Hu X Henry, Ng-Mak Daisy, Cady Roger
Global Outcomes Research, Global Human Health, Merck & Co., Inc., Whitehouse Station, NJ, USA.
Headache. 2008 Jun;48(6):914-20. doi: 10.1111/j.1526-4610.2007.00955.x. Epub 2007 Nov 13.
To explore whether early treatment would shorten the duration of headache from headache onset to its peak and reduce headache severity at peak.
Prior clinical studies almost exclusively focused on headache relief after dosing. No data are available on whether early intervention affects the duration from headache onset to peak and headache severity at peak.
Adult migraineurs were enrolled in this observational study from multi-site headache clinics. Patients recorded their migraine experiences via an electronic diary over 1 month. Patients reported the time and pain severity at onset, dosing, and peak. We used a linear mixed model to evaluate the impact of the timing of treatment and to adjust for covariates and correlation of observations within subjects.
A total of 182 patients reported 970 migraine episodes, 620 of which were treated before headaches progressed to peak. Mean time from headache onset to peak varied from 1.9 hours to 8.9 hours for patients treated within 15 minutes of onset and those who waited for 4 or more hours, respectively. However, early intervention was not associated with reduced headache severity at peak. In multivariate analysis, early treatment, use of triptans, and mild migraine headache in the past 3 months were significantly associated with shorter time from onset to headache peak. A separate model indicated that the timing of medication was not associated with the duration between dosing and headache peak, but use of triptans shortened the time from dosing to headache peak.
Early treatment and use of triptans may lead to shorter duration from migraine headache onset to its peak but did not alleviate headache severity at peak. This could result in decreased migraine burden by reducing total migraine headache duration.
探讨早期治疗是否会缩短从头痛发作到高峰的持续时间，并降低高峰时的头痛严重程度。
既往临床研究几乎都只关注给药后的头痛缓解情况。尚无关于早期干预是否会影响从头痛发作到高峰的持续时间以及高峰时头痛严重程度的数据。
从多个头痛诊所招募成年偏头痛患者参与这项观察性研究。患者通过电子日记记录其1个月内的偏头痛经历。患者报告头痛发作、给药和达到高峰时的时间及疼痛严重程度。我们使用线性混合模型来评估治疗时机的影响，并对协变量以及受试者内观察值的相关性进行校正。
共有182例患者报告了970次偏头痛发作，其中620次发作在头痛进展至高峰前接受了治疗。对于在发作后15分钟内接受治疗的患者和等待4小时或更长时间的患者，从头痛发作到高峰的平均时间分别为1.9小时至8.9小时。然而，早期干预与高峰时头痛严重程度的降低无关。在多变量分析中，早期治疗、使用曲坦类药物以及过去3个月内的轻度偏头痛与从发作到头痛高峰的时间缩短显著相关。一个单独的模型表明，给药时机与给药至头痛高峰的持续时间无关，但使用曲坦类药物缩短了从给药到头痛高峰的时间。
早期治疗和使用曲坦类药物可能会缩短偏头痛从发作到高峰的持续时间，但不会减轻高峰时的头痛严重程度。这可能会通过缩短偏头痛的总持续时间来减轻偏头痛负担。
