Rapoport Alan M, Bigal Marcelo E, Volcy Michel, Sheftell Fred D, Feleppa Michele, Tepper Stewart J
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Headache. 2003 May;43(5):482-9. doi: 10.1046/j.1526-4610.2003.03094.x.
To review the efficacy of naratriptan as preventive treatment in 27 patients with chronic migraine refractory to other commonly used preventive therapies.
The treatment of chronic migraine often poses a major challenge to the clinician. Even when given expert care, patients with chronic migraine may continue to have daily or near-daily headaches.
Clinical records and headache calendars were reviewed of 27 patients fulfilling the following inclusion criteria: (1) aged 18 to 65 years; (2) diagnosis of chronic migraine (formerly transformed migraine), according to the criteria proposed by Silberstein et al; (3) previous failure of at least 4 preventive medications prescribed as part of a management program that included nonpharmacological measures, preventive medication, acute care medication, and detoxification from overused medication; and (4) have used daily naratriptan for no less than 2 consecutive months. The dose of naratriptan prescribed was 2.5 mg twice daily. We considered the following outcomes: (1) frequency of headache, (2) intensity of pain, (3) number of days per month with severe headache, (4) headache index (frequency times intensity), and (5) proportion of patients who reverted to an episodic pattern of pain after 6 months of treatment.
There was a statistically significant reduction in the frequency of headache days 2 months (15.3 days versus 24.1 days at baseline, P<.001), 6 months (9.1 days, P<.001), and 1 year (7.3 days, P<.001) after daily treatment with naratriptan was initiated. There was also a statistically significant reduction in the number of days per month of severe pain at 1 month (5.6 days versus 12.5 days at baseline, P<.01), 2 months (5.7 days, P<.01), 6 months (2.8 days, P<.01), and 1 year (2.6 days, P<.01). Similarly, there was a statistically significant reduction in the headache index at 2 months (33 versus 56.4 at baseline, P<.001), 6 months (19.5, P<.001), and 1 year (17.2, P<.001). Of the 20 patients who continued to use naratriptan daily for at least 6 months, 13 (65%) reverted to an episodic pattern of pain (migraine). At 1 year, 11 (55%) still continued to experience episodic headache, 1 (5%) relapsed to chronic migraine, and 2 (10%) were lost to follow-up. No patients had intolerability to naratriptan during the treatment period, and no one stopped treatment due to adverse events.
Naratriptan may have a role in the preventive treatment of intractable chronic migraine. Prospective, controlled studies should be considered.
回顾那拉曲普坦作为预防性治疗药物，用于27例对其他常用预防性治疗无效的慢性偏头痛患者的疗效。
慢性偏头痛的治疗常常给临床医生带来重大挑战。即便接受了专业护理，慢性偏头痛患者仍可能每日或几乎每日都头痛。
回顾了27例符合以下纳入标准患者的临床记录和头痛日历：（1）年龄在18至65岁之间；（2）根据西尔伯斯坦等人提出的标准，诊断为慢性偏头痛（原转变型偏头痛）；（3）作为管理方案一部分的至少4种预防性药物治疗失败，该管理方案包括非药物措施、预防性用药、急性护理用药以及停用过度使用的药物；（4）连续每日使用那拉曲普坦不少于2个月。那拉曲普坦的处方剂量为每日2次，每次2.5毫克。我们评估了以下结果：（1）头痛频率；（2）疼痛强度；（3）每月重度头痛天数；（4）头痛指数（频率乘以强度）；（5）治疗6个月后恢复为发作性疼痛模式的患者比例。
开始每日使用那拉曲普坦治疗后，2个月（15.3天对比基线时的24.1天，P<0.001）、6个月（9.1天，P<0.001）和1年（7.3天，P<0.001）时，头痛天数频率有统计学显著降低。1个月（5.6天对比基线时的12.5天，P<0.01）、2个月（5.7天，P<0.01）、6个月（2.8天，P<0.01）和1年（2.6天，P<0.01）时，每月重度疼痛天数也有统计学显著降低。同样，2个月（33对比基线时的56.4，P<0.001）、6个月（19.5，P<0.001）和1年（17.2，P<0.001）时，头痛指数有统计学显著降低。在20例继续每日使用那拉曲普坦至少6个月的患者中，13例（65%）恢复为发作性疼痛模式（偏头痛）。1年时，11例（55%）仍继续经历发作性头痛，1例（5%）复发为慢性偏头痛模式，2例（10%）失访。治疗期间无患者对那拉曲普坦不耐受，也无人因不良事件停药。
那拉曲普坦可能在难治性慢性偏头痛的预防性治疗中发挥作用。应考虑开展前瞻性对照研究。
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