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45North-Eastern Thai Journalof Neuroscience
Vol.5 No.2Topic Review
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Vol.5 No.2
North-Eastern Thai Journalof Neuroscience46
John Hughlings Jackson ‰¥âæ∫«à“Õ“°“√™—°
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47North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
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53North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
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8. ªí≠À“‡√◊ËÕߧ«“¡‡§√’¬¥ ¡’ ¡“™‘° à«π
„À≠à∑’ˉ¥â·≈°‡ª≈’ˬπª√– ∫°“√≥å„π°≈ÿà¡ ‰¥â
°≈à“«∂÷ߧ«“¡‡§√’¬¥μ“¡°“√√—∫√Ÿâ «à“Õ“°“√‡§√’¬¥
¡—°‡°‘¥‰¥â∫àÕ¬ à«π„À≠à‡°‘¥®“°§«“¡√Ÿâ ÷°
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‡√◊ËÕß°“√‡®Á∫ªÉ«¬ °≈—«√—°…“‰¡àÀ“¬ ‡§√’¬¥®“°
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‡§√’¬¥®“°§«“¡√Ÿâ ÷°‰¡à¡—Ëπ„®„πμπ‡Õß ·≈–‡¡◊ËÕ
‡°‘¥Õ“°“√‡§√’¬¥°Á àߺ≈„À⇰‘¥Õ“°“√™—°∫àÕ¬¢÷Èπ
÷́Ëß ¡“™‘° à«π„À≠à‡ÀÁπ Õ¥§≈âÕß°—π«à“∂â“ “¡“√∂
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§≈“¬‡§√’¬¥ ‡™àπ °“√Ωñ°∑” ¡“∏‘ °“√À“Õ–‰√∑’Ë
™Õ∫∑” ¥Ÿ‚∑√∑—»πå øí߇æ≈ß ÕÕ°°”≈—ß°“¬ æ—°
ºàÕπ„Àâ‡æ’¬ßæÕ ·≈–∑’Ë ”§—≠§«√√Ÿâ®—°°“√∑”„®
ª≈àÕ¬«“ß ·≈–≈¥§«“¡§“¥À«—ßμàÕμπ‡Õß≈ß
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience54
9. ªí≠À“°“√‰¡à¬Õ¡√—∫°“√‡®Á∫ªÉ«¬ ºŸâªÉ«¬
∑’Ë¡’Õ“°“√≈¡™—°„π™à«ßªï·√°¬—߬ա√—∫‰¡à‰¥â ‡ÀÁπ
‰¥â®“°∫“ߧπ√Ÿâ«à“‚√§π’ÈμâÕßÀ¬ÿ¥¥◊Ë¡ ÿ√“ ·μà°Á
∑”μ—«ª°μ‘¥◊Ë¡μ“¡‡æ◊ËÕπ·≈–√—°…“‰¡àÀ“¬ çÕ¬“°
¥◊Ë¡°Á‰¡à‡ÀÁπ™—° ∂â“®–™—°°Á™—°‡©¬Êé ªØ‘‡ ∏∑—ÈßÊ√Ÿâ
«à“™—°∂’Ë¢÷Èπ —ߧ¡√—∫√Ÿâ‰¡àÕ¬“°„Àâ§πÕ◊Ëπ查∂÷ß
¡“™‘°∫“ߧπ‰¡àÕ¬“°‡¢â “°≈ÿà¡μâÕß√’∫°≈—∫
‡π◊ËÕß®“°¡“æ∫·æ∑¬å‡æ◊ËÕ√—∫¬“μàÕ‡π◊ËÕß·μà‡¡◊ËÕøíß
®“°¢âÕ¡Ÿ≈°“√𔇠πÕæ∫«à“¬—ß¡’æƒμ‘°√√¡
ªØ‘‡ ∏°“√‡®Á∫ªÉ«¬ π—°»÷°…“À≠‘ß«—¬ 18 ªï °≈∫
‡°≈◊ËÕπ¥â«¬°“√À—«‡√“–∫Õ°«à“ ì·≈â«·μà¡—π®–™—°
‡æ√“–‡«≈“™—°ÀπŸ®–‰¡à√Ÿâμ—« √Ÿâ·μà«à“ÀπŸÀßÿ¥Àß‘¥ ÀπŸ
®–‰ª‡§“–ÀâÕ߇æ◊ËÕπ À≈—ß®“°π—Èπ®–‰¡à√Ÿâμ—«‡æ◊ËÕπ
∫Õ°«à“ÀπŸ™—°°√–μÿ°·≈–√âÕßÀ«’¥‡æ◊ËÕπÊ °≈—«°—π
„À≠à«‘Ëßæ≈à“π ÀπŸμ◊Ëπ¡“°Áª°μ‘·μફ¥À—«π‘¥
ÀπàÕ¬·¡àÀπŸ°—ß«≈¡“°°«à“ÀπŸî À≈—ß®“°‰¥â√—∫°“√
·≈°‡ª≈’ˬπª√– ∫°“√≥å°—∫ºŸâÕ◊Ëπ ºŸâªÉ«¬ ß∫øíß
·≈–‡¢â“¡“√à«¡·≈°‡ª≈’ˬπ ¬Õ¡√—∫«à“μπ√Ÿâ ÷°
‡À¡◊Õπ∑’˧πÕ◊Ëπ∫Õ°≈÷°Ê √Ÿâ ÷°Õ“¬∑’Ëμπ™—° °≈—«
‡√’¬π‰¡à∑—π‡æ◊ËÕπμâÕß°“√°“√™à«¬‡À≈◊Õ®“°‡æ◊ËÕπ
‡¡◊ËÕ‰¥âøíß·≈–·≈°‡ª≈’ˬπ°—∫§πÕ◊Ëπ·≈â«√Ÿâ ÷°
∫“¬„®¢÷Èπ
ª√–‡¡‘πº≈ªí®®—¬∫”∫—¥∑’ˇ°‘¥¢÷Èπ®“°°“√∑”°≈ÿà¡
®“°°“√«‘ ‡§√“–Àå°“√∑”°≈ÿà¡®‘μ∫”∫—¥
ª√–§—∫ª√–§√Õß„πºŸâªÉ«¬‚√§≈¡™—°æ∫«à“ªí®®—¬
∫”∫—¥∑’ˇ°‘¥¢÷Èπ∫àÕ¬·≈–‡°◊Õ∫∑ÿ°§√—Èß„π°“√∑”
°≈ÿà¡·μà≈–§√—Èß ‰¥â·°à
