Yuan Dongli, Zhang Yixin, Li Qin, Lv Yuhua, Li Xuelian, Yu Yichuan, Li Wangwen, Tan Ge
Department of Intelligent Medical Systems, Institute of Medical Information, Chongqing Medical University, Chongqing, China.
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2020 Apr 9;11:227. doi: 10.3389/fneur.2020.00227. eCollection 2020.
This study aims to investigate the factors affecting the efficacy of first oral prophylaxis in patients with chronic migraine (CM) and to assess patient compliance with their medication regimens. To identify the therapeutic effect of prevention medication in 740 patients with newly diagnosed CM that did not receive any preventive treatments after 4 weeks in an open-label prospective study with retrospective baseline from January 2016 to January 2018, the factors that may affect the outcomes of preventive treatment were analyzed based on the demographic characteristics, migraine characteristics, family history of headache, and history of medication overuse. Moreover, the patients were followed up to evaluate their compliance with and the side effects of the medication at 4 weeks and at 12 weeks. After 4 weeks of prophylaxis, 94.3% ( = 698) of the patients persisted with taking the medicine. The treatment was effective for 61.7% of CM patients ( = 431) and ineffective for 38.3% ( = 267). The results showed that the effectiveness of the preventive treatment was related to the number of headaches per month, and the effect was better for patients with headaches for 15-20 days/month than for those with headaches for 26-30 days/month (OR = 2.78, 95% CI: 1.26-5.75, = 0.006). After 12 weeks of treatment, only 34.5% ( = 255) of the patients persisted with taking the medicine. The most common reason for non-compliance in CM patients is appointment difficulty in a headache clinic (31.8%). The effect of CM prophylaxis was related to the frequency of headache. Only 34.5% of the patients continued to take medicine after 12 weeks of treatment, suggesting that patient compliance needs to be enhanced in the prophylaxis of CM. For the Chinese headache society, the best way to increase patient compliance should be treatment at dedicated headache centers and timely visits to headache specialists.
本研究旨在调查影响慢性偏头痛（CM）患者首次口服预防性治疗疗效的因素，并评估患者对其药物治疗方案的依从性。在一项从2016年1月至2018年1月进行的具有回顾性基线的开放标签前瞻性研究中，为了确定740例新诊断的CM患者在4周后未接受任何预防性治疗时预防药物的治疗效果，基于人口统计学特征、偏头痛特征、头痛家族史和药物滥用史分析了可能影响预防性治疗结果的因素。此外，对患者进行随访，以评估他们在4周和12周时对药物的依从性和药物副作用。预防性治疗4周后，94.3%（n = 698）的患者持续服药。该治疗对61.7%的CM患者（n = 431）有效，对38.3%（n = 267）无效。结果表明，预防性治疗的有效性与每月头痛次数有关，每月头痛15 - 20天的患者比每月头痛26 - 30天的患者效果更好（OR = 2.78，95%CI：1.26 - 5.75，P = 0.006）。治疗12周后，只有34.5%（n = 255）的患者持续服药。CM患者不依从的最常见原因是在头痛诊所预约困难（31.8%）。CM预防性治疗的效果与头痛频率有关。治疗12周后只有34.5%的患者继续服药，这表明在CM的预防性治疗中需要提高患者的依从性。对于中国头痛学会来说，提高患者依从性的最佳方法应该是在专门的头痛中心进行治疗并及时就诊于头痛专科医生。
