Migrenin Güncel Tedavisi
Özet
Migren, trigeminovasküler sistem aktivasyonu ile karakterize, yüksek prevalansa sahip, yaşam kalitesini ve iş gücü verimliliğini belirgin biçimde azaltan nörovasküler bir primer baş ağrısı bozukluğudur. Bu kitap bölümünde migrenin güncel patofizyolojisi ve bu fizyopatolojik mekanizmalara dayalı modern tedavi yaklaşımları ayrıntılı olarak ele alınmıştır. Kalsitonin gen ilişkili peptid (CGRP) salınımı, kortikal yayılan depresyon, santral sensitizasyon, beyin sapı ve hipotalamik ağların rolü gibi temel mekanizmalar, migren atağının başlaması ve sürdürülmesi bağlamında değerlendirilmiştir. Akut migren tedavisinde nonsteroid antiinflamatuvar ilaçlar, triptanlar, ditanlar ve CGRP reseptör antagonistleri (gepantlar); profilaktik tedavide ise beta blokerler, antiepileptik ilaçlar, antidepresanlar, onabotulinumtoxinA ve CGRP hedefli monoklonal antikorlar güncel klinik kanıtlar ışığında sunulmuştur. Ayrıca status migrenozus tedavisi, kombinasyon tedavilerinin yeri ve deneysel yaklaşımlar tartışılmıştır. Güncel uluslararası kılavuzlar doğrultusunda, bireyselleştirilmiş ve fizyopatoloji temelli tedavi stratejilerinin migren yönetiminde etkinliği artırdığı ve tedavi başarısını iyileştirdiği vurgulanmaktadır.
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