1. °“√ √â“ߧ«“¡À«—ß (inspiration) ‚¥¬¡’
¡“™‘°À≈“¬§π∫Õ°«à“ √Ÿâ ÷°¥’∑’ˉ¥â¡“‡¢â“°≈ÿࡇÀÁπ
¡“™‘°À≈“¬∑à“πÕ“°“√¥’¢÷Èπ ¡’ ¡“™‘°∫“ß∑à“π∑’Ë
À“¬°Á∑”„À⇰‘¥§«“¡À«—ß«à“μπ‡ÕßμâÕßÀ“¬À√◊Õ¡’
Õ“°“√¥’¢÷È𠧑¥«à“‡√“μâÕß Ÿâ·≈–√—°…“μπ‡ÕßμàÕ‰ª
∫“ߧπ°Á∫Õ°«à“
ç°“√‡¢â“°≈ÿࡧ√—Èßπ’È∑”„Àâμπ‡Õß¡’°”≈—ß„®∑’Ë
®–¥Ÿ·≈ “¡’μàÕ‰ªé
´÷Ëß®“°°“√»÷°…“º≈°“√∑”°≈ÿà¡®‘μª√–§—∫
ª√–§√Õß·°à¡“√¥“∑’Ë¥Ÿ·≈∫ÿμ√μ“¡≈”æ—ßæ∫«à“
¡“√¥“√Ÿâ ÷°¡’§«“¡À«—ß¡’°”≈—ß„®∑’Ë®–¥Ÿ·≈∫ÿμ√μàÕ
‰ª16 ·≈– „πμà“ߪ√–‡∑»¡’°“√»÷°…“ªí®®—¬∫”∫—¥
∑’Ë ‡°‘¥¢÷Èπ®“°°“√∑”°≈ÿà¡®‘μ∫”∫—¥°—∫ºŸâªÉ «¬
‚√§®‘μ‡¿∑æ∫«à“ªí®®—¬∫”∫—¥∑’ˇ°‘¥¢÷Èπ∫àÕ¬§◊Õ ‡√◊ËÕß
°“√√Ÿâ ÷°¡’§«“¡À«—ß„π°“√¥”‡π‘π™’«‘μ·≈–°“√
√—°…“‚√§μàÕ‰ª17
2. §«“¡√Ÿâ ÷°§≈⓬§≈÷ß°—π (universaliza-
tion) ¡’ ¡“™‘°„π°≈ÿà¡À≈“¬§π‡°‘¥§«“¡√Ÿâ ÷°¥’∑’Ë
‡ÀÁπ«à“§πÕ◊ËπÊ°Á¡’ªí≠À“‡À¡◊Õπ‡√“ §πÕ◊ËπÊ°Á‡ªìπ
‚√§‡À¡◊Õπ‡√“ ¥—ß∑’Ë ¡“™‘°„π°≈ÿà¡∫Õ°‰«â„π™à«ß
∑⓬¢Õß°“√∑”°≈ÿà¡«à“
ç√Ÿâ ÷°¥’∑’˧πÕ◊Ëπ°Á‡ªìπ‡À¡◊Õπ‡√“ ‰¡à„™à‡√“
§π‡¥’¬«∑’˪ɫ¬‡ªìπ‚√§π’Èé
çÀ“¬§—∫¢âÕß„®∑’˧πÕ◊Ëπ°Á‡ªìπ‡À¡◊Õπ‡√“é
ç°“√‰¥â¡“‡¢â“°≈ÿà¡∑”„Àâ‡√“ ∫“¬„® ‡æ√“–
∑”„Àâ‡√“‰¥â√Ÿâ«à“¡’§πÕ◊ËπÕ’°À≈“¬§π∑’ˇ®Á∫ªÉ«¬
‡À¡◊Õπ‡√“ ·μà°àÕπ‡√“Õ¬Ÿà∑’Ë∫â“π°Á¡’·μà‡√“∑’˪ɫ¬
‡ªìπ‚√§π’È ∫“ß∑’°Á∑”„Àâ‡√“√Ÿâ ÷°πâÕ¬„® ·≈–∑âÕ·∑âé
55North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
π’ˇªìπ‡æ’¬ßμ—«Õ¬à“ß∫“ß à«π¢Õߧ”查∑’Ë
¡“™‘°„π°≈ÿࡉ¥â∫Õ°‡≈à“„À⺟âπ”°≈ÿࡉ¥â√—∫√Ÿâ«à“ ‘Ëß
∑’ˇ¢“‰¥â¡“‡¢â“°≈ÿࡧ√—Èßπ’ȇ¢“√Ÿâ ÷°Õ¬à“߉√ ·≈–‡ªìπ
ª√–‚¬™πå°—∫æ«°‡¢“Õ¬à“߉√ ´÷Ë߉¥â¡’°“√»÷°…“
°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„πºŸâªÉ«¬À≠‘ß∑’Ë
μ‘¥‡™◊ÈÕ‡Õ¥ å ∑’Ë¡’Õ“¬ÿ√–À«à“ß 30-35 ªï æ∫«à“À≈—ß
∑”°≈ÿà¡ ºŸâ‡¢â“√—∫°“√∫”∫—¥‰¥âμ√–Àπ—°«à“ ¡“™‘°
§πÕ◊Ëπ°Á¡’ªí≠À“∑’˧≈⓬§≈÷ß°—π¡’ªí≠À“‡À¡◊Õπ°—π
´÷Ëߧ«“¡√Ÿâ ÷°∑’Ë«à“μπ‡Õ߇ªìπ∑ÿ°¢åÕ¬Ÿà§π‡¥’¬«°Á≈¥
≈ß18 ∑”„À⇰‘¥§«“¡√Ÿâ ÷°„À¡à«à“‡¢“‰¡à‰¥âÕ¬Ÿà§π
‡¥’¬«„π‚≈° ¬—ß¡’‡æ◊ËÕπÊÕ’°À≈“¬§π∑’Ë¡’ªí≠À“
·≈–¡’§«“¡∑ÿ°¢å‡À¡◊Õπ‡¢“
3. §«“¡√Ÿâ ÷°¡’§ÿ≥§à“„πμπ‡Õß (altruism)
‡™àπ ¡’ ¡“™‘°À≈“¬§π∫Õ°«à“
ç√Ÿâ ÷°¥’∑’ˉ¥â¡“·∫àߪíπª√– ∫°“√≥å¥’Ê °—∫
‡æ◊ËÕπÊ∑’Ë¡’°“√‡®Á∫ªÉ«¬¥â«¬‚√§‡¥’¬«°—πé
纡√Ÿâ ÷°¥’¡“° ∑’ˉ¥â¡“∫Õ°‡≈à“ª√– ∫°“√≥å
¢Õßμπ‡Õß„Àâ‡æ◊ËÕπ„π°≈ÿࡉ¥â√—∫√Ÿâ‡æ√“–°«à“º¡®–
ºà“π®ÿ¥π—Èπ¡“‰¥â º¡°Á·¬à‡À¡◊Õπ°—πé
纡«à“‡ªìπ°“√¥’¡“°∑’ˉ¥â¡“查§ÿ¬·≈°
‡ª≈’ˬπª√– ∫°“√≥å∑’ˇªìπª√–‚¬™πå º¡Õ¬“°„Àâ
‘Ëß∑’Ëæ«°‡√“‰¥â查§ÿ¬°—π«—ππ’È ‰¥â¡’°“√𔉪‡º¬
·æ√à„À⇪ìπª√–‚¬™πå ”À√—∫ºŸâ∑’ˉ¥âÕà“π ‚¥¬‡©æ“–
ºŸâ∑’ˇ®Á∫ªÉ«¬¥â«¬‚√§≈¡™—°‡À¡◊Õπ‡√“ º¡«à“¡—π®–
‡ªìπª√–‚¬™πå¡“°‡≈¬∑’ˇ¥’¬«é
´÷Ëß°“√‡¢â“°≈ÿà¡∑”„Àâ ¡“™‘°‰¥â¡’°“√·°âªí≠À“
√à«¡°—π ·≈°‡ª≈’ˬπ¢âÕ¡Ÿ≈ ‘Ëß∑’ˇªìπª√–‚¬™πå´÷Ëß
°—π·≈–°—π ™à«¬‡À≈◊Õ‡æ◊ËÕπ∑’Ë¡’§«“¡∑ÿ°¢å¡“°°«à“
®÷ß∑”„Àâ ¡“™‘°„π°≈ÿࡇÀÁπ§ÿ≥§à“„πμπ‡Õߥ—ß∑’Ë
