Probyn Katrin, Bowers Hannah, Caldwell Fiona, Mistry Dipesh, Underwood Martin, Matharu Manjit, Pincus Tamar
From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Neurology. 2017 Jul 18;89(3):291-301. doi: 10.1212/WNL.0000000000004112. Epub 2017 Jun 14.
To identify predictors of prognosis and trial outcomes in prospective studies of people with chronic headache.
This was a systematic review of published literature in peer-reviewed journals We included (1) randomized controlled trials (RCTs) of interventions for chronic headache that reported subgroup analyses and (2) prospective cohort studies, published in English, since 1980. Participants included adults with chronic headache (including chronic headache, chronic migraine, and chronic tension-type headache with or without medication overuse headache). We searched key databases using free text and MeSH terms. Two reviewers independently extracted data and assessed the methodologic quality of studies and overall quality of evidence identified using appropriate published checklists.
We identified 16,556 titles, removed 663 duplicates, and reviewed 199 articles, of which 27 were included in the review-17 prospective cohorts and 10 RCTs with subgroup analyses reported. There was moderate-quality evidence indicating that depression, anxiety, poor sleep and stress, medication overuse, and poor self-efficacy for managing headaches are potential prognostic factors for poor prognosis and unfavorable outcomes from preventive treatment in chronic headache. There was inconclusive evidence about treatment expectations, age, age at onset, body mass index, employment, and several headache features.
This review identified several potential predictors of poor prognosis and worse outcome postinterventions in people with chronic headache. The majority of these are modifiable. The findings also highlight the need for more longitudinal high-quality research of prognostic factors in chronic headache.
在慢性头痛患者的前瞻性研究中确定预后和试验结果的预测因素。
这是一项对同行评审期刊上已发表文献的系统评价。我们纳入了：（1）报告亚组分析的慢性头痛干预措施的随机对照试验（RCT），以及（2）自1980年以来以英文发表的前瞻性队列研究。参与者包括患有慢性头痛的成年人（包括慢性头痛、慢性偏头痛以及伴有或不伴有药物过度使用性头痛的慢性紧张型头痛）。我们使用自由文本和医学主题词检索了关键数据库。两名评审员独立提取数据，并使用适当的已发表清单评估研究的方法学质量和所确定证据的整体质量。
我们筛选出16556个标题，去除663个重复项，审阅了199篇文章，其中27篇纳入综述——17项前瞻性队列研究和10项报告了亚组分析的RCT。有中等质量的证据表明，抑郁、焦虑、睡眠不佳和压力、药物过度使用以及头痛管理的自我效能低下是慢性头痛预后不良和预防性治疗效果不佳的潜在预后因素。关于治疗期望、年龄、发病年龄、体重指数、就业情况以及一些头痛特征的证据尚无定论。
本综述确定了慢性头痛患者预后不良和干预后结果较差的几个潜在预测因素。其中大多数是可改变的。研究结果还凸显了对慢性头痛预后因素进行更多纵向高质量研究的必要性。
