完全停药是治疗药物过度使用性头痛最可行的方法：一项随机对照开放标签试验。

Complete withdrawal is the most feasible treatment for medication-overuse headache: A randomized controlled open-label trial.

机构信息

Danish Headache Center, Rigshospitalet Glostrup, Copenhagen, Denmark.

出版信息

Eur J Pain. 2019 Jul;23(6):1162-1170. doi: 10.1002/ejp.1383. Epub 2019 Mar 15.

DOI:10.1002/ejp.1383

PMID:30793412

Abstract

BACKGROUND

Complete stop of acute medication and/or migraine medication for treatment of medication-overuse headache (MOH) has previously been reported more effective in reducing headache days and migraine days per month compared with restricted intake of acute medication. However, it is unknown whether complete stop or restricted intake is the most feasible treatment for patients.

OBJECTIVES

To investigate whether feasibility of withdrawal in MOH is different between complete stop of acute medication and restricted intake, and whether reductions in headache-related medication dependence, anxiety and depression differ between the treatments.

METHODS

Medication-overuse headache patients were included in a prospective, open-label, outpatient study and randomized to two months of withdrawal with either no analgesics or acute migraine medication (programme A) or acute medication restricted to 2 days/week (programme B). After 6 and 12 months, patients graded feasibility of withdrawal. Dependence was measured by Severity of Dependence Scale (SDS), while anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS).

RESULTS

We included 72 MOH patients with primary migraine and/or tension-type headache. Forty-nine completed withdrawal and the SDS questionnaire at 12-month follow-up, and the feasibility of withdrawal was significantly higher in programme A compared to programme B (p < 0.001). At 12 months, the dependence was reduced by 44% in programme A compared to 26% in programme B (p = 0.053), while the anxiety score was reduced by 32% and 11%, respectively (p = 0.048).

CONCLUSIONS

Withdrawal with complete stop of acute medication was more feasible and most effective in reducing headache-related anxiety compared with restricted intake.

SIGNIFICANCE

A complete stop of all analgesics is the most effective treatment for MOH regarding reduction in headache days but has often been regarded as too challenging for patients. However, in this study, complete stop appears to be more feasible compared with restricted intake of analgesics seen from the patients' perspective.

摘要

背景

与限制急性药物摄入相比，完全停止急性药物治疗和/或偏头痛药物治疗药物过度使用性头痛（MOH）已被报道能更有效地减少每月头痛天数和偏头痛天数。然而，尚不清楚完全停止或限制摄入哪种治疗方法对患者最可行。

目的

研究完全停止急性药物治疗和限制摄入之间 MOH 停药的可行性是否不同，以及两种治疗方法在头痛相关药物依赖、焦虑和抑郁的减轻程度上是否存在差异。

方法

将 MOH 患者纳入一项前瞻性、开放标签、门诊研究，并随机分为两个月的停药期，一组不使用镇痛药或急性偏头痛药物（方案 A），另一组将急性药物限制在每周 2 天（方案 B）。在 6 个月和 12 个月时，患者对停药的可行性进行评分。依赖程度通过严重依赖性量表（SDS）进行测量，焦虑和抑郁通过医院焦虑和抑郁量表（HADS）进行测量。

结果

共纳入 72 例原发性偏头痛和/或紧张型头痛的 MOH 患者。49 例患者完成了 12 个月的随访，其中包括停药和 SDS 问卷调查，方案 A 的停药可行性明显高于方案 B（p < 0.001）。在 12 个月时，方案 A 的依赖程度降低了 44%，而方案 B 仅降低了 26%（p = 0.053），焦虑评分分别降低了 32%和 11%（p = 0.048）。