°≈à“«¡“ ´÷Ëß®“°»÷°…“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–
§√Õß·∫∫®‘μæ≈«—μ√„πºŸâªÉ«¬®‘μ‡¿∑ ·≈–°“√∑”
°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„π¡“√¥“∑’ˇ≈’Ȭß∫ÿμ√μ“¡
≈”æ—ß æ∫«à“ ¡“™‘°∑’ˇ¢â“°≈ÿࡇ°‘¥§«“¡√Ÿâ ÷°¿“§
¿Ÿ¡‘„®„πμπ‡Õß √Ÿâ ÷°¥’°—∫μπ‡Õß∑’ˉ¥â√à«¡°—π·°â
ªí≠À“·≈–„Àâ¢âÕ¡Ÿ≈∑’ˇªìπª√–‚¬™πå°—∫‡æ◊ËÕπÊ
¡“™‘°„π°≈ÿà¡7,16
4. °“√‰¥â√–∫“¬ (catharsis) §«“¡√Ÿâ ÷°
§«“¡§—∫¢âÕß„® ªí≠À“μà“ßÊ∑’ˇ°‘¥¢÷Èπ °“√‡¢â“°≈ÿà¡
∑”„Àâ ¡“™‘°‰¥â√–∫“¬ÕÕ°∑—Èß ‘Ëß∑’Ë¥’·≈–‰¡à¥’ §«“¡
§—∫¢âÕß„® §«“¡«‘μ°°—ß«≈„Àâ°—∫ ¡“™‘°°≈ÿࡉ¥â
√—∫øíß °“√‰¥â√–∫“¬ÕÕ°®–∑”„Àâ ¡“™‘°√Ÿâ ÷°
∫“¬„® ∑”„À⇢Ⓞ®μπ‡Õß·≈–™’«‘μ¡“°¢÷È𠇙àπ
牥⇢⓰≈ÿࡧ√—Èßπ’ȇªìπ§√—Èß∑’Ë Õß °Á√Ÿâ ÷°¥’∑’Ë
‰¥â¡“查§ÿ¬°—∫‡æ◊ËÕπ‰¥â¡“查§ÿ¬√–∫“¬ªí≠À“
∑”„Àâ‡√“ ∫“¬„®¢÷Èπé
ç√Ÿâ ÷° ∫“¬„®¢÷Èπ§à– ‰¥â查§ÿ¬‰¥â√–∫“¬ ‰¥â
¡’‡æ◊ËÕπ查§ÿ¬é
ç°“√‰¥â¡“‡¢â“°≈ÿà¡°Á¥’§à– ‡æ√“–∑”„Àâ‡√“‰¥â
查‰¥â√–∫“¬ ‘Ëß∑’ˇ√“§—∫¢âÕß„® ∫“ß∑’‡√“‰¥â查
ÕÕ°‰ª∂÷ß·¡â®–·°â‰¢ªí≠À“‰¡à‰¥â ·μà°Á∑”„Àâ‡√“
√Ÿâ ÷°‚≈àßé
π’ȇªìπ§”查 à«πÀπ÷Ëß∑’Ë ¡“™‘°∑’ˇ¢â“°≈ÿࡉ¥â
∫Õ°‡≈à“À≈—ß®“°‰¥â‡¢â“√à«¡°≈ÿà¡∫”∫—¥ ´÷Ëß®“°°“√
»÷°…“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„πºŸâªÉ«¬
‡Õ¥ å‡æ»À≠‘ß º≈°“√∑”°≈ÿà¡æ∫«à“ ¡“™‘°°≈ÿà¡
∫Õ°«à“√Ÿâ ÷° ∫“¬„® ‡¢â“„®μπ‡Õß¡“°¢÷Èπ®“°°“√∑’Ë
‰¥â查‰¥â√–∫“¬ªí≠À“ ·≈–§«“¡§—∫¢âÕß„®18
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience56
5. §«“¡‡ªìπÕ—πÀπ÷ËßÕ—π‡¥’¬«°—π (cohesion)
‡™àπ ¡’ ¡“™‘°„π°≈ÿà¡∫Õ°«à“
ç‡√“μâÕß Ÿâ ‡√“μâÕß„Àâ°”≈—ß„®´÷Ëß°—π·≈–°—π
Õ¬“°„Àâ°”≈—ß„®æ«°‡√“∑ÿ°§π„Àâ ŸâμàÕ‰ªé À√◊Õ
çÕ¬“°„Àâ°”≈—ß„®‡æ◊ËÕπÊ∑ÿ°§ππ“π·§à‰Àπ‡√“°Á
μâÕß√—°…“μàÕ‰ª ¢Õ„Àâ¡“æ∫·æ∑¬åμ“¡π—¥·≈–
°‘π¬“Õ¬à“ßμàÕ‡π◊ËÕßé
‡™à𠇥’¬«°—∫°“√»÷°…“°“√∑”°≈ÿà¡®‘μª√–
§—∫ª√–§√Õß„πºŸâªÉ«¬‡Õ¥ åÀ≠‘ß∑’˺≈°“√∑”°≈ÿà¡
∑”„Àâ ¡“™‘°‡°‘¥§«“¡√Ÿâ ÷°‡¢â“„®‡ÀÁπ„®¡’°“√™à«¬
‡À≈◊Õ‡ªìπÕ—πÀπ÷ËßÕ—π‡¥’¬«°—π18
6. °“√‡√’¬π√Ÿâ∑—°…–∑“ß —ߧ¡ (interper-
sonal learning) ¡“™‘°À≈“¬∑à“π∑’ˇ¢â“°≈ÿà¡
°Á‰¥â‡√’¬π√Ÿâ°“√√—∫øíߪí≠À“¢ÕߧπÕ◊ËπÕ¬à“ßμ—Èß„®
‡ß’¬∫‡æ◊ËÕ‡ªî¥‚Õ°“ „À⺟âÕ◊Ëπ‰¥â√–∫“¬§«“¡‰¡à
∫“¬„® ‡√’¬π√Ÿâ∑’Ë®–查„Àâ°”≈—ß„®ºŸâÕ◊Ë𠇙àπ
ç‡√“∑ÿ°§π‡¢â“„®§ÿ≥π–‡æ√“–Õ“°“√∑’˧ÿ≥
‡≈à“¡“¡—π§ß∑”„Àâ§ÿ≥‡®Á∫¡“° ‡æ√“–æ«°‡√“·§à
™—°‡©¬Ê·μà§ÿ≥¡’Õ“°“√ª«¥∑’Ë„∫Àπⓥ⫬ ·μà
æ«°‡√“∑ÿ°§π°ÁÕ¬“°„Àâ°”≈—ß„®§ÿ≥π–„Àâ√—°…“„Àâ
À“¬é
çÕ¬“°„Àâ°”≈—ß„®∑ÿ°§π ŸâÊ μàÕ‰ªé
π’ȧ◊Õμ—«Õ¬à“ߧ”查∑’ˬ°¡“‡æ◊ËÕ· ¥ß„Àâ
‡ÀÁπ«à“°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§Õß∑”„À⺟âªÉ«¬
‚√§≈¡™—°·≈–≠“μ‘√Ÿâ®—°°“√查„Àâ°”≈—ß´÷Ëß°—π·≈–°—π
√Ÿâ®—°æ¬“¬“¡‡¢â“„®§«“¡√Ÿâ ÷°¢ÕߺŸâÕ◊Ë𠉥â‡√’¬π√Ÿâ
∑—°…–∑“ß —ߧ¡16
7. °“√æ—≤π“∑—°…–°“√‡¢â“°≈ÿà¡ (develop-
ment of socializing techniques) ¡’°“√‡√’¬π√Ÿâ
∑’Ë®–√—∫øíß °≈â“· ¥ß§«“¡§‘¥‡ÀÁπ·≈°‡ª≈’ˬπ
