Medication-overuse headache. Retrospective comparison of preventive treatments

ABSTRACT Objectives: Medication-overuse headache is commonly seen in tertiary centers. Limited evidence is available regarding treatment. We compared the use of one or two drugs, three drugs, or four pharmacological agents for the prevention of headache. Methods: This was a retrospective analysis of 149 consecutive patients. Sudden withdrawal and pharmacological prevention with one or more drugs were carried out. Adherence and the decrease of headache frequency of more than 50% were compared after four months between the one or two, three, and four drug groups. Results: There was no difference in adherence (p > 0.6). Headache frequency reduction was shown in 23 (54.8%, one or two drugs), 33 (70%, three drugs) and 11 (55%, four drugs); p = 0.13 and p = 0.98, not significant. There was a tendency towards significance between the one or two drug takers versus the three drug and four drug takers together (p = 0.09). Conclusions: The use of more drugs was not better at improving headache. However, there is the possibility that acting simultaneously on different sites may promote broader modulation and better outcome.

摘要
研究目的：药物过度使用性头痛（Medication-overuse headache）在三级医疗中心较为常见，目前针对其治疗的相关证据较为有限。本研究对比了单药/两药联合、三药联合以及四药联合的药物方案在头痛预防中的应用效果。
研究方法：本研究为纳入149例连续入组患者的回顾性分析。所有患者均接受了过度使用药物骤停治疗，并联合一种或多种药物进行头痛的药物预防。本研究对比了单药/两药组、三药组、四药组患者在治疗4个月后的治疗依从性，以及头痛发作频率降低≥50%的患者比例。
研究结果：各组患者的治疗依从性无显著差异（p>0.6）。单药/两药组有23例（54.8%）患者头痛发作频率降低≥50%，三药组为33例（70%），四药组为11例（55%）；整体组间比较p=0.13，三药组与单/两药组的两两比较p=0.98，均无统计学显著性。单药/两药组与三药、四药联合组相比，差异存在接近统计学显著性的趋势（p=0.09）。
研究结论：使用更多种类的药物并未在改善头痛预后方面表现更优。然而，同时作用于不同靶点的联合用药方案，或可实现更广泛的神经调节，从而获得更佳的治疗结局。