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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 953-969
DOI: 10.1055/s-0042-1755320
Brazilian Academy of Neurology

Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II

Consenso da Sociedade Brasileira de Cefaleia (SBCe) para o tratamento profilático da migrânea episódica: parte II
Paulo Sergio Faro Santos 
1   Instituto de Neurologia de Curitiba, Departamento de Neurologia, Setor de Cefaleia e Dor Orofacial, Curitiba PR, Brazil.
,
Eliana Meire Melhado 
2   Centro Universitário Padre Albino, Faculdade de Medicina, Departamento de Neurologia, Catanduva SP, Brazil.
,
Alexandre Ottoni Kaup 
3   Houston Headache Clinic, Houston TX, USA.
4   Universidade Federal de São Paulo, São Paulo SP, Brazil.
5   Universidade de Santo Amaro, São Paulo SP, Brazil.
,
Aline Turbino Neves Martins da Costa 
6   Hospital Santa Marcelina , São Paulo SP, Brazil.
,
Célia Aparecida de Paula Roesler 
7   Centro Médico de Neurologia, São Paulo SP, Brazil.
,
Élcio Juliato Piovesan 
8   Universidade Federal do Paraná, Departamento de Clínica Médica, Disciplina de Neurologia, Curitiba PR, Brazil.
,
Elder Machado Sarmento 
9   Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil.
,
Giselle Oliveira Martins Theotonio 
10   Universidade Federal do Rio de Janeiro, Centro de Pesquisas Rene Rachou, Editora UFRJ, Rio de Janeiro RJ, Brazil.
,
Henrique Carneiro de Campos 
11   Clínica Neurológica, Belo Horizonte MG, Brazil.
,
Ida Fortini 
12   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
,
Jano Alves de Souza 
13   Universidade Federal Fluminense, Departamento de Medicina Clínica, Disciplina de Neurologia, Niterói RJ, Brazil.
,
Jayme Antunes Maciel Júnior 
14   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
,
João Batista Alves Segundo 
15   Centro Integrado de Saúde Lineu Araújo, Ambulatório de Neurologia, Teresina PI, Brazil.
,
João José Freitas de Carvalho 
16   Unichristus, Curso de Medicina, Disciplina de Neurologia, Fortaleza CE, Brazil.
17   Hospital Geral de Fortaleza, Serviço de Neurologia, Núcleo de Cefaleias, Fortaleza CE, Brazil.
,
José Geraldo Speziali 
18   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Ribeirão Preto SP, Brazil.
,
Leandro Cortoni Calia 
19   Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil.
,
Liselotte Menke Barea 
20   Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Disciplina de Neurologia, Porto Alegre RS, Brazil.
,
Luiz Paulo Queiroz 
21   Universidade Federal de Santa Catarina, Hospital Universitário, Serviço de Neurologia, Florianópolis SC, Brazil.
,
Marcio Nattan Portes Souza 
22   Universidade de São Paulo, Hospital das Clínicas, São Paulo SP, Brazil.
,
Marcos Ravi Cerqueira Ferreira Figueiredo 
23   Hospital Universitário Antônio Pedro, Serviço de Neurologia, Niterói RJ, Brazil.
,
Maria Eduarda Nobre de Magalhães Costa 
9   Universidade Federal Fluminense, Rio de Janeiro RJ, Brazil.
24   Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.
,
Mário Fernando Prieto Peres 
25   Hospital Israelita Albert Einstein, Departamento de Neurologia, São Paulo, SP, Brazil.
,
Mauro Eduardo Jurno 
26   Fundação José Bonifácio Lafayette de Andrada, Faculdade de Medicina de Barbacena, Barbacena MG, Brazil.
27   Fundação Hospitalar do Estado de Minas Gerais, Hospital Regional de Barbacena Dr. José Américo, Barbacena MG, Brazil.
,
Patrícia Machado Peixoto 
28   Secretaria de Estado da Saúde do Distrito Federal, Brasília DF, Brazil.
,
Pedro André Kowacs 
29   Instituto de Neurologia de Curitiba, Serviço de Neurologia, Curitiba PR, Brazil.
30   Universidade Federal do Paraná, Complexo Hospital de Clínicas, Serviço de Neurologia, Curitiba PR, Brazil.
,
Pedro Augusto Sampaio Rocha-Filho 
31   Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área de Neuropsquiatria, Recife PE, Brazil.
32   Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Ambulatório de Cefaleias, Recife PR, Brazil.
,
Pedro Ferreira Moreira Filho 
33   Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Departamento de Medicina Clínica, Niterói RJ, Brazil.
,
Raimundo Pereira Silva-Neto 
34   Universidade Federal do Pará, Belém PA, Brazil.
35   Universidade do Estado do Pará, Belém PA, Brazil.
,
Yara Dadalti Fragoso 
36   Universidade Metropolitana de Santos, Santos SP, Brazil.
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Abstract

Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder.

Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience.

Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy.

Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease.

Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Resumo

Antecedentes Migrânea afeta um bilhão de pessoas em todo o mundo e mais de 30 milhões de brasileiros; além disso, é um distúrbio subdiagnosticado e subtratado.

Objetivo Sabe-se sobre a necessidade de difundir o conhecimento sobre o tratamento profilático da migrânea; por isso, a Sociedade Brasileira de Cefaleias (SBCe) nomeou um comitê de autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da migrânea episódica com base em artigos da literatura mundial, assim como da experiência pessoal.

Métodos As reuniões foram realizadas inteiramente online, com a participação de 12 grupos que revisaram e escreveram sobre as categorias farmacológicas dos medicamentos e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de medicamentos estudadas na parte II deste Consenso foram: anti-hipertensivos, inibidores seletivos de recaptação de serotonina, inibidores de recaptação de serotonina e noradrenalina, bloqueadores dos canais de cálcio, outros medicamentos e politerapia racional.

Resultados Desta lista de medicamentos, apenas o candesartan foi estabelecido como eficaz no controle da migrânea episódica. Flunarizina, venlafaxina, duloxetina e pizotifeno foram definidos como provavelmente eficazes, enquanto lisinopril, enalapril, escitalopram, fluvoxamina, quetiapina, atorvastatina, sinvastatina, ciproheptadina e melatonina foram possivelmente eficazes na profilaxia da doença.

Conclusões Apesar do esforço da comunidade científica em encontrar medicamentos realmente eficazes no tratamento da migrânea, dado o grande número de medicamentos testados para este fim, ainda dispomos de poucas opções terapêuticas.

Palavras-chave

Cefaleia Histamínica - Enxaqueca Sem Aura - Consenso - Medicina Preventiva

Keywords

Cluster Headache - Migraine Without Aura - Consensus - Preventive Medicine

Authors' Contributions

PSFS: Discussion, group coordinator, writing, reviewing, conceptualization; EMM, PAK: discussion, group coordinator, writing, reviewing, conceptualization, editing, data collection; AOK, ATNMC, CAPR, EMS, GOMT, IF, LCC, LMB, MFPP, PMP, RPSN, HCC: writing, reviewing, discussion, conceptualization; EJP, JJFC: writing, reviewing, editing, group coordinator, discussion; JAS, LPQ, MNPS: writing, reviewing, editing, discussion; JAJM, JBAS, MENMC: writing, reviewing, discussion; JGS: writing; MRCFF, MEJ, PFMF, YDF: writing, reviewing; Rocha-Filho P. F. M.: conceptualization, data collection, writing, reviewing, editing.




Publication History

Received: 11 December 2021

Accepted: 09 April 2022

Article published online:
18 October 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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