Abstract：
OBJECTIVE: The current review aims to provide an overview of migraine treatment strategies in medically complex patients, including those with renal, liver, and cardiovascular disease.
RESULTS: In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.
RESULTS: In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.
摘要：
目的：本综述旨在概述医学复杂患者的偏头痛治疗策略，包括那些有肾脏的，肝脏,和心血管疾病。
结果：在心血管疾病中，激素对于急性治疗可能是安全的；NSAIDs，麦角胺,不建议使用Triptans。β受体阻滞剂,ACEi/ARB,和维拉帕米除了偏头痛的预防性益处外,还有潜在的心血管益处.Frovatriptan在肾脏疾病或轻度至中度肝脏疾病中不需要剂量调整。在轻度和中度肾脏和肝脏疾病中，Gepants是安全的急性和预防性治疗选择。TCA和丙戊酸在肾病中不需要剂量调整。烟草素毒素A在心脏疾病中可能是安全的，肾,和肝功能损害。虽然CGRP单克隆抗体在肾脏和肝脏疾病中可能是安全的，在这些疾病以及心脏病中需要进一步的研究，没有剂量建议。有效的选择可用于那些复杂的医疗合并症。在这些复杂人群中，需要进一步研究新型偏头痛特异性疗法的安全性。
结果：在心血管疾病中，激素对于急性治疗可能是安全的；NSAIDs，麦角胺,不建议使用Triptans。β受体阻滞剂,ACEi/ARB,和维拉帕米除了偏头痛的预防性益处外,还有潜在的心血管益处.Frovatriptan在肾脏疾病或轻度至中度肝脏疾病中不需要剂量调整。在轻度和中度肾脏和肝脏疾病中，Gepants是安全的急性和预防性治疗选择。TCA和丙戊酸在肾病中不需要剂量调整。烟草素毒素A在心脏疾病中可能是安全的，肾,和肝功能损害。虽然CGRP单克隆抗体在肾脏和肝脏疾病中可能是安全的，在这些疾病以及心脏病中需要进一步的研究，没有剂量建议。有效的选择可用于那些复杂的医疗合并症。在这些复杂人群中，需要进一步研究新型偏头痛特异性疗法的安全性。
