急性抗偏头痛药物均可预防慢性偏头痛

伦敦——欧洲头痛与偏头痛信托基金国际大会上报告的德国头痛联盟研究(GHCS)结果表明，发作性偏头痛患者服用任何急性抗偏头痛药物，无论是单一镇痛药、复方镇痛药还是曲坦类，均对慢性偏头痛的发生具有预防作用，且单一镇痛药和曲坦类的预防效果似乎优于复方镇痛药。


Zaza Katsarava博士
 
德国埃森大学神经病专家Zaza Katsarava博士报告的该项以人群为基础的大规模前瞻性研究纳入1,601例阵发性偏头痛 (发作频率≤14天/月) 患者，预期随访2年，所有受试者均未服用任何预防性镇痛药物。其目的是了解服用急性抗偏头痛药物是否导致患者易于出现“偏头痛慢性化”，即由阵发性偏头痛发展为失能性更强和受累程度更重的慢性偏头痛(发作频率≥15天/月)。目前对于复方镇痛药物的这一作用是否更为明显存在争议。“我们的研究目的是了解常规使用这些药物是否与慢性偏头痛高风险有关，以及在什么情况下无需提醒患者相关风险。”

结果令人欣慰。在2年随访期间，6.2%的基线阵发性偏头痛患者发展为慢性偏头痛。校正年龄、性别、体重指数、受教育程度以及基线偏头痛发作频率等因素后，与151例没有使用任何急性抗偏头痛药物的患者相比，使用单一镇痛药物、曲坦类和复方镇痛药物的患者发展为慢性偏头痛的风险分别降低61%、66%和40%。单一镇痛药物的保护作用明显大于复方镇痛药物，表现为其相对风险下降35%。

有与会者认为，使用单一镇痛药物患者偏头痛严重程度可能小于需要服用复方镇痛药物的患者，前者慢性偏头痛风险较小的原因可能正是与其偏头痛严重程度较轻有关，而并不是因为服用单一药物。但Katsarava博士不同意这种说法。他认为，从没有科学证据支持头痛强度是慢性头痛的风险因素。发作频率是最有价值的指标，药物控制的也正是发作频率。

Katsarava博士还强调，已知偏头痛无效治疗药物的过度使用是头痛慢性化的重要原因，因此这项研究并非关注这一问题，而是重点分析急性偏头痛处方药物正常使用者及过度使用者。

GHCS研究由德国联邦教育与研究部资助。Katsarava博士报告担任Allergan公司顾问以及Allergan、默克雪兰诺、拜耳先灵、Biogen和St. Jude Medical公司代言人并接受酬金。

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By: BRUCE JANCIN, Internal Medicine News Digital Network

LONDON – The use of any form of acute antimigraine medication by patients with episodic migraine – be it single analgesics, combination analgesics, or triptans – exerted a protective effect against developing chronic migraine in a large, prospective, population-based study.

"This effect seems to be stronger for single analgesics and triptans than for combination analgesics," Dr. Zaza Katsarava observed in presenting findings from the German Headache Consortium Study at the European Headache and Migraine Trust International Congress.

He reported on 1,601 study participants with baseline episodic migraine – meaning migraine headaches on an average of not more than 14 days per month – who were prospectively followed for 2 years. None were on any form of prophylactic pain medication. The goal was to learn whether use of acute antimigraine medication to abort attacks predisposes patients over time to what has been termed "migraine chronification," or the conversion of episodic migraine into even more disabling and burdensome chronic headache, which in this study was defined as any type of headache occurring 15 or more days per month. There has been controversy regarding whether combination analgesics in particular might have such an unwanted effect.

"The purpose of our study is to learn whether general use of one of these classes of substances is associated with higher risk, in which case we would no longer advise their use in our patients," explained Dr. Katsarava, a neurologist at the University of Essen (Germany).

The answer proved reassuring. During 2 years of follow-up, 6.2% of patients with episodic migraine at baseline developed chronic headache. Compared with the 151 subjects who didn’t use any acute antimigraine medication, those who used single analgesics for that purpose had an adjusted 61% lower risk of progressing to chronic headache. Patients who used triptans had a 66% reduction in risk, and those who utilized combination analgesics had a 40% risk reduction, compared with no intake of acute antimigraine medication. This analysis was adjusted for age, sex, body mass index, education level, and baseline migraine frequency.

The protective effect was significantly greater with single analgesic medications as compared to combination analgesics, as reflected in a 35% lower associated relative risk of conversion to chronic headache.

Several audience members tried to argue that perhaps patients who take only single analgesics for acute antimigraine therapy have less severe migraine attacks than do those needing combination analgesics, and that it’s their lesser severity of migraine episodes rather than their use of single analgesics that renders them less likely to develop chronic headache. But Dr. Katsarava was having none of that.

"It’s the right thing to ask. It’s the argument that the pharmaceutical companies manufacturing combination analgesics make. But headache intensity has never been shown to be a risk factor for developing chronic headache; there is no scientific evidence for that. We know that what counts is the frequency of attacks, and we controlled for that," he countered.

Dr. Katsarava emphasized that this wasn’t a study focused on overuse of migraine abortive medications, which is already known to be an important contributor to headache chronification. Instead, the analysis included both normal users of acute antimigraine medications as prescribed and overusers.

The German Headache Consortium Study is funded by the German Federal Ministry of Education and Research. Dr. Katsarava reported serving as a consultant to Allergan and a paid speaker on behalf of that company as well as Merck Serono, Bayer Schering, Biogen, and St. Jude Medical.