Zhang Yan, Dennis Jeff A, Leach Matthew J, Bishop Felicity L, Cramer Holger, Chung Vincent C H, Moore Craig, Lauche Romy, Cook Ron, Sibbritt David, Adams Jon
Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.
Headache. 2017 Sep;57(8):1228-1242. doi: 10.1111/head.13148. Epub 2017 Jul 25.
Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population.
The study aimed to answer the following questions: (1) Which CAM modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?
This secondary analysis of data from the 2012 U.S. NHIS (a national cross-sectional survey) examined the use of CAM among migraine/headache sufferers, including the main reasons related to CAM use. Data were weighted and analyzed using STATA 14.0.
The sample of 34,525 adults included 6558 (18.7%) headache/migraine sufferers. Of the headache/migraine sufferers, a substantial proportion (37.6%, n = 2427) used CAM for various conditions; however, CAM use specifically for headache/migraine was much less prevalent (3.3%, n = 216). Of those who used CAM for headache/migraine, about half used CAM in conjunction with prescription (47.8%, n = 100) or over-the-counter medication (55.1%, n = 113). As severity of headache/migraine increased so did the likelihood of using CAM (severe migraine odds ratio [OR] = 2.32; 95% confidence interval [CI]: 1.41, 3.82; both recurring headache/severe migraine OR = 3.36; 95% CI: 2.08, 5.43; when compared to those with recurring headache only). The most frequently used CAM modality among all headache/migraine sufferers (N = 6558) was manipulative therapy (22.0%, n = 1317), herbal supplementation (21.7%, n = 1389) and mind-body therapy (17.9%, n = 1100). The top 3 reasons for using CAM for headache were general wellness (28.7%, n = 60/209), improving overall health (26.8%, n = 56/209), and reducing stress (16.7%, n = 35/209).
Although CAM is used by many sufferers of headache/migraine, the use of CAM specifically for the treatment of headache/migraine is relatively low in the United States. The study also assesses the key differences of CAM use among headache/migraine sufferers in NHIS 2012 compared with those in NHIS 2007, and identifies shortfalls in the evidence-base of several CAM modalities used by U.S. adults for headache/migraine. This information may assist health providers and consumers in making informed decisions about the safest and most appropriate approach to managing headache/migraine.
鉴于对药物治疗安全性的担忧，以及头痛和偏头痛对患者生活质量的重大影响，许多人寻求传统药物和护理之外的其他治疗选择来缓解症状；这包括补充和替代医学（CAM）。一些CAM干预措施在头痛和偏头痛管理的临床试验中显示出了有前景的结果。尽管如此，针对这一人群使用CAM的原因以及所使用的CAM类型的研究却很少。
本研究旨在回答以下问题：（1）偏头痛/头痛患者中最常使用的CAM方式有哪些？（2）偏头痛/头痛患者使用CAM的自我报告原因是什么？
对2012年美国国家健康访谈调查（一项全国性横断面调查）的数据进行二次分析，研究偏头痛/头痛患者对CAM的使用情况，包括与使用CAM相关的主要原因。数据经过加权处理，并使用STATA 14.0进行分析。
34525名成年人的样本中包括6558名（18.7%）头痛/偏头痛患者。在头痛/偏头痛患者中相当一部分人（37.6%，n = 2427）因各种病症使用CAM；然而，专门用于头痛/偏头痛的CAM使用情况则要少得多（3.3%，n = 216）。在那些因头痛/偏头痛使用CAM的人中，约一半人同时使用CAM和处方药（47.8%，n = 100）或非处方药（55.1%，n = 113）。随着头痛/偏头痛严重程度的增加，使用CAM的可能性也增加（重度偏头痛优势比[OR] = 2.32；95%置信区间[CI]：1.41，3.82；复发性头痛/重度偏头痛的OR均 = 3.36；95% CI：2.08，5.43；与仅患有复发性头痛的人相比）。在所有头痛/偏头痛患者（N = 6558）中最常使用的CAM方式是手法治疗（22.0%，n = 1317）、草药补充剂（21.7%，n = 1389）和身心治疗（17.9%，n = 1100）。因头痛使用CAM的前三大原因是整体健康（28.7%，n = 60/209）、改善整体健康状况（26.8%，n = 56/209）和减轻压力（16.7%，n = 35/209）。
虽然许多头痛/偏头痛患者使用CAM，但在美国专门用于治疗头痛/偏头痛的CAM使用相对较少。该研究还评估了2012年美国国家健康访谈调查中头痛/偏头痛患者与2007年相比在使用CAM方面的关键差异，并指出美国成年人用于头痛/偏头痛的几种CAM方式在证据基础方面的不足。这些信息可能有助于医疗服务提供者和消费者就是否采用最安全、最合适的方法来管理头痛/偏头痛做出明智的决定。
