A型肉毒毒素注射联合红外偏振光治疗慢性偏头痛的疗效观察

The effect of botulinum toxin type A combined with infrared polarized light for the treatment of chronic migraine

目的探讨彩超水囊引导下A型肉毒毒素注射联合红外偏振光治疗慢性偏头痛的临床价值。方法选取91例慢性偏头痛患者，按随机数字表法分为4组：对照组（A组，共22例）应用尼莫地平片治疗慢性偏头痛2个月；红外偏振光治疗组（B组，共22例）应用红外偏振光治疗慢性偏头痛，共治疗50～60d；肉毒素治疗组（C组，共24例）应用彩超水囊引导下额肌、颞肌及枕肌等肌肉A型肉毒毒素肌肉注射治疗慢性偏头痛；联合治疗组（D组，共23例）同时应用彩超水囊引导下额肌、颞肌及枕肌等肌肉A型肉毒毒素肌肉注射联合红外偏振光治疗慢性偏头痛，红外偏振光治疗50—60d。研究时间持续6个月，调查每例慢性偏头痛患者治疗前3个月、治疗后1、3和6个月头痛发作情况，行偏头痛残疾程度评估问卷（MIDAS）评分及生活质量评价量表评分，比较慢性偏头痛发作频率、发作持续时间、发作严重程度、使用止痛药物情况及其慢性偏头痛恢复状况，并观察其不良反应。结果治疗中脱失11例，A组3例，B组2例，C组4例，D组2例。A组、B组与C组及D组治疗后1、3和6个月后偏头痛残疾程度评估问卷评分显著低于治疗前评分，差异有统计学意义（P〈0．01）；生活质量评价量表评分显著高于治疗前评分，差异有统计学意义（P〈0．01）。D组在治疗后1、3和6个月，MIDAS评分及生活质量评价量表评分与A组、B组与C组治疗后1、3和6个月比较，差异有统计意义（P〈0．05）。2例出现头昏，未予任何处理均在2周后消失，21例患者注射后额纹、鱼尾纹不同程度变浅或消失。结论彩超水囊引导下A型肉毒毒素肌肉注射联合红外偏振光治疗慢性偏头痛发作临床疗效显著，不良反应轻微，值得临床推广。

Objective To observe the clinical efficacy and safety of local injection of botulinum toxin A （BTX-A） combined with infrared polarized light for patients with chronic migraine （CM）. Methods Ninety-one patients with CM were randomly divided into 4 groups. Group A served as the control group in which Nimodipine was used to treat CM （ n = 22） ; in group B infrared polarized light was used to irradiate the area of the CM for 50 to 60 d （ n = 22 ） ; in group C subcutaneous injections of BTX-A were used （ n = 24） ; and in group D infrared polarized light irradiation of the affected area was combined with subcutaneous injections of BTX-A （ n = 23 ）. The onset of headaches, their severity, quality of life, as well as side effects were recorded using the migraine disability assessment scale （MIDAS） and the short form of the medical outcomes study form （MOS-SF）. The results obtained before and after 6 months of treatment were compared. Results Both of MIDAS and MOS-SF assessment showed significant differences before treatment and after 1 , 3 and 6 months of treatment in all groups. After 1, 3 and 6 months of treatment, the MIDSA and MOS-SF results revealed statistically significant differences between groups A and D, as well as between groups B and C. Conclusion BTX-A injection combined with infrared polarized light exerts significant therapeutic effects on CM with few side effects.