Palacios-Ceña Maria, Wang Kelun, Castaldo Matteo, Ordás-Bandera Carlos, Torelli Paola, Arendt-Nielsen Lars, Fernández-de-Las-Peñas César
Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, University Rey Juan Carlos.
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Clin J Pain. 2019 Apr;35(4):315-320. doi: 10.1097/AJP.0000000000000685.
The objective of this study was to investigate differences in clinical, psychological, and psychophysical outcomes according to use of prophylactic medication (amitriptyline) in tension-type headache (TTH).
In total, 173 individuals with TTH participated. Headache features and symptomatic medication intake were collected with a 4-weeks headache diary at baseline and at 6-months. Burden of headache (Headache Disability Inventory-HDI), sleep quality (Pittsburgh Sleep Quality Index-PSQI), anxiety/depression (Hospital Anxiety and Depression Scale-HADS), and trait/state anxiety levels (State-Trait Anxiety Inventory-STAI) were also assessed at baseline. Pressure pain thresholds (PPT) were assessed over the temporalis, C5-C6 joint, second metacarpal, and tibialis anterior at baseline. Differences between participants taking or not taking prophylactic medication based on self-perceived effectiveness of the medication on headache characteristics were assessed.
In total, 49 (28%) reported taking prophylactic medication for the headaches (amitriptyline: 100%). From these, 11 (23%) reported no effect, 25 (51%) reported moderate effect, and 13 (26%) reported positive effect with medication. Patients taking prophylactic medication had longer headache history, higher frequency of headaches (61% CTTH), higher headache burden, worse quality of sleep, and higher depression than those not taking medication. Prophylactic medication was less effective in patients with generalized pressure pain hyperalgesia. No other significant differences were found.
Prophylactic medication is used by TTH patients with higher headache frequency, higher headache burden, worse sleep quality, and higher depression. Lower effectiveness of prophylactic amitriptyline was associated with widespread pain hyperalgesia.
本研究旨在调查预防性使用药物（阿米替林）治疗紧张型头痛（TTH）时在临床、心理和心理生理结局方面的差异。
共有173名紧张型头痛患者参与研究。在基线期和6个月时，通过为期4周的头痛日记收集头痛特征和对症药物摄入情况。在基线期还评估了头痛负担（头痛残疾评定量表-HDI）、睡眠质量（匹兹堡睡眠质量指数-PSQI）、焦虑/抑郁（医院焦虑抑郁量表-HADS）以及特质/状态焦虑水平（状态-特质焦虑量表-STAI）。在基线期评估颞肌、C5-C6关节、第二掌骨和胫前肌的压痛阈值（PPT）。根据患者对药物对头痛特征的自我感知疗效，评估服用或未服用预防性药物的参与者之间的差异。
共有49名（28%）患者报告服用了头痛预防性药物（阿米替林：100%）。其中，11名（23%）患者报告无效，25名（51%）患者报告有中度疗效，13名（26%）患者报告药物有积极疗效。服用预防性药物的患者比未服用药物的患者头痛病史更长、头痛频率更高（61%为慢性紧张型头痛）、头痛负担更重、睡眠质量更差且抑郁程度更高。预防性药物对广泛性压痛性痛觉过敏患者的疗效较差。未发现其他显著差异。
头痛频率较高、头痛负担较重、睡眠质量较差且抑郁程度较高的紧张型头痛患者会使用预防性药物。预防性使用阿米替林疗效较低与广泛性疼痛性痛觉过敏有关。
