阿米替林联合阿普唑仑治疗偏头痛伴失眠疗效观察

目的观察阿米替林联合阿普唑仑治疗偏头痛伴失眠患者的疗效。方法将113例符合2013年国际头痛协会（第三版）（ICHD-3）的头痛分类标准中有先兆的偏头痛或无先兆偏头痛的诊断及匹兹堡睡眠质量指数（PSQI）评分≥8分的患者随机分为3组，治疗1组予以阿米替kg25mg/次，早晚各1次，阿普唑仑O．4mg，每晚睡前1次；治疗2组给予阿米替林25mg／次，早晚各1次；对照组仅早晚各给予1粒淀粉胶囊，观察治疗后4周及8周后头痛及睡眠改善情况。结果治疗组在治疗4周及8周后，头痛发作频率、持续时间、严重程度及入睡潜伏期、总睡眠时间均有所改善，相比治疗2组，治疗1组改善更明显，差异有统计学意义（P〈0．01）；而对照组无任何改善。结论无论是单用阿米替林还是联合使用阿普唑仑，对偏头痛伴失眠患者的头痛症状均有改善，但联合用药效果更佳，提示治疗偏头痛伴随的失眠症状是加快缓解偏头痛症状的一个重要潜在途径。

Objective To investigate the clinical curative effect of amitriptyline combined with alprazolam in the treatment of migraine associated with insomnia. Methods In the study, 113 subjects with IHS-III migraine with and/or without aura and with insomnia were randomly divided into three groups, the first treatment group were treated with 25 mg amitriptyline （ in the morning and evening ） and 0.4mg alprazolam at bedtime, the second treatment group were treated with 25 mg amitriptyline （ in the morning and evening ） , the control group were treated with starch capsule and then the headaches and sleep condition were followed up during the 4-week treatment period and 8-week treatment period. Results The two treatment groups all had a improvement in the headache frequency, duration, intensity and total sleep time, sleep latency during the 4-week and 8-week treatment period, compared with the second treatment group, aforementioned variables improved more obvious in the first treatment group and had a significant statistical differences （ P〈0.01 ） , headaches and insomnia condition had any improvement in the control group. Conclusions Either only amitriptyline or amitriptyline combined with alprazolam can relieve the headaches and insomnia, yet combination medication has a better curative effect. Improving the sleep condition may be a potential way to relieve migraine condition.