Conceptos básicos clinicoterapéuticos

espanolLa migrana es la octava causa de discapacidad por enfermedad, afecta al 15% de la poblacion europea y supone un alto coste economico para la sociedad. Su diagnostico es clinico y se basa en los criterios de la International Classification of Headache Disorders de la International Headache Society. Esta determina tres formas de migrana: episodica con aura, episodica sin aura y cronica. Ademas, establece las infrecuentes complicaciones de la migrana: estatus migranoso, infarto migranoso… El tratamiento consiste en medidas generales para controlar los factores que precipitan los ataques de migrana y los que la pueden cronificar. En ataques moderados son eficaces los antiinflamatorios no esteroideos (evidencia IA) y en los graves los triptanes (evidencia IA). En mas del 50% de pacientes se requiere un tratamiento preventivo, siendo evidencia IA: β-bloqueantes, acido valproico, topiramato, amitritptilina y flunarizina. En la migrana cronica se indica con evidencia IA la toxina botulinica A y el topiramato. En el presente articulo realizamos una actualizacion de la epidemiologia, diagnostico y tratamiento de la migrana. EnglishMigraine is the eighth cause of disability by disease, affects 15% of the European population, and brings a high cost to society. Its diagnosis is clinical and is based on the criteria of the International Classification of Headache Disorders (ICHD-3 Beta) of the International Headache Society. Three forms of migraine are described: episodic without aura, episodic with aura, and chronic. It also describes the uncommon complications of migraine: migraine status, migraine infarction, etc. The treatment involves general measures to control the trigger factors that precipitate migraine attacks, and those that can to transform migraine from episodic to chronic (evidence IA). Nonsteroidal anti-inflammatory drugs (NSAID) are effective in moderate attacks and triptans in severe attacks (evidence IA). More than 50% of patients require preventive treatment and this is, for evidence IA: beta-blockers, valproate, topiramate, amitriptyline, and flunarizine. In chronic migraine evidence IA toxin botulinum A and topiramate is indicated. For this article, we carried out an update of the epidemiology, diagnosis, and treatment of migraine.