Kiarashi Jessica, Jion Yasmin, Giglio Brandon, Pavlovic Jelena, Armand Cynthia E, Grosberg Brian M, Lipton Richard B, Vollbracht Sarah, Robbins Matthew S
UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY.
Neurol Clin Pract. 2021 Jun;11(3):188-193. doi: 10.1212/CPJ.0000000000000965.
To review our inpatient experience treating a variety of headache disorders with heterogeneous therapies and to determine outcomes and predictors of response.
We conducted an institutional review board-approved retrospective chart review of elective inpatient headache admissions from the Montefiore Headache Center from 2014 to 2018. We examined factors associated with response and outcomes at discharge and posthospitalization follow-up in an intractable population. Patients received different classes of IV medications including antiemetics, neuroleptics, dihydroergotamine, lidocaine, steroids, valproic acid, and nerve blocks, and home preventive medications were either continued or changed before discharge. Improvements were defined at discharge by headache intensity compared with before hospitalization.
Among the 83 admissions, pain improvement at discharge occurred in 90.4% (n = 75) of the overall sample, 89.5% (n = 60) of those with chronic migraine, 75.0% (n = 9) of patients with new daily persistent headache, and 89.5% (n = 34) of all those with acute medication overuse. Fifty-six patients (67.5%) reported improvement of a 3-or-more-point reduction in headache intensity at discharge, with a mean reduction of 4.84 ± SD 2.51 (range 1-10). Of the 66 patients who received IV dihydroergotamine, 59 (89.4%) of them improved at discharge. Of the 11 (13.2%) patients who received IV lidocaine, 7 (63.6%) improved. Of the 14 (16.9%) patients who received nerve blocks, all 14 (100%) improved at discharge. Of the 75 patients who had improved at discharge, 63 (84%) followed up and 50 (79.4%) of those patients remained improved. At the second follow-up, 68 (81.9%) patients returned for follow-up on average of 71 days (range 10-283) after discharge.
Our inpatient headache experience featured numerous treatments with high rates of improvement in the short and intermediate term for all headache disorders. These results may suggest that stratified hospitalized care including polytherapy may be useful for many patients.
回顾我们使用多种不同疗法治疗各类头痛疾病的住院治疗经验，并确定疗效及反应的预测因素。
我们对2014年至2018年蒙特菲奥里头痛中心择期住院的头痛患者进行了一项经机构审查委员会批准的回顾性病历审查。我们研究了难治性人群出院时及出院后随访时与反应和疗效相关的因素。患者接受了不同种类的静脉药物治疗，包括止吐药、抗精神病药、双氢麦角胺、利多卡因、类固醇、丙戊酸和神经阻滞，并且在出院前继续或更换了家庭预防性药物。出院时的改善情况通过与住院前相比的头痛强度来定义。
在83例入院患者中，总体样本中有90.4%（n = 75）在出院时疼痛得到改善，慢性偏头痛患者中有89.5%（n = 60），新发性每日持续性头痛患者中有75.0%（n = 9），所有急性药物过度使用患者中有89.5%（n = 34）。56例患者（67.5%）报告出院时头痛强度降低了3分或更多，平均降低4.84±标准差2.51（范围1 - 10）。在66例接受静脉注射双氢麦角胺的患者中，59例（89.4%）出院时病情改善。在11例（13.2%）接受静脉注射利多卡因的患者中，7例（63.6%）病情改善。在14例（16.9%）接受神经阻滞的患者中，所有14例（100%）出院时病情改善。在出院时病情改善的75例患者中，63例（84%）进行了随访，其中50例（79.4%）患者病情仍有改善。在第二次随访时，68例（81.9%）患者在出院后平均71天（范围10 - 283天）返回接受随访。
我们的住院头痛治疗经验表明，对于所有头痛疾病，多种治疗方法在短期和中期均有较高的改善率。这些结果可能表明，包括联合治疗在内的分层住院治疗对许多患者可能有用。
