【エイコサペンタエン酸（EPA）製剤による片頭痛発作予防：高齢の片頭痛患者3例における治療経験より】
Prophylactic efficacy of eicosapentaenoic acid (EPA) for the three elderly patients with frequent migraine
著者：樋口真秀 (Masahide Higuchi)
出展：日本頭痛学会誌 Vol.35 No.1, 51-55:2008

[要　約]
種々の予防的治療に抵抗性を示す高齢の片頭痛患者3名(いずれも70歳代の女性で発作頻度は15回/月以上)に対し､イワシ魚脂由来のEPAエチルエステル製剤(EPA-E)を連日投与した結果､片頭痛予防効果を認めた｡他の予防薬剤が全く無効であった2名において､EPA-Eは著効 (投与前の頭痛頻度が30％以下に減少)と有効(同･40％位に減少)と判定した｡もう1名はバルプロ酸の著効後に同剤からEPA-E単独投与に切り替えたが､頭痛頻度･強度とも初診時より著明に改善した｡動脈硬化を有する高齢片頭痛患者では､トリプタン製剤使用時に心臓･血管疾患リスクが懸念されるため､EPA-Eの予防的投与が推奨される｡

[英文抄録]
　Eicosapentaenoic acid (EPA), which is derived from fish oil, has shown to prevent major coronary events and cerebral-infarction, through its anti-platelet aggregation, anti-inflammation and anti-vascular spasm effects. These activities might contribute to prevent migraine attacks. However, the prophylactic effect of EPA on frequent migraine has been controversial. Since May, 1st to June, 30th in 2007, 126 anibulant patients with frequent migraine required some prophylactic agents. Among these patients, three elderly females (70 year-old and above) required triptans, but not nonsteroidal anti-inflammatory drugs, to relieve migrainous pain. They received antiplatelet drugs to prevent cardio- and cerebro-vascular events by triptans, which did not affect the frequency of migraine attack. Two patients had failed to respond to any prophylactic treatment, and another patient had responded to propranolol and valproic acid, but discontinued these drugs due to hypotension and liver dysfunction, respectively. In expectation of an anti- vascular events effect as well as a prophylactic efficacy against frequent migraine, the three females received 900 mg highly purified EPA ethyl ester microcapsule (EPA-E, Epadel-S®, which contains more than 96.5% EPA: Mochida Pharmaceuticals, Co., Ltd., Tokyo, Japan) two times daily. Overall, EPA-E was well tolerated, and this agent continued to be administered thereafter. Two patients showed more than 70 % reduction, and one showed 60% reduction in the headache frequency compared to those of their first visits. The result of this report suggests that EPA-E decreases frequency of migraine attacks. In the light of its prophylactic nature against both cardio- and cerebro-vascular events, application of EPA-E is recommended especially to elderly patients suffering from migraine.




脳神経外科（脳外科）・神経内科・頭痛外来の樋口脳神経クリニックには、兵庫県の阪神間 （西宮、芦屋、尼崎、宝塚、伊丹、川西）、神戸市や大阪府下の広範囲から患者さんが受診されます。主な対象疾患は、頭痛、特に片頭痛 （偏頭痛）、緊張型頭痛 （筋収縮性頭痛、筋緊張性頭痛）、群発頭痛です。さらに、高血圧の治療、脳卒中 （脳梗塞、脳出血）の予防に対応します。院長の樋口真秀は大阪大学医学部を卒業した｢脳神経外科の専門医｣であり､日本頭痛学会より認定された｢頭痛専門医｣です｡