Migraine

Краткая информация для пациента

Есть ли FDA-допуск для этого показания?

Not FDA-cleared for migraine. The FDA cleared medicinal leeches in 2004 (K040187) only for venous congestion in microsurgical reconstruction. Use for migraine is investigational and not FDA-evaluated.

Какие доказательства существуют?

Tier C (investigational). Two uncontrolled case series (Michalsen 2004 n=27; Bahramsoltani 2017 n=30) reported reductions in monthly migraine days after 2-4 sessions. There are no randomized controlled trials. Migraine trials show high placebo response, so uncontrolled improvements should be interpreted cautiously. Evidence-based preventive therapies (CGRP inhibitors, topiramate, beta-blockers, onabotulinumtoxinA) remain first-line.

Основные риски

• Bleeding from each bite site for 6 to 24 hours after detachment
• Bruising and tenderness around the temples, mastoid, and neck for 3 to 7 days
• Itching and irritation at bite sites for days to weeks
• Local skin infection or, rarely, Aeromonas infection from leech gut bacteria (~1-20% across hirudotherapy generally)
• Allergic reaction to leech saliva (uncommon)
• Temporary worsening of headache for 1 to 2 days after the session
• Small permanent scars at bite sites

Кому не следует это рассматривать

• Patients taking blood thinners such as warfarin (INR >2.0), apixaban, rivaroxaban, dabigatran, or heparin
• Patients with hemophilia or other inherited bleeding disorders
• Patients with severe anemia (hemoglobin under 10 g/dL)
• Patients with a weakened immune system
• Patients with secondary headache (rule out tumor, hemorrhage, infection first via neurology workup)
• Patients with active medication-overuse headache (analgesic withdrawal needed first)

О чём спросить врача

• Have I been evaluated by a neurologist and had imaging if indicated to rule out secondary causes?
• Have I completed an adequate trial of evidence-based preventives (topiramate, beta-blockers, CGRP inhibitors, onabotulinumtoxinA)?
• What evidence supports leech therapy for my migraine specifically, and what is the realistic chance of benefit?
• What is the practitioner's experience treating migraine with leech therapy?
• What antibiotic plan do you use for Aeromonas prevention?
• What red flags require me to seek urgent care?
• What is the cost, and is it covered by insurance? (typically not)

Когда срочно обратиться за медицинской помощью

• Sudden worst headache of life or thunderclap headache (possible subarachnoid hemorrhage — call 911)
• Headache with fever, neck stiffness, confusion, or rash (possible meningitis)
• New neurologic symptoms — weakness, numbness, speech difficulty, vision loss
• Bleeding from a bite site lasting more than 24 to 48 hours, or soaking through dressings
• Spreading redness, warmth, pus, or red streaks at bite sites (cellulitis or Aeromonas)
• Fever above 38.0 C / 100.4 F or chills
• Hives, throat tightness, or breathing difficulty