What are the latest breakthroughs and challenges in migraine treatment?
这是偏头痛治疗的好时刻，因为我们有新药可预防急性攻击。这些新药中的第一个，即Erenumab，已经在美国可用，希望它很快在其他国家 /地区可用。其他药物，例如Fremanezumab，Galcanezumab和Eptinezumab。
新药是对降钙素基因相关肽途径作用的单克隆抗体。可用的研究表明，这些药物可有效预防偏头痛。此外，它们具有良好的耐受性和易用性，因为它们可以每月甚至每季度通过皮下注射一次。
由于副作用，患者缺乏预期的益处以及对日常摄入量的依从性，他们将对疾病的治疗进行大量改善，因为目前可用的药物与治疗的依从性不佳有关。新药的缺点是由很高限制将从中受益的患者数量的成本代表的。
What is the aim of the consensus article and what are you hoping to achieve for patients and physicians?
偏头痛主要影响妇女在生殖年龄上，偏头痛女性的荷尔蒙避孕问题在日常临床实践中非常普遍。一群头痛，荷尔蒙避孕和中风的联合专家twoconsensus文件on the use of hormonal contraception in women with migraine. The documents were supported by the European Headache Federation (EHF) and the European Society of Hormonal Contraception and Reproductive Health.
The aim of the documents was to provide suggestions useful for the everyday clinical practice. On one side, there are the headache specialists who treat migraine patients but who do not have in some instances sufficient knowledge of the benefits and harms of all the possible contraceptive options. On the other side, we have the gynecologists who know hormonal contraceptives but may pay not enough attention to the presence of migraine.
在两篇共识论文中，我们将知识汇集在一起，以改善偏头痛女性中激素避孕药的使用。
Would you like to pick out relevant examples to illustrate the importance of the findings from the consensus article?
I can give you two examples each referring to one of the two consensus documents.
The first consensus article was about safety as the use of hormonal contraceptive containing estrogens increases the risk of ischemic stroke in women with migraine and especially in those with migraine with aura. I’ve recently admitted to my hospital a woman aged 37 years who developed a left hemispheric ischemic stroke. After extensive investigations, the only evident factors which could have triggered the stroke were a history of migraine with aura and the recent initiation of an oral combined hormonal contraceptive containing 30 mcg of ethinylestradiol.
This young woman was left with a serious disability. By applying our guidelines this stroke would probably have been prevented as the use of the combined hormonal contraceptive was contraindicated because the woman had migraine with aura.
The second consensus article was about the impact of exogenous sexual hormones on the course of migraine. I can provide the example of a 24 years old woman with polycystic ovary syndrome and dysmenorrhea who started treatment with a 24/7 combined hormonal pill following the suggestion of her gynecologist. The woman experienced worsening of her previous migraine without aura attacks soon after the first cycle of treatment. The pain was particularly severe and occurred during the pill-free week. In this case the replacement of the 24/7 pill with an oral extended combined hormonal contraceptive regimen led to improvement of the attacks.
这两个例子指出了我们文件的两个要点：偏头痛的女性的荷尔蒙避孕措施和激素对偏头痛的影响。应用指南，我们可以预防缺血性中风，改善偏头痛，并避免与使用激素避孕有关的恶化。
Tell us more about the process and efforts of getting this document together, how long did it take and what challenges did you encounter?
每个文件都花了大约一年的时间。两者都是根据标准化方法开发的，该方法暗示系统审查以获取基于证据的建议。主要的挑战是，在这一领域，科学证据的质量很低，建议主要基于专家的意见。
可以想象，当证据有限时，就某些事情达成共识并不容易。关于某些建议的讨论非常动画，需要进行几轮修订以就共同的建议达成共识。我们不能保证，随着新证据的可用，我们的一些建议不会改变。
在您看来，最重要的目标是什么？
I think that there are two important goals of our documents. The first is to provide guidelines which can be easily applied in the everyday clinical practice by those who are involved in the care of women with migraine and in the prescription of hormonal contraceptives. Hopefully, the consensus documents will be valuable also for the general practitioners who are the main care providers for many women.
其次，我们希望这些文件可以促进有关该主题的进一步研究，以提供进一步改善当前知识的证据。
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