ª√– ∫°“√≥å ‡™àπ
ç°“√¡“∑”°≈ÿà¡Õ¬à“ßπ’È°Á¥’ ∂◊Õ‡ªìπ°“√¡“查
§ÿ¬·≈°‡ª≈’Ë¬π§«“¡√Ÿâ´÷Ëß°—π·≈–°—π ∫“ߧπ‰¡à查
·μà°Á‡ÀÁππ—ËßøíߧπÕ◊Ëπ查π–§à–é
牥â„Àâ°”≈—ß„®´÷Ëß°—π·≈–°—π ‡ÀÁπ„®‡¢â“„®
‡æ◊ËÕπ∑’ˇ¢“¡’§«“¡∑ÿ°¢å¡“°°«à“‡√“é
8. °“√‰¥â√—∫¢âÕ¡Ÿ≈¢à“« “√ (imparting of
information) ¡’ ¡“™‘°À≈“¬§π‰¥â∫Õ°‡≈à“
§«“¡√Ÿâ ÷° ‡™àπ
纡¡“‡¢â“°≈ÿà¡π’È º¡√Ÿâ ÷°¥’ ‰¥âª√–‚¬™πå ‰¥â
¡“查§ÿ¬·≈°‡ª≈’ˬπª√– ∫°“√≥å´÷Ëß°—π·≈–°—π
·≈–‰¥â¢âÕ¡Ÿ≈„π°“√¥Ÿ·≈μπ‡Õßé
ç©—π‰¥â∑√“∫«‘∏’°“√ªØ‘∫—μ‘μ—«‡æ◊ËÕÀ≈’°‡≈’ˬß
ªí®®—¬°√–μÿâπ∑’Ë®–∑”„À⇰‘¥Õ“°“√™—°é
ç©—π√Ÿâ ÷°¥’π– ‡æ√“–«à“¡“‡¢â“°≈ÿà¡∑”„À≥â
‡√’¬π√Ÿâ«‘∏’°“√§≈“¬§«“¡‡§√’¬¥ ‡æ◊ËÕ«à“μπ‡Õß®–
‰¥â𔉪ªØ‘∫—μ‘·≈– “¡“√∂∫Õ°§πÕ◊Ëπ∑’Ë ‡¢“¡’
ªí≠À“‡√◊ËÕ߇§√’¬¥‰¥â¥â«¬é
纡«à“°“√‰¥â¡“查§ÿ¬°—π°Á¥’π– ‰¥â‡√’¬π√Ÿâ
«‘∏’°“√ªØ‘∫—μ‘μ—«‡¡◊ËÕ‡°‘¥Õ“°“√™—°«à“§«√∑”Õ¬à“߉√
‡√“®–‰¥â∫Õ°„À⇢“¥Ÿ·≈‡√“«à“§«√∑”Õ¬à“߉√‡¡◊ËÕ
‡√“™—°é ‡ªìπμâπ
9. °“√‰¥â√Ÿâ§«“¡®√‘ߢÕß™’«‘μ (existential
factors) °“√√Ÿâ®—°ª≈àÕ¬«à“ß °“√∑”„® °“√ª≈ß ‡™àπ
¡’ ¡“™‘°°≈ÿà¡∫“ߧπ∫Õ°«à“
ç‡√“μâÕß√Ÿâ®—°ª≈àÕ¬«“ß √Ÿâ®—°ª≈ß Õ–‰√®–
‡°‘¥¡—π°ÁμâÕ߇°‘¥é
ç∑ÿ°§π¡’ªí≠À“¥â«¬°—π∑—Èßπ—Èπ Õ¬à“‰ª§‘¥¡“°
57North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
‡√“μâÕß√Ÿâ®—°ª≈ß·≈–ª≈àÕ¬«“ßé
Õÿª √√§·≈–«‘∏’°“√·°â‰¢ë ºŸâªÉ«¬¡’ªí≠À“‚√§≈¡™—°¢≥–¡’ªí≠À“
∑“ß°“¬¿“æ ‡Àπ◊ËÕ¬ ÕàÕπ‡æ≈’¬ ¡“æ∫·æ∑¬å®–
‰¡àÕ¬“°‡¢â“°≈ÿà¡
ë ºŸâªÉ«¬‰¡à¡—Ëπ„®°≈—«°“√™—°„π°≈ÿà¡ ·π–π”
„À⺟âªÉ«¬ —߇°μÕ“°“√π”°√–μÿâπ·≈–∫հ欓∫“≈
‡æ◊ËÕ„Àâ°“√™à«¬‡À≈◊Õ∑—π∑à«ß∑’
ë °“√‡§¬™‘πμàÕ°“√μàÕ§‘«‡æ◊ËÕ√Õμ√«®°—∫
·æ∑¬å °≈—«∂Ÿ°√—¥§‘«·≈â«∑”„À≥â√—∫°“√μ√«®™â“
®÷߉¡àÕ¬“°‡¢â“°≈ÿà¡μâÕß„Àâ≠“μ‘§Õ¬¥Ÿ§‘«·≈–øíß
‡√’¬°™◊ËÕ®÷ß ∫“¬„®
ë ºŸâ ªÉ «¬·≈–≠“μ‘¡’ «‘ ∂’ ™’ «‘ μ∑’Ë √’ ∫√â Õπ
‡π◊Ë Õß®“°ºŸâªÉ «¬¡’Õ“™’æÀ√◊Õ≠“μ‘μâÕß√’∫‰ª
ª√–°Õ∫Õ“™’æ∑”„À≡àÕ¬“°‡¢â“°≈ÿà¡°≈—«‡ ’¬‡«≈“
·μà‡¡◊ËÕ¢Õ„À⇢Ⓡæ◊ËÕ∑¥≈ÕߺŸâªÉ«¬≈Õ߇¢â“·≈â«°Á
√Ÿâ ÷°¡’ª√–‚¬™πå
ë ‡¢â“°≈ÿà¡∫àÕ¬·≈⫉¡àÕ¬“°‡¢â“Õ’° ‰¡à™Õ∫
查 ‰¡àÕ¬“°§ÿ¬ ‡∫◊ËÕ ¡—°æ∫„πºŸâªÉ«¬∑’Ë´÷¡‡»√â“ ·μà
‡¡◊ËÕ∂Ÿ°°√–μÿâπ„À⇢⓺ŸâªÉ«¬¬‘È¡·≈â«¡’§«“¡À«—ß
¢âÕ‡ πÕ·π–„π°“√¥”‡π‘π°≈ÿà¡ë ‡æ◊ËÕ„Àâ°“√¥”‡π‘π°≈ÿࡇ¢â“ Ÿàª√–‡¥Áπ∑’Ë
‡°‘¥ª√–‚¬™π剥â√«¥‡√Á«¢÷Èπ§«√°√–μÿâπºŸâªÉ«¬∑’Ë
√Ÿâ ÷°¥’∑’ˇ§¬¡“‡¢â“°≈ÿà¡·≈â« ‡¢â“√à«¡‡ªìπμ—«Õ¬à“ß
„π°≈ÿà¡ ‡æ◊ËÕ‡ªìπ·√ß®Ÿß„®·≈–∂à“¬∑Õ¥„À⺟âÕ◊Ëπ‰¥â
√—∫√Ÿâª√–‚¬™πå¢Õß°“√‡¢â“°≈ÿà¡
ë §«√®—¥„À⇪ìπ°‘®°√√¡‡¢â“ Ÿàß“πª√–®”
‚¥¬¡’欓∫“≈ºŸâ¥”‡π‘π°≈ÿà¡∑’Ë¡’∑—°…–·≈–®—¥°“√
∫√‘À“√‡«≈“„π°“√¥”‡π‘π°“√
ë °“√∫√‘À“√®—¥°“√∑’Ë¥’„π°“√®—¥§‘« °“√
μ√«® —¡¿“…≥姫“¡μâÕß°“√ªí≠À“μà“ßÊ ‡™àπ
ªí≠À“∑“ß°“¬ Õ“®§«√¡’‡ πÕ„Àâπ—Ëßøí߇©¬ÊÀ√◊Õ
„Àâæ—°‰¥â
ë °“√·®âß«—μ∂ÿª√– ß§å °“√μ‘¥ª√–°“»
‡™‘≠™«π ·≈–· ¥ßº≈ß“π°≈ÿà¡∑’ËÀπⓧ≈‘π‘°®–
™à«¬„π°“√μ—¥ ‘π„®‡¢â“„™â∫√‘°“√°≈ÿࡉ¥âßà“¬¢÷Èπ
®“°°“√∑”°≈ÿà¡®‘μª√–§—∫ª√–§√Õß„π
