Tepper Stewart J, Bigal Marcelo E, Sheftell Fred D, Rapoport Alan M
The New England Center for Headache, Stamford, CT 06902, USA.
Headache. 2004 Sep;44(8):794-800. doi: 10.1111/j.1526-4610.2004.04147.x.
To review the efficacy of botulinum neurotoxin type A (BoNT-A) in the preventive treatment of refractory headache.
Even after receiving expert care, some patients with refractory headache continue to have high disability and persistent headaches.
Clinical records and headache calendars of 100 patients fulfilling the following inclusion criteria were reviewed: (1) age from 18 to 65 years; (2) primary headache with previous failure of at least four preventive treatments; and (3) have received BoNT-A and have been followed for at least 6 months after the BoNT-A injections. BoNT-A (100 units) was diluted in 4-cc normal saline. The muscles injected included some or all of the following: frontalis, temporalis, corrugator, procerus, occipitalis, semispinalis, splenius capitis, trapezius, cervical paraspinalis, and sternocleidomastoid. Migraine-related disability was assessed using the Migraine Disability Assessment (MIDAS) questionnaire.
There was a statistically significant reduction of the frequency of headache days 1 month after BoNT-A was administered (14.2 vs 28.2 days at the baseline, P <.001), which was maintained through the 3 months of study; similarly, a significant reduction in the headache index (22.3 vs 40.3, P <.001) and number of severe days with headache per month (2.6 vs 7.4, P <.001) were found at 1 month and maintained through the 3 months of study. MIDAS scores were reduced from 34.5 at baseline to 15.9 at 3 months (P <.001). A similar pattern was found in those overusing versus nonoverusing acute medication, though the response was more dramatic in the nonoverusing subgroup.
BoNT-A may play a role in the preventive treatment of refractory headache. A significant number of patients showed decrease in clinically important measurements of their headaches as well as reduced headache-related disability with this treatment. Prospective, controlled studies must be considered for severely disabled, refractory patients.
回顾A型肉毒杆菌神经毒素（BoNT-A）在难治性头痛预防性治疗中的疗效。
即使接受了专家护理，一些难治性头痛患者仍有高度残疾和持续性头痛。
回顾了100例符合以下纳入标准患者的临床记录和头痛日历：（1）年龄18至65岁；（2）原发性头痛，之前至少四种预防性治疗失败；（3）接受过BoNT-A治疗，且在BoNT-A注射后至少随访6个月。将BoNT-A（100单位）用4毫升生理盐水稀释。注射的肌肉包括以下部分或全部：额肌、颞肌、皱眉肌、降眉间肌、枕肌、半棘肌、头夹肌、斜方肌、颈旁脊柱肌和胸锁乳突肌。使用偏头痛残疾评估（MIDAS）问卷评估与偏头痛相关的残疾情况。
在注射BoNT-A后1个月，头痛天数频率有统计学显著降低（基线时为28.2天，1个月后为14.2天，P<.001），并在3个月的研究中持续；同样，在1个月时头痛指数（22.3对40.3，P<.001）和每月严重头痛天数（2.6对7.4，P<.001）有显著降低，并在3个月的研究中持续。MIDAS评分从基线时的34.5降至3个月时的15.9（P<.001）。在过度使用与未过度使用急性药物的患者中发现了类似模式，尽管未过度使用亚组的反应更显著。
BoNT-A可能在难治性头痛的预防性治疗中起作用。大量患者在接受这种治疗后，头痛的临床重要指标有所下降，与头痛相关的残疾也有所减轻。对于严重残疾的难治性患者，必须考虑进行前瞻性对照研究。
