Acute migraine medications and evolution from episodic to chronic migraine: A longitudinal population-based study
Acute migraine medications and evolution from episodic to chronic migraine: A longitudinal population-based study
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DOI：
10.1111/j.1526-4610.2008.01217.x
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发表时间：
2008-09-01
期刊：
影响因子：
5
通讯作者：
Lipton, Richard B.
中科院分区：
文献类型：
--
作者：
Bigal, Marcelo E.;Serrano, Daniel;Lipton, Richard B.
背景。-虽然有症状的药物过度使用被认为在从发作性到慢性或转化型偏头痛（TM）的进展中起主要作用，但这些药物的基于人群的纵向数据是有限的。在调整头痛进展的其他危险因素后，评估特定类别的急性药物在发作性偏头痛（EM）患者TM发展中的作用。作为美国偏头痛患病率和预防研究（AMPP）的一部分，我们最初调查了12万人的人群样本，以确定每年随访5年的偏头痛患者样本。使用逻辑回归和线性回归，我们建立了从2005年的EM到2006年的TM的过渡概率与基线药物使用状态的关系。对性别、头痛频率和严重程度以及预防药物的使用进行了调整。在2005年8219例EM患者中，209例（2.5%）到2006年已发展为TM。基线头痛频率是TM的一个危险因素。以acctaminophen使用者作为参照组，使用含巴比妥类药物（OR = 2.06，95%CI = 1.3-3.1）或阿片类药物（OR = 1.98，95%CI = 1.4-2.2）的个体发生TM的风险增加。发现使用巴比妥类药物存在剂量-反应关系。在基线时使用曲坦类药物（OR = 1.25，95%CI = 0.9-1.7）与TM的预期风险无关。总体而言，NSAID（OR = 0.85，95%CI = 0.63-1.17）与TM无关。事实上，NSAID是保护过渡到TM在低至中度每月头痛天，但与过渡到TM在每月头痛天的高水平的风险增加。EM患者以每年2.5%的速度发展TM。调整协变量后，任何巴比妥类药物和阿片类药物的使用与TM风险增加相关，而曲坦类药物则无关。NSAID是保护性或诱导剂，取决于头痛的频率。
Background.-Though symptomatic medication overuse is believed to play a major role in progression from episodic to chronic or transformed migraine (TM), population-based longitudinal data on these agents are limited.Objectives.-To assess the role of specific classes of acute medications in the development of TM in episodic migraine (EM) sufferers after adjusting for other risk factors for headache progression.Methods.-As a part of the American Migraine Prevalence and Prevention study (AMPP), we initially surveyed a population sample of 120,000 individuals to identify a sample of migraineurs to be followed annually over 5 years. Using logistic and linear regression, we modeled the probability of transition from EM in 2005 to TM in 2006 in relation to medication use status at baseline. Adjustments were made for gender, headache frequency and severity, and prevention medication use.Results.-Of 8219 individuals with EM in 2005, 209 (2.5%) had developed TM by 2006. Baseline headache frequency was a risk factor for TM. Using acctaminophen user as the reference group, individuals who used medications containing barbiturates (OR = 2.06, 95%CI = 1.3-3.1) or opiates (OR = 1.98, 95%CI = 1.4-2.2) were at increased risk of TM. A dose-response relationship was found for use of barbiturates. Use of triptans (OR = 1.25, 95%CI = 0.9-1.7) at baseline was not associated with prospective risk of TM. Overall, NSAIDs (OR = 0.85, 95%CI = 0.63-1.17) were not associated with TM. Indeed, NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days.Conclusion.-EM sufferers develop TM at the rate of 2.5% per year. Any use of barbiturates and opiates was associated with increased risk of TM after adjusting for covariates, while triptans were not. NSAIDs were protective or inducers depending on the headache frequency.