ºŸâªÉ«¬‚√§≈¡™—°∑’Ë·ºπ°ºŸâªÉ«¬πÕ°§√—Èßπ’È æ∫«à“
‡°‘¥ª√“°Ø°“√≥åª√–‡¥Áπªí≠À“∑“ß®‘μ —ß§¡∑’Ë
‡°‘¥¢÷ÈπÀ≈“°À≈“¬ §◊Õ ªí≠À“‡√◊ËÕߧ«“¡μâÕß°“√
¥â“π¢âÕ¡Ÿ≈‡°’ˬ«°—∫¿“«– ÿ¢¿“æ °“√‡®Á∫ªÉ«¬ °“√
√—°…“ ªí≠À“°“√¥Ÿ·≈μπ‡Õ߇¡◊ËÕ‡ªìπ‚√§≈¡™—°
ªí≠À“‡√◊ËÕß°“√«‘π‘®©—¬ °“√√—°…“·≈–°“√‡¢â“∂÷ß
∫√‘°“√ ÿ¢¿“æ ªí≠À“‡√◊ËÕß¿“æ≈—°…≥å ªí≠À“
‡√◊ËÕߧ«“¡√Ÿâ ÷°∑âÕ·∑â ‘ÈπÀ«—ß ªí≠À“‡√◊ËÕߧÿ≥¿“æ
™’«‘μ ªí≠À“‡√◊ËÕߧ«“¡°—ß«≈„®·≈–§«“¡§—∫¢âÕß„®
ªí≠À“‡√◊ËÕߧ«“¡‡§√’¬¥ ªí≠À“‡√◊ËÕß°“√‰¡à
¬Õ¡√—∫°“√‡®Á∫ªÉ«¬ à«πªí®®—¬∫”∫—¥∑’ˇ°‘¥¢÷Èπ
∫àÕ¬·≈–‡°◊Õ∫∑ÿ°§√—Èß∑’Ë∑”°≈ÿà¡ ‰¥â·°à °“√¡’§«“¡
À«—ß §«“¡√Ÿâ ÷°§≈⓬§≈÷ß°—𠧫“¡‡ªìπÕ—πÀπ÷ËßÕ—π
‡¥’¬«°—π °“√‰¥â√–∫“¬ °“√‰¥â‡√’¬π√Ÿâ∑—°…–°“√‡¢â“
°≈ÿà¡ °“√‰¥â·≈°‡ª≈’ˬπª√– ∫°“√≥å °“√‡¢â“„®
§«“¡®√‘ߢÕß™’«‘μ ¥—ßπ—Èπ®–‡ÀÁπ«à“°“√∑”°≈ÿà¡®‘μ
ª√–§—∫ª√–§Õß„πºŸâªÉ«¬‚√§≈¡™—°·≈–≠“μ‘™à«¬
∑”„À⺟âªÉ«¬·≈–≠“쑉¥â¡’°“√·≈°‡ª≈’ˬπ‡√’¬π√Ÿâ
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience58
√à«¡°—π ¡’°“√ª√—∫μ—«μàÕªí≠À“ °“√‡º™‘≠ªí≠À“
∑’ˇÀ¡“– ¡ ¡’·À≈àß π—∫ πÿπ ‡°‘¥§«“¡¡—Ëπ§ß∑“ß
Õ“√¡≥å ¡’°“√‡√’¬π√Ÿâ·∫∫Õ¬à“ß∑’Ë¥’„π°“√¥Ÿ·≈
μπ‡ÕßμàÕ‰ª
‡Õ° “√Õâ“ßÕ‘ß1. «‘√‘¬“ ‡™◊ÈÕ≈’ ·≈–§≥–. §ÿ≥¿“æ™’«‘μ¢ÕߺŸâ
ªÉ«¬‚√§≈¡™—°„π‚√ß欓∫“≈»√’π§√‘π∑√å.
«“√ “√ ¡“§¡®‘μ·æ∑¬å·Ààߪ√–‡∑»‰∑¬
2549;51 : 356-64.
2. °—≈¬“≥å ∏’√–«‘∫Ÿ≈¬å ·≈– Õ‘ √’ μ√’°¡≈. °“√
”√«®ªí≠À“∑“ß°“√·æ∑¬å¥â“π‚√§√–∫∫
ª√– “∑¢Õß‚§√ß°“√ √ÿªª√–‡¥Áπªí≠À“
∑“ß°“√·æ∑¬å∑’ˇªìπªí≠À“¢Õߪ√–‡∑»„π
°“√ª√–™ÿ¡«‘™“°“√°√¡°“√·æ∑¬å ª√–®”ªï
2549 : 66
3. ≈¡™—°. §âπ®“° http://www.thaiepilepsy.com/
index.php?option=com_content&
view=article&id=47:epidemiology&
catid=34:epilepsy&Itemid=57, §âπ‡¡◊ËÕ 22
¡’.§. 2553.
4. Meleis Al .Theoretical of nursing.
4th ed. Philadelphia Lippincott willams
& Walkins, 2007.
5. Townsend MC. Psychiatric mental
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6. ¬ÿæ‘π ·°â«π“. °“√∑”°≈ÿà¡®‘μ∫”∫—¥·∫∫ª√–
§—∫ª√–§Õß∑“ß®‘μ„®·≈–Õ“√¡≥å„π∫‘¥“
¡“√¥“‡¥Á° ¡Õßæ‘°“√. √“¬ß“π°“√»÷°…“
Õ‘ √–ª√‘≠≠“欓∫“≈»“ μ√¡À“∫—≥±‘μ
“¢“«‘™“°“√欓∫“≈ ÿ¢¿“殑μ·≈–®‘쇫™
∫—≥±‘μ«‘∑¬“≈—¬ ¡À“«‘∑¬“≈—¬¢Õπ·°àπ. 2547
7. ‰æ»√’ ¢”§¡ ·≈– §≥–. °“√∑”®‘μ∫”∫—¥
ª√–§—∫ª√–§Õß·∫∫®‘μæ≈«—μ ”À√—∫ºŸâªÉ«¬
®‘ μ ‡ ¿ ∑∑’Ë √— ∫ ‰ «â √— ° … “ „ π ‚ √ ßæ¬ “ ∫ “ ≈
æ√–»√’¡À“‚æ∏‘Ï.«“√ “√ ¡“§¡æ¬“∫“≈œ
“¢“¿“§μ–«—πÕÕ°‡©’¬ß‡Àπ◊Õ. 2552;27 :
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8. Corey G. Theory and politico of group
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9. º°“¬¡“» °‘μμ‘«‘∑¬“°ÿ≈, ·≈– «—π¥’ ™ÿπÀ
«‘° ‘μ. §«“¡μâÕß°“√¢ÕߺŸâ¥Ÿ·≈‡¥Á°≈¡™—°
·≈–ªí®®—¬∑’Ë¡’§«“¡ —¡æ—π∏å°—∫§«“¡μâÕß°“√.
ߢ≈“π§√‘π∑√凫™ “√.ªï∑’Ë 2551;26 :339-42.
