Patterns of Use and Reasons for Discontinuation of Prophylactic Medications for Episodic Migraine and Chronic Migraine: Results From the Second International Burden of Migraine Study (IBMS-II)
Patterns of Use and Reasons for Discontinuation of Prophylactic Medications for Episodic Migraine and Chronic Migraine: Results From the Second International Burden of Migraine Study (IBMS-II)
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DOI：
10.1111/head.12055
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发表时间：
2013-04-01
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：
Blumenfeld, Andrew M.;Bloudek, Lisa M.;Lipton, Richard B.
我们的目的是描述发作性偏头痛（EM）和慢性偏头痛（CM）患者的预防性药物使用模式。背景：有几类药物在说明书上和说明书外都用于预防偏头痛，包括受体阻滞剂（如心得安、替马洛尔）、三环抗抑郁药（如阿米替林）、抗癫痫药（如托吡酯、丙戊酸）和神经毒素（如肉毒杆菌毒素）。方法收集2010年国际上基于网络的成人偏头痛患者的预防性药物使用情况和停药原因。通过偏头痛残疾评估量表对人口统计学和头痛相关残疾进行描述性分析，并通过使用预防性药物和EM或CM进行分层。建立单因素和多因素logistic回归模型评估预防用药的预测因素。结果共1565名受访者完成调查。仅有28.3%的EM受访者和44.8%的CM受访者目前正在使用预防性药物；43.4%的EM患者和65.9%的CM患者报告有任何预防使用（既往或目前）。EM和CM的平均预防用药次数分别为2.92次和3.94次。使用频率最高的是抗抑郁药（EM为60.9%，CM为54.7%），其次是受体阻滞剂（EM为35.4%，CM为36.8%）和抗癫痫药（EM为28.6%，CM为36.3%）。经年龄、性别、种族、每日头痛年数和国家调整后，CM患者使用预防性药物的几率高于EM患者（优势比2.72；95%可信区间2.15 ~ 3.57）。与头痛相关的残疾程度和年龄越大，使用预防药物的几率也越大，与头痛频率无关。结论：少于一半的EM和CM患者目前正在使用预防性药物治疗偏头痛，正如预期的那样，CM的治愈率更高。CM患者比EM患者尝试了更多的药物，这可能反映出更高的治疗需求。
Objective Our objective was to characterize patterns of preventive medication use in persons with episodic migraine (EM) and chronic migraine (CM). Background Several classes of medications are used both on- and off-label for the prevention of migraine, including -blockers (eg, propranolol, timolol), tricyclic antidepressants (eg, amitriptyline), anti-epileptic drugs (eg, topiramate, valproic acid), and neurotoxins (eg, onabotulinumtoxinA). Methods Preventive medication use and reasons for discontinuation were collected in an international, Web-based, cross-sectional survey of adults with migraine during 2010. Descriptive analyses were conducted on demographics and headache-related disability as measured by the Migraine Disability Assessment Scale, stratified by use of preventive medication, and EM or CM. Univariate and multivariate logistic regression models were constructed to assess predictors of preventive medication use. Results One thousand one hundred and sixty-five respondents completed the survey. Only 28.3% of EM and 44.8% of CM respondents were currently using preventive medication; any use of prophylaxis (prior or current) was reported by 43.4% of those with EM and 65.9% with CM. The mean number of prophylactic medications ever used was 2.92 for EM and 3.94 for CM. Antidepressants were used most frequently (EM 60.9%; CM 54.7%), followed by -blockers (EM 35.4%; CM 36.8%) and anti-epileptics (EM 28.6%; CM 36.3%). Odds of preventive medication use were higher among CM than EM, adjusting for age, gender, race, years of daily headache, and country (odds ratio 2.72; 95% confidence interval 2.15 to 3.57). Greater headache-related disability and older age were also associated with greater odds of ever having used prophylaxis, regardless of headache frequency. Conclusions Less than half the persons with EM and CM were currently using preventive medication for migraine, with treatment rates being higher for CM, as expected. Those with CM tried more medications than those with EM, possibly reflecting higher levels of treatment need.