سبل جديدة للتعامل مع الصداع النصفي.. علاجات متنوعة لأعراضه أو تجنب نوباته

اليوم، أصبح أمام من يعانون آلام الصداع النصفي، أو الشقيقة، خيارات أكثر عن أي وقت مضى للتخفيف من حدة الألم أو حتى تفادي نوبات الصداع النصفي من الأساس.
إذا كنت تعرضت يوماً لصداع نصفي، فإنك تعي جيداً أنه ليس بصداع عادي، ذلك أنه لا يسبب ألما خافقا عادة في أحد جانبي الرأس فحسب، وإنما قد يسبب كذلك تغييرات في الرؤية، وحساسية تجاه الضوء وشعور بالغثيان. وفي الواقع، إنه نمط من الصراع يجعلك ترغب في الانسحاب إلى غرفة مظلمة هادئة والبقاء فيها حتى يرحل الألم.
ويمكن للتعافي من الصداع النصفي أن يستغرق وقتاً، ذلك أن آلامه قد تستمر لساعات أو ربما أياما. ويعاني من الصداع النصفي ما يقدر بـ28 مليون امرأة داخل الولايات المتحدة، تبعاً لتقديرات «المؤسسة الأميركية للصداع النصفي».
من جانبها، أعلنت منظمة الصحة العالمية أن الصداع النصفي يأتي ضمن أكبر 10 ظروف معوقة، ذلك أن آلام الصداع النصفي تتسبب في إهدار أيام عمل وإنتاجية، وتكاليف مرتفعة على صعيد الرعاية الصحية، بجانب بالطبع تكاليف أخرى غير مادية على رأسها عدم قضاء وقت ممتع مع النفس والأسرة والأصدقاء.
ومع هذا، ومقارنة بسنوات ماضية، ثمة خيارات أكثر اليوم عن أي وقت مضى لعلاج هذا الصداع.
— الصداع النصفي
– هل يمثل الصداع مشكلة؟ شرحت د. إليزابيث لودر، بروفسورة علم الأعصاب بكلية الطب التابعة لجامعة هارفارد ورئيسة قسم الصداع النصفي والألم داخل قسم علم الأعصاب بمستشفى «بريغهام آند ويمينز فولكنر هوسبيتال»، أنه: لا يسعى الكثير من السيدات اللائي يعانين من صداع نصفي على نحو منتظم إلى تلقي العلاج. وربما يأتي ذلك من شعورهن بأنه يتعين عليهن فحسب التكيف مع الأمر أو أن الأمر لا يستلزم علاجاً لأنهن لا يعانين منه يومياً. وكثير من السيدات يقولن لي: «آسفة، أعلم أن هناك الكثير من الناس أسوأ حالاً عني بكثير».
ومع هذا، فإنه إذا كان الصداع النصفي يؤثر بالسلب على حياتك، ويدفعك للتغيب عن عملك أو يحول دون استمتاعك بالحياة، فإن الأمر يستحق بالتأكيد محاولة إيجاد علاج له.
– هل هذا صداع نصفي حقاً؟ تتمثل الخطوة الأولى نحو علاج الصداع النصفي، في التشخيص. ويعتمد الأطباء على معايير للتشخيص مقبولة على نطاق واسع للتمييز بين الصداع النصفي وأنماط أخرى من الصداع. ومن أجل تشخيص صداع ما باعتباره نصفيا على وجه التحديد، يجب أن تستمر آلام الصداع ما بين 4 و72 ساعة. وعادة ما تتركز الآلام في جانب واحد من الرأس. وغالباً ما يكون الألم خافقاً أو وثاباً، مع شعور بالألم المتفاوت في حدته بين المعتدل والحاد يتفاقم مع المجهود البدني.
وأوضحت الدكتورة لودر أنه: «يجب أن يتعرض شخص ما لخمس هجمات تتوافق مع غالبية أو جميع هذه المعايير كي يجري تشخيصه بأنه يعاني من صداع نصفي». وإذا ما اشتبه الطبيب المعالج لك أنك تعانين من صداع نصفي، فإن العلاج سيعتمد على معدل تكرار حدوث الأعراض.
في بعض الحالات، تؤدي تغييرات في الهرمونات إلى حدوث صداع. وتعاني بعض السيدات من صداع بالتزامن مع التقلبات الشهرية في الهرمونات أو التحولات في الهرمونات التي تصاحب عملية انقطاع الحيض.
وتقول الدكتورة لودر إن: «ثمة تقدما جرى إحرازه على صعيد علاج الصداع النصفي، وإن كان ليس بالمعدل الذي كنا نأمله». ومع هذا، تظل الحقيقة أنه أصبح هناك اليوم خيارات متنوعة لمواجهة الصداع النصفي. وبوجه عام، تنتمي العلاجات المتاحة إلى فئتين: علاجات تتعامل مع الصداع عندما يصاب به المرء، وأخرى تحاول منع وقوع الصداع النصفي من الأساس.
