Диагностика и лечение мигрени: рекомендации российских экспертов

Мигрень – одна из самых распространенных форм головной боли, которая может приводить к значимому снижению качества жизни. Выделяют мигрень с аурой, мигрень без ауры, а также хроническую мигрень, которая значительно снижает трудоспособность пациентов и часто сочетается с психическими расстройствами и лекарственно-индуцированной головной болью. К осложнениям мигрени относятся мигренозный статус, персистирующая аура без инфаркта, мигренозный инфаркт (инсульт) и эпилептический припадок, вызванный мигренозной аурой. Диагноз мигрени устанавливается на основании жалоб, анамнеза заболевания, данных объективного осмотра и диагностических критериев Международной классификации головных болей 3-го пересмотра. Дополнительные методы исследования рекомендуются только при наличии «красных флажков» – симптомов, настораживающих в отношении вторичного характера головной боли.
Лечение мигрени направлено на уменьшение частоты и интенсивности приступов, на снижение количества принимаемых обезболивающих препаратов. Оно включает три основных подхода: поведенческая терапия, терапия для купирования приступов и профилактическая терапия. Поведенческая терапия направлена на модификацию образа жизни. Для купирования приступов рекомендуются нестероидные противовоспалительные средства, простые и комбинированные анальгетики, триптаны, а также противорвотные препараты (при выраженной тошноте или рвоте). При частых или тяжелых приступах мигрени, а также при хронической мигрени показана профилактическая терапия, которая включает антидепрессанты, антиконвульсанты, бета-блокаторы, антагонисты рецепторов ангиотензина II, ботулинический токсин типа А – гемагглютинин комплекс и моноклональные антитела к кальцитонин-ген-связанному пептиду или его рецепторам. Фармакотерапию рекомендуется комбинировать с нелекарственными методами, к которым относятся когнитивно-поведенческая терапия, прогрессирующая мышечная релаксация, майндфулнесс, метод биологической обратной связи, постизометрическая релаксация, иглорефлексотерапия, лечебная гимнастика, блокада большого затылочного нерва, неинвазивная высокочастотная ритмическая транскраниальная магнитная стимуляция, внешняя стимуляция первой ветви тройничного нерва, электрическая стимуляция затылочных нервов (нейростимуляция).

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