze-FDA-Approved for Migraine Therapy
Ukudalwa kwezixhobo zokunyanga nokukhusela imigraine kuye kwaguqula unyango lwe-migraine. Ezi zixhobo ziyinxalenye enkulu elula ukuyisebenzisa, elula, kwaye idibene nemiphumo embi kakhulu. Ukuhla kweendleko ziyindleko kunye nenyaniso yokuba ezinye izixhobo azisebenzi kuwo wonke umntu.
Sekunjalo, ukutshala imali kwisixhobo kunokuthi kube yindlela efanelekileyo yokuthatha imithi, ngakumbi ukuba imithi ayisebenzanga, okanye abantu abaxhomekeke kumachiza abangaphezu kokusweleka kwentloko .
Isixhobo esisithintelayo sokuthintela i-migraine esibizwa ngokuba yiCefaly ijolise kwi-nerve ye-supraorbital (tSNS) engayigcinanga inxalenye yebunzi, isikhumba sesifuba nesofu. Yisistim esebenzayo ibhetri eguqulwe njengebhokisi lebhokisi elisetyenziselwa imihla ngemizuzu yesibini.
Isixhobo esikhuselekileyo, esinokunyamezela, kunye nesisetyenziswa ngumsebenzisi ngokwemiqathango enkulu kwiNcwadi yeNtloko kunye neNtlungu, kunye neepesenti ezingaphantsi kweesithathu zabantu ababikela imiphumo emibi embi. Kungaba yinto enhle kubantu abangakwazi ukunyamezela okanye abangafuni ukuthatha imithi yokuthintela imithi yokuthintela imithi.
Enye ifowuni yindlela yokuvuselela i-nervous nerve (non-invusive vagus nerve stimulation (nVNS) (ebizwa ngokuba yiGammaCore) engasetyenziselwa ukukhusela nokuphatha unyango olushukumisayo. Isebenza ngokuvuselela i-vagus nerve-ngoko ibanjelwe ecaleni kwentamo malunga nemizuzu emibini emva kokufaka i-gel eqhubayo. Kukholelwa ukuba isebenza ngokunciphisa amanqanaba aphezulu e-glutamate kwi-system trigeminal system.
Kwisifundo kwi- Journal of Headache and Pain, iziphumo zibonise ukuphucula kwinani leentloko ngenyanga, kunye neentlungu zentlungu, kubathathi-nxaxheba kunye neengxaki ze-episodic okanye ezingapheliyo. Zimbalwa iziphumo ezimbi zabikwa kwaye akukho nanye yayinzulu. Ezi ziphumo zecala zazibandakanya ukucaphukisa isikhumba kunye nentamo.
Isixhobo sesithathu esibizwa ngokuba ngumgqugquzeli we-magnetic magnetic (sTMS) se-Spring (sTMS) sivunywe yi-FDA ukuze siphathe imigraine nge-aura. Isetyenziswe ngokusebenzisa ifowuni emva kwekhanda lakho kwaye ucinezela iqhosha, elikhupha amandla ombane ashukumisayo kwingqondo. Ingasetyenziselwa kuphela emva kweeyure ezingama-24 njengonyango. Kukholelwa ukuba kusebenza ngumbandezelo okhuseleyo wokusasazeka, ukutshatyalaliswa komsebenzi wombane oqhaqhawula kuyo yonke ingqondo.
ILizwi
Nangona i-culraine ye-migraine kunye nezoxhobo ziyakuthandeka kwaye zithembisa, khumbula ukuba unyango kunye nokuthintela ukuhlaselwa kwe-migraine kungaba yinkqubo enobunzima kwaye ingenakulungiswa-enye yezilingo kunye nephutha eliya kutshintsha njengoko i-migraines yakho, indlela yokuphila, kunye / okanye ukukhetha okukhethwa kukho.
Hlala usebenza ngokulandela i-neurologist yakho rhoqo kwaye uhlale usesikhathini kwiindaba ze-migraine, ngaphandle kokugxininisa kwimigangatho yezobugcisa. Makhe sibe nethemba ukuba esi sifo esixhatshazayo sinokukhutshwa ngokukhawuleza kungekudala kuwe okanye wakho othandekayo.
> Imithombo:
> Antonaci F, Ghiotto N, Wu S, Pucci E, Costa A. Inkqubela phambili yonyango lwe-migraine. Springplus. 2016 Meyi 17; 5: 637.
> Chan K, MaassenVanDenRrink A. I-Glutamate receptor antagonists ekulawuleni i-migraine. Zi yobisi . 2014 Julayi; 74 (11): 1165-76.
> Färkkilä M et al. Ukusebenza kunye nokunyamezela kwe-lasmiditan, ngomlomo we-5-HT (1F) we-agonist receptor, ukwenzela unyango olunzima lwe-migraine: isigaba sesi-2 esilawulwa yi-placebo-esilawulwayo, isigaba esifanayo, isifundo esenzelwe i-dose. Lancet Neurol . NgoNovemba ka-2012; 11 (5): 405-13.
> Magis D, uSava S, d / Elia TS, Baschi R, J. J. Schoenen Ukhuseleko kunye nokwaneliseka kwezigulane kwi-transcutaneous supraorbital neurostimulation (tSNS) kunye nesisombululo seCefaly kwonyango lwentloko: uphando lwabantu abaphethwe intloko abayi-2,313. J Ubuhlungu bentloko . Ngo-2013 uDis 1; 14: 95.
> Sun H et al. Ukukhusela nokusebenza kwe-AMG 334 ngokuthintela i-epradic migraine: i-random, i-double-blind, i-placebo-elawulwayo, isigaba sesivivinyo sesi-2. Lancet Neurol. 2016; 15 (4): 382-90.