10. ¡»—°¥‘Ï ‡∑’¬¡‡°à“ ·≈–§≥–: §«“¡√Ÿâ·≈–
∑—»π§μ‘¢Õßπ—°‡√’¬πª√–∂¡»÷°…“μàÕ‚√§≈¡
™—°. «“√ “√ª√– “∑«‘∑¬“»“ μ√å ¿“§μ–«—π
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ºŸâ∑’ˇªìπ‚√§≈¡™—°∑’Ë¡“√—∫°“√√—°…“∑’Ë·ºπ°
ºŸâªÉ«¬πÕ° ‚√ß欓∫“≈ «πª√ÿß.«“√ “√
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ª√–§ÕßμàÕ§«“¡√Ÿâ ÷°¡’§ÿ≥§à“„πμπ‡Õß·≈–
§«“¡‡™◊ËÕ¡—Ëπ„πμπ‡ÕߢÕß¡“√¥“∑’Ë¥Ÿ·≈∫ÿμ√
μ“¡≈”æ—ß.«‘∑¬“π‘æπ∏åª√‘≠≠“欓∫“≈
»“ μ√å¡À“∫—≥±‘μ ¡À“«‘∑¬“≈—¬¢Õπ·°àπ.
2541
17. I Garcia-Cabeza, Gonzalez de Chavez
M. Therapeutic factors and insight in
group therapy for outpatients diagnosed
with schizophrenia. Psychosis Journal
2009;1 :134:44.
18. Prager M, Nichols S, Schaffner B. Thera-
peutic factors in a support group for
non-IVDU HIV(+) women. International
Conference on AIDS 1992;8 : 226.
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience60
Topic Review
¿≠. ÿ¿‘≠≠“ μ—π쓪°ÿ≈ “¢“«‘™“‡¿ —™°√√¡ªØ‘∫—μ‘ §≥–‡¿ —™»“ μ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ
°“√„™â¬“ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π
‚√§ª«¥»’√…–‰¡‡°√π‡ªìπ‚√§∑’Ë¡’§«“¡
”§—≠‡π◊ËÕß®“°‡ªìπ‚√§∑’Ë àߺ≈„À⺟âªÉ«¬‡°‘¥¿“«–
∑ÿææ≈¿“æ∑—Ë«‚≈° ®“°√“¬ß“π¢Õß World Health
Organization (WHO) „πªï æ.».2544 æ∫«à“
‚√§ª«¥»’√…–‰¡‡°√π‡ªìπ‚√§∑’Ë∑”„À⺟âªÉ«¬‡°‘¥
¿“«–∑ÿææ≈¿“懪ìπ≈”¥—∫∑’Ë 19 ·≈–À“°®—¥
≈”¥—∫‡©æ“–‡æ»À≠‘ßæ∫«à“Õ¬Ÿà≈”¥—∫∑’Ë 121 ‚√§
ª«¥»’√…–‰¡‡°√π‡ªìπ‚√§∑“ß√–∫∫ª√– “∑∑’Ëæ∫
‰¥â∫àÕ¬æ∫√âÕ¬≈– 11 ¢Õߪ√–™“°√∑—Ë«‚≈°2 ‚¥¬
ºŸâªÉ«¬®–¡’Õ“°“√ª«¥»’√…–‡ªìπÊ À“¬Ê ´÷ËßÕ“°“√
ª«¥»’√…–Õ¬Ÿà„π√–¥—∫ª“π°≈“ß∂÷ß√ÿπ·√ß ¢≥–ª«¥
ºŸâªÉ«¬¡—°¡’Õ“°“√§≈◊Ëπ‰ âÀ√◊ÕÕ“‡®’¬π√à«¡°—∫¡’
Õ“°“√°≈—«· ß·≈–°≈—«‡ ’¬ß√à«¡¥â«¬ ·≈–Õ“®¡’
Õ“°“√°”‡√‘∫¡“°¢÷Èπ‡√◊ËÕ¬Ê∫“ߧπ¡’Õ“°“√¡“°®π
‡ªìπ‚√§ª«¥»’√…–‰¡‡°√π™π‘¥‡√◊ÈÕ√—ß3 ºŸâªÉ«¬‚√§
ª«¥»’√…–‰¡‡°√π∂÷ß√âÕ¬≈– 90 μâÕß∑π∑ÿ°¢å
∑√¡“π®“°Õ“°“√°”‡√‘∫ πÕ°®“°π’Ȭ—ß àߺ≈μàÕ
™’«‘μ§√Õ∫§√—«·≈– —ߧ¡ ‚¥¬ºŸâªÉ«¬ªÆ‘‡ ∏°“√∑”
°‘®°√√¡√à«¡°—∫§√Õ∫§√—«√âÕ¬≈– 1 ·≈–ªÆ‘‡ ∏
°“√‡¢â“√à«¡ —ߧ¡√âÕ¬≈– 304
¥—ßπ—Èπ°“√√—°…“®÷ß·∫àßÕÕ°‡ªìπ 2 ·π«∑“ß
¥â«¬°—π §◊Õ °“√√—°…“„π√–¬–‡©’¬∫æ≈—π·≈–°“√
ªÑÕß°—π ‚¥¬°“√√—°…“„π√–¬–‡©’¬∫æ≈—π¡’‡ªÑ“
À¡“¬„π°“√≈¥Õ“°“√ª«¥¢≥–¡’Õ“°“√‚¥¬¬“∑’Ë
„™â‡ªì𬓷°âμàÕ‰ªπ’Ȫ«¥5,6 ¥—ßμ“√“ß∑’Ë 1
61North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
μ“√“ß∑’Ë 1 ¬“∑’Ë„™â„π°“√√—°…“‚√§ª«¥»’√…–‰¡‡°√π√–¬–‡©’¬∫æ≈—πμ“¡·π«∑“ߢÕß The European
Federation of Neurological Societies (EFNS) 2009
Drug Daily dose(mg) Level of evidence
Analgesics
Acetylsalicylic acid (ASA) 1000 (oral, intravenous) A
ASA plus Paracetamol plus Caffeine 250 plus 200-250 plus 50 A
Ibuprofen 200-800 A
Naproxen 500-100 A
Diclofenac 50-100 A
Paracetamol 1000 (oral, suppository) A
Metamizol 1000 (oral, intravenous) B
Tolfenamic acid 200 B
Ergot alkaloids
Ergotamine plus Caffeine 0.5-2 plus 50-200 B
Triptans (5-HT 1B/D
-agonists)
Sumatriptan 25-100(oral), 25(suppository), A
10-20(Nasal spray), 6(subcutaneous)
Zolmitriptan 2.5-5 (oral, nasal spray) A
Naratriptan 2.5 A
Rizatriptan 10 A
Almotriptan 12.5 A
Triptans (5-HT 1B/D
-agonists)
Eletriptan 20-40 A
Frovatriptan 2.5 A
Antiemeitcs
Metroclopramide 10-20(oral), 20(suppository), B
10(intramuscular, intravenous,
subcutaneous)
Domperidone 20-30 B
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience62
°“√„™â¬“√—°…“„π√–¬–‡©’¬∫æ≈—π¬—ßæ∫
ªí≠À“§◊Õ ‡°‘¥Õ“°“√°≈—∫¡“„À¡à (recurrence)
À≈—ß®“°„™â¬“ ‡™àπ ºŸâªÉ«¬∑’ˉ¥â√—∫¬“ ergotamine
(ergotamine 2 mg plus caffeine 200 mg) ¡’
Õ“°“√°≈—∫¡“„À¡à√âÕ¬≈– 30 ¬“ sumatriptan
(100 mg) √âÕ¬≈– 41 À≈—ß®“°„™â¬“‰ª·≈â« 24
™—Ë«‚¡ß ºŸâªÉ«¬¡’°“√„™â¬“‡°‘π¢π“¥ ¡’ªí≠À“
§ÿ≥¿“æ™’«‘μμË” ‡™àπ μâÕߢ“¥ß“π ¢“¥‚√߇√’¬π ∑π
∑ÿ°∑√¡“π®“°Õ“°“√ª«¥ ¥—ßπ—Èπ®÷ß¡’°“√√—°…“
·∫∫ªÑÕß°—π‡æ◊ËÕ≈¥§«“¡∂’Ë„π°“√‡°‘¥Õ“°“√ª«¥
‡æ‘Ë¡§ÿ≥¿“æ™’«‘μ„À⺟âªÉ«¬ ≈¥ªí≠À“®“°°“√„™â¬“
‚¥¬¬“∑’Ë„™â„π°“√√—°…“ ¥—ßμ“√“ß∑’Ë 2
‡°≥±å„π°“√æ‘®“√≥“„™â¬“ªÑÕß°—π‚√§ª«¥
»’√…–‰¡‡°√πμ“¡·π«∑“ߢÕß The European
Federation of Neurological Societies (EFNS)
2009 ¡’¥—ßμàÕ‰ªπ’È
1. ¡’Õ“°“√ª«¥»’√…–μ—Èß·μà 2 §√—ÈßμàÕ‡¥◊Õπ
2. Õ“°“√ª«¥»’√…–¡’ªí≠À“μàÕ§ÿ≥¿“æ
™’«‘μÕ¬à“ß√ÿπ·√ߧ◊Õ ºŸâªÉ«¬μâÕߢ“¥ß“π ¢“¥
