Caronna Edoardo, Gallardo Victor José, Hernández-Beltrán Natalia, Torres-Ferrus Marta, Pozo-Rosich Patricia
Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Front Neurol. 2018 Oct 16;9:808. doi: 10.3389/fneur.2018.00808. eCollection 2018.
To evaluate the early response of onabotulinumtoxinA as a treatment tool in patients with chronic migraine (CM) and medication overuse (MO). This is a retrospective study in patients with CM and MO who received two cycles of onabotulinumtoxinA infiltrations following PREEMPT protocol. We evaluated the efficacy of onabotulinumtoxinA in MO resolution, defined as less than 10 days/month of acute medication intake (triptans, opioids, and combinations) or 15 days/month (non-steroidal anti-inflammatory drugs - and simple analgesics). In addition, we analyzed changes in headache frequency, pain intensity, and headache-related disability (MIDAS scale). A multivariate analysis was carried out to identify factors independently related to MO resolution. We included 139 consecutive patients with CM and MO. After 2 cycles of onabotulinumtoxinA, 73.4% had ≥50% reduction in acute medication intake and 57.6% achieved MO resolution. 7.9% of patients did not use any acute medication after treatment. Even though both MO-ongoing group and MO-resolution group improve in headache frequency, the reduction was significantly higher for the group which discontinued the use of acute medication after onabotulinumtoxinA treatment ( < ). In this group, 73.0% reduced headache frequency ≥50%. Daily headache changed from 71.2 to 23.2% ( < ). Both groups showed an improvement in pain intensity and in MIDAS score ( < ). In the multivariate analysis we observed that MO resolution had an inverse association with medication intake at baseline (OR:0.294, < ) and a direct association with frequency (OR:20.455, < ) and MIDAS score (OR: 6.465, < ) improvements. OnabotulinumtoxinA has an early beneficial effect on the discontinuation of acute medication in a substantial proportion of patients with CM and MO. Therefore, onabotulinumtoxinA might be considered a therapeutic tool in CM with MO.
评估A型肉毒毒素作为慢性偏头痛（CM）伴药物过度使用（MO）患者治疗工具的早期反应。这是一项针对CM伴MO患者的回顾性研究，这些患者按照PREEMPT方案接受了两个周期的A型肉毒毒素注射。我们评估了A型肉毒毒素在解决药物过度使用方面的疗效，定义为急性药物摄入量（曲坦类、阿片类药物及其组合）每月少于10天或（非甾体抗炎药和简单镇痛药）每月少于15天。此外，我们分析了头痛频率、疼痛强度和头痛相关残疾（MIDAS量表）的变化。进行多变量分析以确定与解决药物过度使用独立相关的因素。我们纳入了139例连续的CM伴MO患者。在接受两个周期的A型肉毒毒素治疗后，73.4%的患者急性药物摄入量减少了≥50%，57.6%的患者实现了药物过度使用的解决。7.9%的患者在治疗后未使用任何急性药物。尽管持续药物过度使用组和已解决药物过度使用组的头痛频率均有所改善，但在接受A型肉毒毒素治疗后停用急性药物的组中，头痛频率的降低更为显著（<）。在该组中，73.0%的患者头痛频率降低了≥50%。每日头痛发生率从71.2%降至23.2%（<）。两组在疼痛强度和MIDAS评分方面均有改善（<）。在多变量分析中，我们观察到药物过度使用的解决与基线时的药物摄入量呈负相关（OR：0.294，<），与频率改善（OR：20.455，<）和MIDAS评分改善（OR：6.465，<）呈正相关。A型肉毒毒素对相当一部分CM伴MO患者停用急性药物具有早期有益作用。因此，A型肉毒毒素可被视为CM伴MO的一种治疗工具。
