不同药物联合治疗药物过度使用性头痛的疗效及安全性

The safety and efficacy of different combined therapy in treatment of medication-overuse headache

目的观察药物过度使用性头痛(medication overuse headache,MOH)的临床特征及不同药物联合治疗MOH的疗效及安全性。方法对头痛门诊序贯就诊的480例偏头痛患者详细采集病史,筛选很可能的MOH患者,与周期性发作偏头痛患者比较其临床特征,并行偏头痛残疾程度评估问卷(migraine disabilityassessment questionnaire,MIDAS)调查。对所有MOH患者强烈建议停用各种止痛剂,随机分组分别给予盐酸氟桂利嗪+普萘洛尔(Ⅰ组)或托吡酯+阿米替林(Ⅱ组)治疗,疗程3个月。观察两组治疗转归及不良反应发生率。结果 46例为很可能的MOH。MOH组起病年龄与周期性偏头痛组无明显差异(30.2±9.3岁;31.1±9.5岁)(P>0.05)。MOH组头痛家族史比例(67.4%)稍高于周期性偏头痛组(54.9%)(P>0.05),MOH组服用复方止痛药及中重度残疾的比例均显著高于周期性偏头痛组(分别为89.1%与39.3%;76.1%与19.5%)(P均<0.001)。治疗3个月后,Ⅰ组与Ⅱ组服用止痛药的比例为10.5%与10.0%,每月头痛天数为(3.21±0.85)d与(3.05±0.83)d,MIDAS总分(19.70±7.00)与(18.30±6.77),不良反应发生率分别为10.5%(Ⅰ组)与10.0%(Ⅱ组),两组间均无统计学差异(P>0.05)。结论有头痛家族史长期频繁使用复方止痛剂更易导致MOH,造成残疾。撤用止痛剂,盐酸氟桂利嗪+普萘洛尔或托吡酯+阿米替林均可明显缓解症状,耐受性好,值得临床推广。

Objective To examine the clinical features of medication overuse headache （MOH） and evaluate the safety and efficacy of different combined therapy in treatment of medication-overuse headache. Methods The clinical data was collected in 480 sequential treatment migraine patients at the headache clinic in our hospital, the general criteria of MOH was used to screen the probable MOH. The clinical features of MOH were compared with those of age- and gender-matched periodic migraine patients. The migraine disability assessment questionnaire scores（MIDAS） were compared between two groups. All MOH patients were strongly recommended to withdraw from overused analgesics. MOH patients were then randomly divided into two groups receiving either lunarizine and propra- nolol （group Ⅱ ） or topiramate and amitriptyline （groupⅡ ） for three months, respectively The outcome of therapy and incidence of adverse events were compared between these two groups. Results Forty six probable MOH patientswere identified. There was no significant difference in age of onset between MOH group and periodic migraine group （30.2 ± 9.3 vs 31.1 ± 9.5）（P 〉 0.05）. The proportion of positive family history of headache was slightly higher in MOH group than in periodic migraine group （67.4% vs 54.9%） （P 〉 0.05）. The proportion of taking combined anal- gesics and the incidence of moderate to severe disability were significantly higher in MOH patients than in periodic migraine group （89.1% vs 39.3% and 76.1% vs 19.5%） （P 〈 0.001, respectively）. After three months treatment,there were no significant differences in the taking analgesics （10.5% vs 10.0%）, days with headache every month （3.21 ± 0.85 vs 3.05 ± 0.83） and MIDAS （19.70 ±7.00 vs 18.30 ± 6.77） （P 〉 0.05, respectively） between group I and group Ⅱ. The incidence of adverse events was not significantly different between group Ⅰ and group Ⅱ （10.5% in group I and 10.0% in group Ⅱ , P 〉 0.05）. Conclusions The patients with headache family history and long-term frequently use of combined analgesics are prone to MOH and disability. Withdrawal of analgesics and com- bination therapy of either flunarizine plus propranolol or topiramate plus amitriptyline can markedly relieve the symp- toms of MOH patients with good tolerance, which should be recommended in the clinical practice.