‚√߇√’¬π‡¡◊ËÕ¡’Õ“°“√ª«¥»’√…– ‡ªìπμâπ
3. ‰¡àμÕ∫ πÕßμàÕ°“√√—°…“„π°“√„™â¬“
√—°…“„π√–¬–‡©’¬∫æ≈—∫
4. ¡’Õ“°“√π”∫àÕ¬À√◊ÕÕ“°“√𔇪ìπ√–¬–
‡«≈“π“π
μ“√“ß∑’Ë 2 ¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√πμ“¡·π«∑“ߢÕß The European Federation of
Neurological Societies (EFNS) 2009
Drug Daily dose(mg) Level of evidence
Betablockers
Metoprolol 50-200 A
Propanolol 40-240 A
Bisopolol 5-10 B
Calcium channel blockers
Flunarizine 5-10 A
Antiepileptic drugs
Valproic acid 500-1800 A
Topiramate 25-100 A
Gabapentin 1200-1600 C
Non-steroidal anti inflammatory drugs
(NSAID)
Acetylsalicylic acid (ASA) 300 C
Naproxen 250-500 twice daily B
63North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
Drug Daily dose(mg) Level of evidence
Antidepressant
Amitriptyline 50-150 B
Venlafaxine 75-150 B
Miscellaneous drugs
Lisinopril 20 C
Candesartan 16 C
Coenzyme Q10 300 C
Riboflavin 400 C
Magnesium 24 mmol C
Methysergide 4-12 C
Tanacetum parthenium 6.25 mg twice daily C
®“°·π«∑“ß°“√√—°…“¢Õß The European
Federation of Neurological Societies (EFNS)
2009 ¬“∑’Ë„™â„π°“√√—°…“‡ªìπμ—«‡≈◊Õ°·√° (First-
line) §◊Õ propanolol, metoprolol, flunarizine,
valproic acid ·≈–topiramate ´÷Ëß¡’¢âÕ¡Ÿ≈
π—∫ πÿπ™—¥‡®π (°“√·π–π”„Àâ„™âÕ¬Ÿà„π√–¥—∫ A)
§◊Õ ¡’°“√»÷°…“πà“‡™◊ËÕ∂◊Õ π—∫ πÿπª√– ‘∑∏‘º≈
¢Õß°“√√—°…“·≈–§«“¡ª≈Õ¥¿—¬®“°°“√„™â¬“) ·≈–
ºŸâªÉ«¬∑’Ë¡’‚√§√à«¡Õ◊Ëπʧ«√®–¡’°“√‡≈◊Õ°¬“„Àâ
‡À¡“– ¡°—∫ºŸâªÉ«¬·μà≈–√“¬8 ´÷Ëß®–°≈à“«∂÷ß√“¬
≈–‡Õ’¬¥„π°≈ÿ࡬“∑’ˇªìπμ—«‡≈◊Õ°·√°
¬“°≈ÿà¡ Betablockers
¬“∑’Ë¡’°“√»÷°…“„πºŸâªÉ«¬‚√§ª«¥»’√…–
‰¡‡°√π¡’ propanolol, metoprolol, bisopolol,
timolol, atenolol ·μà∑’Ë¡’¢âÕ¡Ÿ≈ π—π πÿπ™—¥‡®π
§◊Õ propanolol ·≈– metoprolol ·μà°≈‰°°“√
ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π¬—߉¡à™—¥‡®π‚¥¬‡™◊ËÕ
«à“¬“Õ“®¡’º≈ block beta receptor ∑’Ë post-syn-
aptic receptor ¡’º≈∑”„À⇰‘¥‡ âπ‡≈◊Õ¥„π
¡ÕßÀ¥μ—« (vasoconstriction) ∑—Èß¡’º≈μàÕ√–∫∫
serotoninergic ·≈–Õ“®¡’º≈¬—∫¬—Èß°“√‡°‘¥
cortical spreading depression (CSD)11 à«π
¬“∑’ˇ¢â“ central nervous system (CNS) ‰¥â¥’
„π°≈ÿà¡π’ȧ◊Õ¬“∑’Ë¡’§ÿ≥ ¡∫—μ‘ lipophilic §◊Õ
Propanolol ·≈– Metoprolol §«√æ‘®“√≥“‡≈◊Õ°
„™â„πºŸâªÉ«¬∑’Ë¡’‚√§√à«¡ ‡™àπ hypertension,
angina, myocardial infarction, tremor,
anxiety À√◊Õ panic attacks ·≈–§«√À≈’°‡≈’ˬß
„πºŸâªÉ«¬ asthmas, COPD, depression,
congestive heart failure (unstable), hypoten-
sion, diabetes mellitus, peripheral vascular
disease, Raynaudûs disease ‡ªìπμâπ12 ¢π“¥
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience64
∑’Ë„™â„π°“√ªÑÕß°—π§◊Õ ¬“ propanolol 40-240 mg/
d metoprolol 50-200 mg/d ·μà°“√‡√‘Ë¡μâπ
¢π“¥¬“®–‡√‘Ë¡∑’Ë¢π“¥μË”°àÕπ·≈⫇æ‘Ë¡¢π“¥¬“®π
∂÷ß¢π“¥‡ªÑ“À¡“¬ (target dose)·≈–§«√ —߇°μ
º≈¢â“߇§’¬ß®“°¬“√à«¡¥â«¬„π°“√‡æ‘Ë¡¢π“¥¬“13
º≈¢â“߇§’¬ß¢Õ߬“°≈ÿà¡π’È §◊Õ depression,
fatigue, reduced tolerance for physical
activity, Impotence, bronchospam, nausea,
dizziness ·≈–insomnia
¬“°≈ÿà¡ Calcium channel blockers
Flunarizine ‡ªìπ¬“∑’Ë¡’°“√»÷°…“ π—∫ πÿπ
™—¥‡®π„π°“√„™âªÑÕß°—π°“√‡°‘¥‚√§ª«¥»’√…–
‰¡‡°√π ·≈–‡ªì𬓄π°≈ÿà¡ calcium channel
blockers ∑’ËÕ¬Ÿà„π·π«∑“ß°“√ªÑÕß°—π‚√§ª«¥
»’√…–‰¡‡°√π¢Õß EFNS 2009 ·¡â¬“‰¡à¡’
®”Àπà“¬„π∑âÕßμ≈“¥ª√–‡∑» À√—∞Õ‡¡√‘°“·μà®–
æ∫°“√„™âÕ¬à“ß·æ√àÀ≈“¬„πª√–‡∑»∑“߬ÿ‚√ª ≈–
μ‘πÕ‡¡√‘°“ ·≈–‡Õ‡™’¬14 °≈‰°„π°“√ÕÕ°ƒ∑∏‘Ï
¢Õ߬“§◊Õ¬—∫¬—Èß calcium channel ´÷ËßÕ“®¡’º≈
„π°“√¬—∫¬—Èß°“√‡°‘¥ CSD15 ¬“§«√æ‘®“√≥“‡≈◊Õ°
„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡ ‡™àπ dizziness,
vertigo ·≈–§«√À≈’°‡≈’ˬ߄πºŸâªÉ«¬‚√§
Parkinsonûs disease, depression ‡ªìπμâπ ∑’Ë
‚¥¬¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–
‰¡‡°√π §◊Õ 5-10 mg/d §«√‡√‘Ë¡®“°¢π“¥μË”
°àÕπ·≈⫧àլʇæ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß¢π“¥‡ªÑ“
À¡“¬√à«¡°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“ à«π¬“
Calcium channel blockers Õ◊ËπÊ∑’Ë¡’°“√„™â
ªÑÕß°—π„π‚√§ª«¥»’√…–‰¡‡°√π §◊Õ verapamil
¢π“¥ 240-480 mg/d, nimodipine 120 mg/d,
ditiazem 120-160 mg/d ·≈–¡’°“√»÷°…“°“√„™â
¬“°≈ÿà¡ calcium channel blockers μ—«„À¡à¡“