— تخفيف الألم
العقاقير. إذا كنت تعاني من الصداع النصفي من حين لآخر فحسب، فإن العقاقير التي تباع دون وصفة من الطبيب مثل الأسبرين، مع أو دون كافيين، ربما تشكل سبيلاً جيداً لتخفيف الألم. إلا أنه ينبغي الحذر من الصداع الارتدادي الذي قد ينشأ عن الإفراط في الاعتماد على العقاقير المخففة للألم.
أما إذا كان الصداع الذي تعانيه أكثر تكراراً أو حاد الألم، فإنك ربما ترغب في استشارة طبيب بخصوص إتباع توجه وقائي، مع وصف عقار لمعالجة الهجمات الفردية.
تجدر الإشارة إلى أنه عادة ما يجري وصف عقاقير تنتمي لفئة تعرف باسم «تريبتان» triptans لعلاج الهجمات الفردية. وتتوافر عقاقير التريبتان في صورة حبوب أو بخاخات في الأنف أو حقن، وتعمل من خلال تحفيز المخ على إنتاج «سيروتونين»، وهو موصل عصبي يعمل داخل المخ. ويساعد السيروتونين في الحد من الالتهابات ويقبض الأوعية الدموية في المخ، الأمر الذي يؤدي إلى الشعور بالراحة من الألم، تبعاً لما شرحته «المؤسسة الوطنية للصداع». ويشعر معظم الأشخاص براحة من الألم في غضون ساعتين من تناول هذا العقار، بينما قد يحتاج آخرون إلى جرعة أخرى.
من ناحيتها، قالت الدكتورة لودر: «اتسمت عقاقير التريبتان في العادة بارتفاع تكلفتها بشدة، لكن توافر نسخ عامة (جنيسة) أسهم في خفض الأسعار. وتقدم هذه العقاقير نتيجة جيدة للغاية فيما يتراوح بين 70 في المائة و80 في المائة من الحالات».
ومع هذا، ربما يعجز البعض عن تناول عقاقير التريبتان بسبب أعراضها الجانبية إذا كانوا يعانون ظروفاً صحية بعينها، مثل أمراض القلب. وبإمكان التريبتان التأثير على تدفق الدماء ليس فقط المتجهة إلى الرأس، وإنما كذلك القلب، الأمر الذي يحمل مخاطر بالنسبة للمرضى الذين يعانون أمراضا في الشريان التاجي.
— علاجات مصممة للوقاية
تتضمن الفئة الثانية من علاجات الصداع النصفي، علاجات مصممة للوقاية وتتضمن أقراص وحقن وإجراء تغييرات في أنماط السلوك.
ويجري توجيه هذا النمط من العلاج بصورة أساسية لمن يعانون من الصداع النصفي على نحو مزمن أو متكرر. وقد أضيفت بعض الخيارات الحديثة نسبياً إلى هذه الفئة في السنوات الأخيرة، منها:
– حقن سم البوتيولينيوم – أحد العلاجات التي أجيزت عام 2010 للأشخاص الذين يعانون من صداع نصفي مزمن. يعرف سم البوتيولينيوم باسم تجاري «بوتوكس» Botox والذي يستخدم كعلاج تجميلي للتخلص من التجاعيد. ومن المعتقد أن حقن هذا العقار في فروة الرأس والرقبة يعوق نقل الألم، ونجح بشكل مؤكد في منع الصداع النصفي لدى بعض الأشخاص. ومن أجل تفعيل هذا التوجه، ستحتاج إلى الحصول على علاجات متعددة على امتداد فترة من الوقت. وفي العادة، تستمر فترة العلاج الواحدة ما بين 10 و12 أسبوعاً.
– عقاقير يجري تناولها عن طريق الفم عام 2018. من المتوقع أن تستقبل الأسواق فئة جديدة من العقاقير تعرف باسم الأجسام المضادة للببتيد المرتبط بجين الكالسيتونين anti – CGRP antibodies.
وتقاوم هذه الأجسام تأثير الببتيد المرتبط بجين الكالسيتونين calcitonin gene – related peptide (CGRP)، وهي مادة كيميائية يفرزها الجسم في الطبيعي تؤدي من بين أمور أخرى إلى تمدد الأوعية الدموية. وقد جرى الاعتماد على علاجات مشابهة بالأجسام المضادة لعلاج اضطرابات روماتيزمية أو أمراض عصبية، مثل التصلب المتعدد. وقد أظهرت هذه الأجسام المضادة الجديدة بعض الفاعلية في الحيلولة دون وقوع الصداع النصفي.
