接上文Part.1

Foods to Avoid/应避免的食物

As noted, food sensitivities are not that common. Patients tend to focus on the foods, as they are a tangible trigger that one can control (as opposed to weather, for example). However, most people are sensitive to only two or three types of food in the diet. If a particular food is going to cause a headache, it usually will occur within 3 hours of eating. Table 4 provides a list of foods to avoid.

如前所述，食物过敏并不特别常见。患者倾向于关注食物，因为这是一个可以控制的有形触发因素（例如与天气相反）。然而，大多数人只对饮食中的两三类食物敏感。如果某种食物会引起头痛，通常会在进食后3小时内发生。表4提供了一份需要避免的食物清单。

Migraine Treatments/偏头痛的治疗方法

Tables 5 to 7 review all the first- and second-line migraine-abortive medications. Keys to treatment management are outlined in the Figure.

表5至7回顾了所有一线和二线偏头痛治疗药物。图中概述了治疗管理的关键。

Medications: Abortives/药物：中止剂

The most common first-line treatment for migraines includes triptans. More than 200 million patients worldwide have used triptans. The most effective way to usetriptans is to take them early in the headache—the earlier a patient takes these agents, the better the effect. Sumatriptan is an extremely effective migraine-abortive medication with minimal side effects. It is effective for approximately 70% of patients and is the gold standard in abortive headache treatment. The usual dose is one tablet every 3 hours, as needed; maximum dose, two tablets per day. However, clinicians do need to limit triptan use (ideally, 3 days per week) to avoid rebound headaches or medication overuse headache (MOH). See section on rebound/MOH.

偏头痛最常见的一线治疗方法包括曲坦类药物。全世界有超过2亿病人使用过曲坦类药物。使用曲坦类药物最有效的方法是在头痛早期服用，病人越早服用，效果越好。舒马曲坦是一种极其有效的偏头痛治疗药物，副作用很小。它对大约70%的病人有效，是中止性头痛治疗的金标准。通常的剂量是根据需要，每3小时一片；最大剂量是每天两片。然而，临床医生确实需要限制曲坦类药物的使用（最好是每周3天），以避免反弹性头痛或药物过度使用性头痛（MOH）。参见反弹/MOH部分章节。

Triptans are helpful for moderate as well as more severe migraines. Certain patients tolerate one of the triptans better than another, and it is worthwhile to try several in an individual patient. Triptans are an excellent choice for migraine patients who are not at risk for coronary artery disease (CAD). Patients in their 50s or 60s can use these drugs, but they should be prescribed cautiously, and only in those patients who have been screened for CAD. Over the 23 years that triptans have been available, serious side effects have been few; they appear to be much safer than was previously thought in 1993. Most of the triptans are now available as generics.

曲坦类药物对中度和更严重的偏头痛都有帮助。某些病人对一种曲坦类药物的耐受性优于另一种，可以在个别病人身上尝试几种。对于没有冠状动脉疾病（CAD）风险的偏头痛患者，曲坦类药物是一个很好的选择。50多岁或60多岁的病人可以使用这些药物，但应谨慎开药，而且只适用于已接受过CAD筛查的病人。在曲坦类药物上市的23年里，严重的副作用很少；它们似乎比之前在1993年认为的要安全得多。大多数曲坦类药物现在都作为通用药物供选择。

For patients who cannot tolerate triptans, there are a number of other effective non-triptan first-line approaches, including diclofenac potassium powder (Cambia), Excedrin Migraine, naproxen, ketorolac (po/IM/nasal: Sprix nasal spray), ibuprofen, and Prodrin (similar to Midrin, but without the sedative). We often combine 2 first-line approaches (a triptan and a non-steroidal anti-inflammatory drug[NSAID] combination, for instance).

对于不能建立耐受曲普坦类药物的患者，还有其他一些有效的非曲普坦类药物的一线治疗方法，包括双氯芬酸钾粉（Cambia）、Excedrin Migraine、萘普生、酮咯酸（po/IM/鼻腔：Sprix鼻腔喷雾）、布洛芬和Prodrin（与Midrin类似，但没有镇静剂）。我们经常将2种一线方法结合起来（例如，使用一种曲坦类药物和一种非甾体抗炎药[NSAID]的组合）。

In general, drugs containing ergotamine (also called ergots) are effective second-line therapy for migraines. They were the first anti-migraine drugs available, but they have many side effects, and at most, should be used only 2 days per week. Dihydroergotamine (DHE) is the safest ergot derivative. DHE is primarily a “venoconstrictor,” with little arterial effects. This renders it very unlikely to cause cardiac problems. Indeed, since its introduction in 1945, DHE has been remarkably safe. Intravenous DHE is a very effective migraine-abortive agent administered in the office or emergency room. Nasal (Migranal Nasal Spray) and inhaled forms of DHE (hopefully soon to be released) have been found to be safe and effective as well. Barbiturates and opioids have been studied and are effective, but because of the risk for addiction, should be used sparingly. For severe prolonged migraines, corticosteroids (oral, IV, or intramuscular) often are effective. It is important to use low doses of steroids.

一般来说，含有麦角胺（也称为麦角）的药物是偏头痛的有效二线治疗方法。是最早的抗偏头痛药物，但有许多副作用，最多只能每周使用2天。二氢麦角胺（DHE）是最安全的麦角衍生物。DHE主要是一种“静脉收缩剂”，对动脉几乎没有影响。这使得它不太可能引起心脏问题。事实上，自1945年推出以来，DHE一直非常安全。静脉注射 DHE 是一种非常有效的偏头痛中止剂，在办公室或急诊室给药。鼻腔（Migranal鼻喷雾剂）和吸入形式的DHE（希望很快被释放）也被认为是安全有效的。巴比妥类药物和阿片类药物已经过研究，并且是有效的，但由于有成瘾的风险，应谨慎使用。对于严重的长期偏头痛，皮质类固醇（口服、静脉注射或肌肉注射）通常有效。关键是是需要注意控制低剂量的使用类固醇。

Many patients have 3 to 6 abortives: triptan, NSAIDs, Excedrin, an anti-nausea medication, and a painkiller (opioid/butalbital). They use each in different situations, for different types and degrees of headache.

许多病人有3到6种药：曲坦类药物、非甾体抗炎药、艾司西酞普兰、抗反胃药和止痛药（阿片类药物/布托类药物）。在不同的情况下，针对不同类型和程度的头痛分别使用。

To Be Continued.../未完待续...

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