„™â„π°“√ªÑÕß°—𠇙àπ isradipine10,13
º≈¢â“߇§’¬ß¢Õß flunarizine §◊Õ depres-
sion, weight gain, parkinsonism º≈¢â“߇§’¬ß
¢Õ߬“ verapamil, nimodipine, ditiazem §◊Õ
constipation (‚¥¬‡©æ“– verapamil), dizzi-
ness, hypotension, peripheral edema,
weight gain
¬“°≈ÿà¡ Antiepileptic
Valproic acid ‡ªìπ¬“∑’Ë¡’¢âÕ¡Ÿ≈™—¥‡®π„π
°“√„™â¬“ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π ‚¥¬
valproic acid ¡’º≈„π°“√¬—∫¬—Èß°“√‡°‘¥ cortical
spreading depression (CSD) ‡æ‘Ë¡ gamma-
aminobutyric acid (GABA) ¬—∫¬—Èß glutamate,
calcium channel „π ¡Õß ·≈–Õ“®¬—∫¬—Èß sero-
tonergic „π∫√‘‡«≥ dorsal raphe nuclei9,11,15
¬“§«√æ‘®“√≥“‡≈◊Õ°„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡
‡™àπ epilepsy, mania, anxiety ·≈–§«√À≈’°
‡≈’ˬ߄πºŸâªÉ«¬‚√§ liver disease, bleeding dis-
orders ‡ªìπμâπ ¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§
ª«¥»’√…–‰¡‡°√π §◊Õ 500-1800 mg/d §«√‡√‘Ë¡
®“°¢π“¥μË”°àÕπ·≈⫧àլʇæ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß
¢π“¥‡ªÑ“À¡“¬√à«¡°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“
Topiramate ‡ªì𬓠antiepileptic °≈ÿà¡
„À¡à∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π
¬“ÕÕ°ƒ∑∏‘Ϭ—∫¬—Èß glutamate, sodium channel,
L-type calcium channel ‡æ‘Ë¡ GABA ¬—∫¬—Èß
65North-Eastern Thai Journalof Neuroscience
Vol.5 No.2
°“√‡°‘¥ CSD„π ¡Õß 1,9,11,15 ¬“§«√æ‘®“√≥“
‡≈◊Õ°„™â„πºŸâªÉ«¬∑—Ë«‰ªÀ√◊Õ¡’‚√§√à«¡ ‡™àπ epilepsy,
mania, anxiety, essential tremor, overweigh
·≈–§«√À≈’°‡≈’ˬ߄πºŸâªÉ«¬‚√§ kidney stone
¢π“¥¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π
§◊Õ 50-100 mg/d §«√‡√‘Ë¡®“°¢π“¥μË”°àÕπ·≈â«
§àÕ¬Ê ‡æ‘Ë¡¢π“¥¬“¢÷Èπ®π∂÷ß¢π“¥‡ªÑ“À¡“¬√à«¡
°—∫ —߇°μº≈¢â“߇§’¬ß®“°¬“
º≈¢â“߇§’¬ß¢Õß valproic acid §◊Õ weight
gain, tremor à«π topiramate §◊Õ weight loss,
parethesia, cognitive effect, kidney stone
μ“√“ß∑’Ë 3 ¬“∑’Ë„™â„π°“√ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π‡ªìπμ—«‡≈◊Õ°·√°μ“¡ EFNS 2009
Flunarizine 5 mg Oral hs ‡æ‘Ë¡ 5 mg /2 weeks Parkinson, depression, Depression, weight
(target & max dose other extrapyramidal gain
10 mg)
Propranolol 40 mg Oral OD ‡æ‘Ë¡ 40 mg/week Asthma, COPD, Depression, fatigue,
(target dose 120 mg, depression, congestive bradycardia
max 240 mg) heart failure (unstable),
hypotension, diabetes
mellitus, peripheral
vascular disease,
Raynaudûs disease
Metoprolol 50 mg Oral OD ‡æ‘Ë¡ 50 mg/week Asthma, COPD, Depression, fatigue,
(target dose 100 mg, depression,congestive bradycardia
max 200 mg) heart failure (unstable)
hypotension, diabetes
mellitus, peripheral
vascular disease,
Raynaudûs disease
Topiramate 50 mg Oral OD ‡æ‘Ë¡ 50 mg/week Kidney stone Weight loss, parethesia,
(target & max dose cognitive effect,
100 mg) kidney stone
Valproic acid 500 mg Oral OD ‡æ‘Ë¡ 500 mg/week Liver disease,bleeding Weight gain, tremor
(target dose 1000 mg, disorders
max 1800mg)
¬“ ¢π“¥¬“‡√‘Ë¡μâπ °“√ª√—∫¢π“¥¬“ ¢âÕ§«√À≈’°‡≈’ˬß
„π°“√„™â¬“º≈¢â“߇§’¬ß¢Õ߬“
Vol.5 No.2
North-Eastern Thai Journalof Neuroscience66
√ÿª°“√„™â¬“√—°…“‚√§ª«¥‰¡‡°√π§«√‡≈◊Õ°„Àâ
‡À¡“– ¡°—∫Õ“°“√¢ÕߺŸâªÉ«¬ À“°ºŸâªÉ«¬∑’Ë¡’
Õ“°“√∫àÕ¬·≈– àߺ≈μàÕ™’«‘μª√–®”«—π °“√∑”ß“π
§«√æ‘®“√≥“„À⬓ªÑÕß°—π‚√§ª«¥»’√…–‰¡‡°√π
‡æ◊ËÕ‡æ‘Ë¡§ÿ≥¿“æ™’«‘μ·≈–≈¥ªí≠À“®“°°“√„™â¬“
„π√–¬–‡©’¬∫æ≈—π ‚¥¬§«√§”π÷ß∂÷ßÕ“°“√·≈–
‚√§√à«¡Õ◊ËπÊ¢ÕߺŸâªÉ«¬ π—∫ πÿπ°“√‡≈◊Õ°„™â¬“
‡Õ° “√Õâ“ßÕ‘ß1. World Health Organization. The world
health report 2001, Chapter 2. Geneva:
WHO 2001. Available at http://
www.who.int/whr/2001/en/index.html.
Accessed 12 June 2009.
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The global burden of headache: a docu-
mentation of headache prevalence and
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27:193-210.
3. Buse DC, Rupnow MFT, Lipton RB.
Assessing and managing all aspects
of migraine: migraine attacks, migraine-
related functional impairment, common
comorbidities, and quality of life. Mayo
Clin Proc 2009;84:422-35.
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