肉毒素A治疗药物过量性头痛的疗效观察  

Curative effect of botulinum toxin A in the treatment of medication overuse headache

作　　者：崔晓晨 陈春富[1] 张立功[1] 张娜[1] 陈嫄[1] 李聪聪[1] 刁晓君[1] CUI Xiao-chen;CHEN Chun-fu;ZHANG Li-gong(Department of Neurologyf Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院神经内科

出　　处：《临床神经病学杂志》2019年第6期401-405,共5页Journal of Clinical Neurology

基　　金：山东省科学技术发展计划(2014GSF118005)

摘　　要：目的对比观察肉毒素A治疗药物过量性头痛(MOH)的疗效。方法选取山东省立医院头痛门诊就诊的MOH患者60例。随机分为肉毒素组和托吡酯组。MOH患者停用过度使用的止痛剂,肉毒素组31个部位皮下多点注射肉毒素A,共155 U(5 U/每部位)。治疗3个月后按上述方法重复注射1次。托吡酯组患者给予口服托吡酯治疗。随访观察6个月。应用偏头痛残疾程度评估问卷(MIDAS)评估头痛致残程度。通过简明健康状况调查表(SF-36)评估患者的健康状况。对比分析两组的临床疗效及药物不良反应。结果与托吡酯组相比,肉毒素组患者头痛发作次数明显减少(t=3.095,P=0.003)、头痛持续时间明显缩短(t=2.468,P=0.017),头痛严重程度明显下降(t=2.019,P=0.048),止痛药使用频率明显下降(t=2.267,P=0.027),MIDAS评分明显下降(t=2.867,P=0.006),差异有统计学意义。除了生理机能、躯体职能,其他SF-36项目分值均明显升高(均P<0.05)。两组患者不良反应发生率差异有统计学意义(χ~2=8.972,P=0.004)。结论肉毒素A可有效减轻MOH患者头痛症状。与口服托吡酯比较,肉毒素A的不良反应发生率低,患者耐受性良好。Objective To comparatively observe the therapeutic effects of botulinum toxin type A in the treatment of medication overuse headache(MOH).Methods Sixty cases of MOH patients visiting Neurology Headache Outpatient of Shandong Provincial Hospital were randomly divided into treatment group and control group.MOH patients stopped using overused analgesics.The treatment group was treated with botulinum toxin A subcutaneous injection,thirty-one injection sites were selected.There were a total of 155 U,with each site 5 U.Three months later the same method and dose of injection were repeated.The control group was treated with topiramate orally for six months.All patients were investigated for 6 months.The degree of headache disability was assessed by the Migraine Disability Assessment Questionnaire(MIDAS).The health status of the patients was assessed by 36-item Short Form Health Survey(SF-36).The clinical efficacy and adverse drug reactions were compared between the two groups.Results Compared with the control group,patients who were treated with botulinum toxin type A had less headache attack times(t=3.095,P=0.003)and shorter duration(t=2.468,P=0.017),obvious improvement on headache severity(t=2.019,P=0.048)and frequency of analgesics use(t=2.267,P=0.027),and the decline of the scores of MIDAS(t=2.867,P=0.006),the differences were statistically significant.In addition to the health items for physiological function and physical function,other SF-36 items score was significantly increased(P<0.05).There was a significant difference between two groups in drug adverse effects rate(χ~2=8.972,P=0.004).Conclusions Botulinum toxin A can effectively improve headache in MOH.Compared with oral topiramate,botulinum toxin type A showed less adverse effects with good compliance.

关 键 词：药物过量性头痛 肉毒素A 托吡酯 SF-36简明健康状况调查表 

分 类 号：R741.041[医药卫生—神经病学与精神病学]