慢性偏头痛和药物过度使用性头痛患者的疼痛应对

Pain Coping in Patients With Chronic Migraine and Medication Overuse Headache.

作者信息

van den Hoek Thomas C, Pijpers Judith A, van Zwet Erik W, de Boer Irene, Terwindt Gisela M

机构信息

Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.

Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands.

出版信息

Brain Behav. 2025 Aug;15(8):e70739. doi: 10.1002/brb3.70739.

DOI:10.1002/brb3.70739

PMID:40791067

Abstract

BACKGROUND

Chronic migraine (CM) is a leading cause of disability and often linked to medication overuse headache (MOH). Psychological factors, such as pain coping, may contribute to chronification and medication overuse. While behavioral therapy can help, identifying patients who will benefit remains challenging. This study compared pain coping in individuals with CM and MOH to those with episodic migraine (EM) and controls without headache. It also assessed whether baseline pain coping in CM patients could predict withdrawal treatment success.

METHODS

In patients that received behavioral therapy as part of the Chronification and Reversibility of Migraine clinical trial, patients with CM and MOH were assessed at baseline and after treatment on pain acceptance with the Acceptance and Action Questionnaire II for Pain (AAQ-II-P), and with the Pain-catastrophizing scale (PCS) and Headache Specific Locus of Control (HSLC) questionnaires. The non-headache groups were assessed once. In total, 65 CM, 34 EM, and 49 non-headache controls were included.

RESULTS

Patients with CM experienced less pain acceptance compared with EM patients and healthy controls with AAQ-II-P (adjusted mean difference [AMD]: 10.0 [95% CI: 3.7-16.2], p < 0.001 and AMD: 13.9 [95% CI: 7.8-20.1], p < 0.001, respectively) and had higher PCS (AMD: 12.1 [95% CI: 5.2-19.0], p < 0.001, AMD: 17.3 [95% CI: 10.5-24.0], p < 0.001, respectively), but comparable PCS to patients with back pain or depression. Patients with CM were more likely to believe their headaches were due to coincidence compared to EM, HSLC-chance (AMD: 4.0 [95% CI: 0.3-7.7], p = 0.034). Importantly, higher PCS scores were associated with greater reduction in migraine days after treatment (OR: 1.06 [95% CI 1.01-1.11], p = 0.030).

CONCLUSIONS

Patients with CM demonstrated poorer pain coping compared to those with EM and healthy controls. High catastrophizing in patients with CM predicts a better response to behavioral withdrawal treatment.

摘要

背景

慢性偏头痛（CM）是导致残疾的主要原因，且常与药物过度使用性头痛（MOH）相关。疼痛应对等心理因素可能导致偏头痛慢性化和药物过度使用。虽然行为疗法可能有帮助，但确定哪些患者会从中受益仍然具有挑战性。本研究比较了CM和MOH患者与发作性偏头痛（EM）患者及无头痛对照组在疼痛应对方面的差异。研究还评估了CM患者的基线疼痛应对情况是否能够预测撤药治疗的成功率。

方法

在作为偏头痛慢性化与可逆性临床试验一部分接受行为疗法的患者中，对CM和MOH患者在基线和治疗后使用疼痛接纳与行动问卷-II（AAQ-II-P）、疼痛灾难化量表（PCS）和头痛特异性控制点（HSLC）问卷评估疼痛接纳情况。非头痛组仅评估一次。总共纳入了65例CM患者、34例EM患者和49例无头痛对照组。

结果

与EM患者和健康对照组相比，CM患者在AAQ-II-P上的疼痛接纳程度较低（调整后均值差异[AMD]：分别为10.0[95%CI：3.7 - 16.2]，p < 0.001和AMD：13.9[95%CI：7.8 - 20.1]，p < 0.001），PCS得分较高（AMD：分别为12.1[95%CI：5.2 - 19.0]，p < 0.001，AMD：17.3[95%CI：10.5 - 24.0]，p < 0.001），但与背痛或抑郁症患者的PCS得分相当。与EM患者相比，CM患者更倾向于认为其头痛是由巧合引起的，HSLC-机遇（AMD：4.0[95%CI：0.3 - 7.7]，p = 0.034）。重要的是，较高的PCS得分与治疗后偏头痛天数的更大减少相关（OR：1.06[95%CI 1.01 - 1.11]，p = 0.030）。