Headache, Opiate Use, and Prescribing Trends in Women With Idiopathic Intracranial Hypertension: A Population-Based Matched Cohort Study.
Headache, Opiate Use, and Prescribing Trends in Women With Idiopathic Intracranial Hypertension: A Population-Based Matched Cohort Study.
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DOI：
10.1212/wnl.0000000000201064
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发表时间：
2022-10-31
期刊：
影响因子：
9.9
通讯作者：
Sinclair AJ
中科院分区：
文献类型：
--
作者：
Adderley NJ;Subramanian A;Perrins M;Nirantharakumar K;Mollan SP;Sinclair AJ
既往未在一项针对特发性颅内高压（IIH）的大型匹配队列研究中评价过阿片类药物和头痛治疗的医生处方习惯。我们的目的是评价IIH女性患者与偏头痛女性患者和对照人群的阿片类和头痛药物处方习惯。我们还调查了IIH与人群对照组相比新发头痛的发生率。我们进行了一项以人群为基础的配对回顾性队列研究，以探讨头痛的结局。横断面分析被用来描述药物处方模式。我们使用了IQVIA医学研究数据（一个匿名的、在英国具有全国代表性的初级保健电子病历数据库）的数据，时间为1995年1月1日至2019年9月25日。年龄在16岁及以上的妇女有资格入选。IIH（暴露）妇女与年龄和体重指数匹配，最多10名对照妇女没有IIH但有偏头痛（偏头痛对照），没有IIH或偏头痛（人群对照）。共纳入3，411名IIH女性，13，966名偏头痛对照和33，495名人群对照。IIH组与人群对照组相比，新发头痛的校正风险比为3.09（95% CI 2.78-3.43）。在诊断后的第一年，58%的IIH女性被处方乙酰唑胺和20%的托吡酯。总的来说，20%的IIH女性在诊断后的第一年内服用阿片类药物，6年后降至17%，而偏头痛患者分别为8%和11%。与偏头痛对照组相比，IIH患者服用阿片类药物的人数是其两倍，与人群对照组相比，IIH患者服用阿片类药物的人数是其3倍。与偏头痛对照组相比，IIH患者也被开了更多的头痛预防药物。与偏头痛和对照组相比，IIH女性患者更可能被处方阿片类药物和简单的镇痛药。患有IIH的女性在其病程中尝试了更多的预防性药物，这表明IIH中的头痛可能更难治疗。
Physician prescribing habits for opiates and headache therapies have not been previously evaluated in a large, matched cohort study in idiopathic intracranial hypertension (IIH). Our objective was to evaluate opiate and headache medication prescribing habits in women with IIH compared with matched women with migraine and population controls. We also investigated the occurrence of new onset headache in IIH compared with population controls. We performed a population-based matched, retrospective cohort study to explore headache outcomes. Cross-sectional analyses were used to describe medication prescribing patterns. We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical record database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged 16 years and older were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls). A total of 3,411 women with IIH, 13,966 migraine controls, and 33,495 population controls were included. The adjusted hazard ratio for new onset headache in IIH compared with population controls was 3.09 (95% CI 2.78–3.43). In the first year after diagnosis, 58% of women with IIH were prescribed acetazolamide and 20% topiramate. In total, 20% of women with IIH were prescribed opiates within the first year of their diagnosis, reducing to 17% after 6 years, compared with 8% and 11% among those with migraine, respectively. Twice as many women with IIH were prescribed opiates compared with migraine controls, and 3 times as many women with IIH were prescribed opiates compared with population controls. Women with IIH were also prescribed more headache preventative medications compared with migraine controls. Women with IIH were more likely to be prescribed opiate and simple analgesics compared with both migraine and population controls. Women with IIH trialed more preventative medications over their disease course suggesting that headaches in IIH may be more refractory to treatment.