Usai S, Grazzi L, Andrasik F, D'Amico D, Rigamonti A, Bussone G
Headache Centre, National Neurological Institute C. Besta, Via Celoria 11, I-20133 Milan, Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S272-3. doi: 10.1007/s10072-004-0306-4.
Patients with chronic migraine and medication overuse are particularly difficult to treat. No clear consensus exists about treatment strategies to be used and little data exists about the functional impact of headache in these patients. The purpose of the study was to determine (1) the clinical course of a sample of chronic migraine patients with medication overuse 36 months following treatment intervention and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. Of 106 patients meeting the criteria for chronic migraine with medication overuse (according to Silberstein and Lipton), 71 went on to complete a structured inpatient treatment, consisting of medication withdrawal and then prophylactic treatment. As a group, the patients were significantly improved at 36-month follow-up, with respect to 2 headache parameters (days of headache per month and number of used medications per month assessed by the diary card) and 2 measures of functional impact extracted from the MIDAS questionnaire (MIDAS total score and frequency of headache). Chronic migraine accompanied with medication overuse led to considerable disability prior to treatment. However, notable improvement both in headache parameters and in disability measures occurred concurrently with treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used as an outcome measure in patients with chronic headache to assess disability during such a long follow-up period.
慢性偏头痛且药物过度使用的患者尤其难以治疗。对于应采用的治疗策略尚无明确共识，且关于这些患者头痛对功能的影响的数据也很少。本研究的目的是确定：（1）治疗干预36个月后，慢性偏头痛且药物过度使用患者样本的临床病程；（2）通过偏头痛残疾评估（MIDAS）问卷评估的功能损害在治疗后是否有所改善。在106名符合慢性偏头痛且药物过度使用标准（根据西尔伯斯坦和利普顿的标准）的患者中，71名继续完成了结构化的住院治疗，包括药物戒断，然后进行预防性治疗。作为一个群体，患者在36个月随访时，在2个头痛参数（每月头痛天数和通过日记卡评估的每月用药数量）以及从MIDAS问卷中提取的2个功能影响指标（MIDAS总分和头痛频率）方面有显著改善。慢性偏头痛伴药物过度使用在治疗前导致了相当大的残疾。然而，头痛参数和残疾指标在治疗的同时都有显著改善。这表明成功的治疗除了单纯减轻症状外，还有更广泛的积极益处。据我们所知，这是首次将MIDAS问卷用作慢性头痛患者的结局指标，以评估如此长时间随访期间的残疾情况。