ورغم أن هذه العقاقير لم تبد فاعلية أكبر عن العقاقير الحالية، فإنها ربما تمنح السيدات اللائي لم يستجبن بصورة جيدة للعقاقير المتاحة الآن خياراً جديداً لتجريبه، وربما تتسم بقدر أقل من الأعراض الجانبية عن علاجات أخرى. ومع ذلك، فإنه حتى هذه اللحظة لم يتم تحديد سلامة هذا العلاج على المدى الطويل.
ومن المعتقد أنه بمرور الوقت ستزداد الخيارات العلاجية المتاحة للصداع النصفي. وفي تلك الأثناء، إذا كنت تعاني من صداع نصفي، عليك استشارة الطبيب والانتباه لحقيقة أن الطبيب المعالج ربما يحتاج لتجريب تنويعات مختلفة من العقاقير للوصول إلى التوجه الملائم لاحتياجاتك.
— هل يمكن تغيير أسلوب الحياة للوقاية من الصداع النصفي؟
من الممكن عبر إجراء بعض التغييرات على أسلوب الحياة الحد من معدل التعرض للصداع النصفي لدى بعض الأفراد. في هذا الصدد، قالت الدكتورة لودر: «بمقدور الأفراد أنفسهم تحديد الأشياء التي تزيد احتمالية تعرضهم للصداع النصفي».
بالنسبة لبعض الأفراد، يتسبب نقص الكافيين أو تناول الكحوليات في تحفيز الصداع النصفي. وفي الوقت الذي يعتقد بعض الأطباء وجود محفزات للصداع النصفي في صورة بعض الأطعمة، فإنه لا تتوافر بيانات موثوق بها تدعم هذه الفكرة.
وبجانب تحديد محفزات الصداع النصفي، بمقدورك كذلك تقليص احتمالية التعرض لصداع نصفي من خلال تناول الوجبات بانتظام واتباع عادات صحية جيدة مثل الحصول على قسط وافر من النوم وتجنب الضغط العصبي.
– الصداع النصفي المصاحب بالهالة… مخاوف وأخطار
– الملاحظ أن ما يتراوح بين 15 في المائة و30 في المائة ممن يعانون من الصداع النصفي يتعرضون لهالة aura قبل أن يبدأ ألم الصداع. ويشير مصطلح «الهالة» إلى ظاهرة عصبية عبارة عن اضطراب بصري مثل وميض أو ضوء مبهر أو تشويش أو حتى فقدان جزئي للبصر.
وربطت أبحاث بين هذا النمط من الصداع النصفي وبين عيب خلقي محدد بالقلب يطلق عليه «عيب الحاجز الأذيني» patent foramen ovale PFO. ويتمثل هذا العيب في وجود ثقب في الأنسجة الفاصلة بين الأذين الأيمن والأيسر من القلب. ويعتبر هذا الثقب أمراً طبيعياً في الأجنة، لكنه في الظروف الطبيعية يغلق نفسه عند الولادة. ومع هذا، فإنه يظل مفتوحاً لدى بعض الأشخاص. وتبعاً لما أعلنته «الجمعية الأميركية للصداع»، فإن قرابة ما يتراوح بين 40 في المائة و60 في المائة من الأفراد الذين يعانون من صداع نصفي مصحوب بهالة، يعانون كذلك من عيب الحاجز الأذيني. ومع هذا، فإنه من غير الواضح حتى هذه اللحظة، ما إذا كان عيب الحاجز الأذيني يسبب الصداع النصفي أم أن الأفراد الذين يعانون هذا النمط من الصداع يعتبرون لسبب ما آخر أكثر احتمالاً لأن يعانوا من الحالتين معاً.
وأوضحت الدكتورة لودر أنه حال وجود هذا العيب الخلقي في القلب، فأنت لست في حاجة بالضرورة إلى فعل أي شيء لإصلاحه، لأن التجارب السريرية أظهرت أن محاولات الإصلاح الجراحي لا توفر أي مميزات فيما يخص الصداع النصفي.
ومع هذا، يبقى من المهم بالنسبة للنساء اللائي يعانين من هذا النمط من الصداع الانتباه إلى أن باحثين خلصوا إلى أن الأفراد الذين يعانون صداعا نصفيا تصاحبه الهالة يواجهون مخاطر أعلى كثيراً لأن يصابوا بسكتة دماغية. وعليه، فإنه يتعين على النساء اللائي يعانين هذا النمط من الصداع النصفي الحذر إزاء تناول حبوب منع الحمل التي تحوي الإستروجين أو تلقي علاج إستروجين بعد انقطاع الحيض، لأن كلاهما يزيد مخاطرة التعرض لسكتة دماغية، حسبما نوهت الدكتورة لودر.
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