Lang Hui, Peng Cheng, Wu Kongyuan, Chen Xiwen, Jiang Xin, He Li, Chen Ning
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
Department of Neurology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan, China.
Front Neurol. 2024 Sep 20;15:1453183. doi: 10.3389/fneur.2024.1453183. eCollection 2024.
Medication overuse headache (MOH) is a chronic headache caused by regular overuse of medications. OnabotulinumtoxinA (BoNTA) is used for preventive treatment of MOH. However, its efficacy and safety remain controversial.
Seven online databases (Cochrane Library, Embase, Medline, PubMed, China National Knowledge Infrastructure, Wanfang data, and Chinese BioMedical Literature Database) were searched for relevant articles published between January 2002 and March 2024. We included randomized controlled trials (RCTs) and cohort studies on the treatment of MOH using BoNTA versus a placebo or other active treatments.
We retrieved 487 articles in the database search. Of these, four eligible RCTs were identified after detailed screening. A total of 1,259 patients with MOH (622 patients treated with BoNTA, 607 with placebo, and 30 with topiramate) were included in the four RCTs. We found that BoNTA significantly reduced headache frequency compared with placebo (mean difference, 1.89; 95% confidence interval (CI), 1.11-2.67; = 0%; < 0.001). There was no significant difference between BoNTA and the placebo in terms of secondary outcomes, which included reductions in acute medication intake (MD, 1.30; 95% CI, -1.18-3.78; = 0%; = 0.30), Migraine Disability Assessment questionnaire scores (MIDAS, MD, -4.04; 95% CI, -29.36-21.28; = 0%; = 0.75), and Headache Impact Test scores (HIT-6, MD, 0.03; 95% CI, -1.77-1.83; = 0%; = 0.97). BoNTA was more likely to cause adverse events (OR, 1.87; 95% CI, 1.45-2.42; = 0%; < 0.001) than placebo.
The results of this study show that BoNTA reduces headache frequency and is effective for the treatment of MOH.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022315845.
药物过量使用性头痛（MOH）是一种因定期过度使用药物引起的慢性头痛。A型肉毒毒素（BoNTA）用于MOH的预防性治疗。然而，其疗效和安全性仍存在争议。
检索了七个在线数据库（Cochrane图书馆、Embase、Medline、PubMed、中国知网、万方数据和中国生物医学文献数据库），以获取2002年1月至2024年3月期间发表的相关文章。我们纳入了关于使用BoNTA与安慰剂或其他积极治疗方法治疗MOH的随机对照试验（RCT）和队列研究。
在数据库检索中，我们共检索到487篇文章。经过详细筛选，确定了四项符合条件的RCT。这四项RCT共纳入了1259例MOH患者（622例接受BoNTA治疗，607例接受安慰剂治疗，30例接受托吡酯治疗）。我们发现，与安慰剂相比，BoNTA显著降低了头痛频率（平均差值，1.89；95%置信区间（CI），1.11 - 2.67；P = 0%；P < 0.001）。在次要结局方面，BoNTA与安慰剂之间没有显著差异，次要结局包括急性药物摄入量的减少（MD，1.30；95% CI，-1.18 - 3.78；P = 0%；P = 0.30）、偏头痛残疾评估问卷评分（MIDAS，MD，-4.04；95% CI，-29.36 - 21.28；P = 0%；P = 0.75）以及头痛影响测试评分（HIT - 6，MD，0.03；95% CI，-1.77 - 1.83；P = 0%；P = 0.97）。与安慰剂相比，BoNTA更有可能导致不良事件（OR，1.87；95% CI，1.45 - 2.42；P = 0%；P < 0.001）。
本研究结果表明，BoNTA可降低头痛频率，对MOH的治疗有效。
