Resumen
Introducción: La migraña es la cefalea primaria de mayor impacto en la población general; de acuerdo con la información local se calcula que al menos 3 millones de personas en Colombia padecen esta condición, conduciendo esta entidad a alta carga y discapacidad.
Objetivo: Determinar información unificada respecto al tratamiento preventivo y agudo de los pacientes con migraña. Se incluye información del tratamiento de la migraña crónica y su asociación al uso excesivo de analgésicos.
Materiales y métodos: Consenso de expertos mediante metodología virtual Delphi en dos rondas con el grupo total y una con el grupo desarrollador. Se hizo una revisión de la literatura para obtener información destinada al diseño de preguntas con relevancia clínica. Se incluyeron neurólogos de las principales regiones del país.
Resultados: Se debe ofrecer tratamiento preventivo a los pacientes que sufren por lo menos 6 días al mes de dolor de cabeza por migraña durante 6 a 12 meses de acuerdo con las condiciones clínicas de cada paciente. Topiramato, ácido valproico/divalproato de sodio, metoprolol, propranolol, amitriptilina, y flunarizina son sugeridos como medicamentos de primera línea. Respecto al tratamiento agudo en pacientes ambulatorios se recomienda el uso de triptanes orales y subcutáneos, AINEs orales, anti eméticos, combinaciones de medicamentos y derivados de ergotamina. En pacientes en el servicio de urgencias y hospitalizados, las opciones sugeridas son metoclopramida, dexametasona y AINEs parenterales. Los medicamentos preventivos en migraña crónica incluidos en el consenso son onabotulinum toxina tipo A, topiramato, amitriptilina y ácido valpróico/ divalproato de sodio. En casos de migraña crónica asociada a uso excesivo de analgésicos se recomienda la suspensión del medicamento usado de manera excesiva, indicándose AINEs, esteroides y triptanes de vida media larga en terapia de transición. La estimulación del nervio occipital es una opción para pacientes refractarios, considerándsoe una terapia reservada para un equipo interdisciplinario liderado por un neurólogo especialziado en el diagnóstico y tratamiento de pacientes con dolor de cabeza.
Conclusiones: Se obtienen recomendaciones y sugerencias del tratamiento agudo y preventivo de los pacientes con migraña. Se presentan recomendaciones para el tratamiento de casos refractarios y del uso excesivo de analgésicos.
Citas
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