Department of Psychology, University of West Florida, Pensacola, FL 32514, USA.
Cephalalgia. 2010 May;30(5):610-4. doi: 10.1111/j.1468-2982.2009.01932.x. Epub 2010 Feb 15.
Chronic migraine accompanied by medication overuse is particularly difficult to treat. The number of treatment investigations is limited, few have included follow-up beyond 6 months and almost none has examined whether treatment leads to concurrent improvements in disability and functional impairment. This open-label study addresses these limitations. We have been prospectively following an initial cohort of 84 chronic migraine patients with medication overuse, who at the time of this evaluation had been reduced to 58, for an extended period to assess longer-term maintenance of effects, using measurement procedures identical to those in the original investigation. Thus, the specific aim was to determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated and followed prospectively for 5 years. All patients completed a brief inpatient treatment programme, in which they were withdrawn from their offending medications and subsequently placed on more appropriate preventive antimigraine medications. Both end-point, wherein missing data points were estimated, and continuer analyses, wherein data analysis was limited to the 58 individuals with complete datasets, revealed significant improvement on all measures studied-headache days per month, analgesic consumption and Migraine Disability Assessment (MIDAS) total score. The percentage reduction from baseline to 5 years for the MIDAS total score was 76.0%, while the percentage of individuals revealing improvements of clinically significant magnitude (≥ 50%) on the MIDAS was 91.9%. MIDAS total scores were lower at 5 years than at some of the intervening follow-up intervals. Comparisons of those who completed the 5-year follow-up (n = 58) with those who did not revealed no differences at baseline. This finding, coupled with the nearly identical results for the end-point and continuers analyses, suggests that attrition did not have a bearing on outcome. None of the patients completing the 5-year follow-up had relapsed since the prior 3-year follow-up assessment. High levels of maintenance were revealed at 5 years, with disability scores showing some continued improvement over time. The implications of these findings and the limitations of the study are discussed.
慢性偏头痛伴药物过度使用尤其难以治疗。治疗研究的数量有限，很少有研究随访时间超过 6 个月，几乎没有研究检查治疗是否会同时改善残疾和功能障碍。这项开放标签研究解决了这些限制。我们一直在前瞻性地跟踪最初的 84 名慢性偏头痛伴药物过度使用的患者，在本次评估时，这些患者已减少到 58 名，以评估长期维持效果，使用与原始研究相同的测量程序。因此，具体目的是确定经过前瞻性治疗和随访 5 年的慢性偏头痛伴药物过度使用患者的临床状况，就疼痛指数和残疾程度而言。所有患者均完成了简短的住院治疗计划，在此期间，他们停止使用引起问题的药物，随后使用更合适的预防性抗偏头痛药物。终点分析（其中缺失数据点被估计）和继续分析（其中数据分析仅限于具有完整数据集的 58 名个体）均显示所有研究指标均有显著改善-每月头痛天数、镇痛药消耗和偏头痛残疾评估（MIDAS）总分。从基线到 5 年的 MIDAS 总分的百分比降低为 76.0%，而 MIDAS 总分显示临床显著改善（≥50%）的个体比例为 91.9%。5 年后的 MIDAS 总分低于一些随访间隔的分数。与未完成 5 年随访的患者（n=58）相比，完成 5 年随访的患者在基线时没有差异。这一发现，加上终点和继续分析的几乎相同结果，表明流失对结果没有影响。完成 5 年随访的患者中，自上次 3 年随访评估以来，没有复发。5 年后仍显示出较高的维持水平，残疾评分随着时间的推移继续有所改善。讨论了这些发现的意义和研究的局限性。
