成人片頭痛 ガイドライン：NSAIDSや補完医療

成人：エピソード片頭痛薬物治療ガイドライン　update　の補足版で、NSAIDｓ・補完治療の分

Petasites（フキの一種らしいが、butterbur　の抽出物）のエビデンスが目立つ。

にひきかえ、NSAIDｓ全般は、予防効果のエビデンスレベル としては、それ以下。




Evidence-based guideline update: NSAIDs and other complementary treatments 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 1346-1353 



Petasites (butterbur) が予防としても有効で、偏頭痛発作頻度・重症度軽減のため、片頭痛患者に投与されるべき　 (Level A)


Fenoprofen、 ibuprofen、 ketoprofen、 naproxen。 naproxen sodium、 MIG-99 (feverfew)、 magnesium、 riboflavin、 subcutaneous histamine は片頭痛予防に有効 (Level B)

有効可能性：  cyproheptadine, Co-Q10、 estrogen、 mefenamic acid、 flurbiprofen (Level C)


データ不一致・不適切：アスピリン、インドメタシン、ω３、高圧酸素

Montelukast は、片頭痛予防に対して無効　 (Level B)



 結論：

• Petasites is established as effective for migraine prevention (2 Class I studies).
• Riboflavin is probably effective for migraine prevention (1 Class I trial and 1 imprecise Class II study).
• Co-Q10 is possibly effective for migraine prevention (1 Class II study).
• A combination of soy isoflavones (60 mg), dong quai (100 mg), and black cohosh (50 mg) is possibly effective for migraine prevention (1 Class II study). Percutaneous estradiol is possibly effective for migraine prevention (1 Class II study); however, there is an increased risk of migraine recurring after estradiol patch discontinuation.
• Magnesium is probably effective for migraine prevention (multiple Class II trials). MIG-99 (feverfew) is probably effective for migraine prevention (1 Class I study, 1 positive Class II study, and 1 underpowered negative Class II study).
• The efficacy of HBO for migraine prevention is unclear (1 imprecise negative Class II study).
• The efficacy of omega-3 for migraine prevention is unclear (1 imprecise Class I study).