药物过度使用性头痛的临床治疗观察

THE CLINICAL EVALUATION OF THERAPEUTIC EFFICIENCY OF MEDICATION OVERUSE HEADACHE

摘要:

目的：观察药物过度使用性头痛（medication overuse headache, MOH）的临床特点及疗效评估。方法：纳入符合诊断标准的MOH患者，采用程序化戒药治疗结合相对个体化治疗，完成1年随访。采用头痛日记、视觉模拟评分法(visual analogue scale, VAS)记录治疗前及随访期间每月头痛天数、急性止痛药物使用的天数及头痛程度，对合并情绪障碍者评估治疗前后焦虑、抑郁程度。结果：19例入组患者仅1例简单型，余为复杂型。在随访期间每月头痛天数、急性止痛药物使用天数及头痛程度与治疗前相比，均有明显降低（P<0.01）。治疗第6、12个月总有效率分别为64.70%、68.75%。伴随的焦虑、抑郁程度于治疗第6个月较基线明显降低（P<0.05），第12个月较基线降低但无统计学意义。有与无情绪障碍共病MOH患者相比，随访第6、12个月疗效相当，但前者治疗前每天服用止痛药剂量更多（P<0.05）。结论：MOH患者多伴有情绪障碍，且为复杂型。建议程序性戒药治疗基础上采用个体化的治疗方案。

Abstract:

Objective: To analyze the clinical characteristics and therapeutic effect of medication overuse headache (MOH). Methods: MOH patients were screened according to the diagnostic criteria . The structured detoxification treatment were adopted, and part of the patients were received the individualized treatment. The MOH patients were followed up for one year. The number of days of acute pain per month, the days of taking analgesics per month, the headache intensity were recorded before treatment and during follow-up period by using the headache diary and visual analogue scale (VAS) . The levels of anxiety and depression of those patients with emotional disorder were evaluated before and during follow-up period . Results: Among 19 cases of MOH patients enrolled in the treatment study, only one case is simple type, the others are complicated type. During the follow-up period, the MOH patients’ headache frequency and the days of taking analgesics and the headache intensity compared with baseline, were significantly reduced (P<0.01).The total effective rates were 64.70% and 68.75% at the 6th month and at the 12th month , respectively. At the 6th month the patients’ anxiety and depression levels were significantly lower than that of the baseline (P<0.05). At the 12th month the patients’ anxiety and depression levels were lower than that of the baseline too, but the difference was not statistically significant. At follow-up 6th and 12th month there was no significant difference found in the treatment efficacy between patients with emotional disorder and patients without. Before treatment,the MOH patients with emotional disorders took more analgesics everyday compared with the patients with no emotional disorders（P<0.05）. Conclusion: Most of the MOH patients are often accompanied by emotional disorders and to be complicated type. Based on the structured detoxification treatment, the individualized treatment program is recommended.