药物过度使用性头痛复发的关联因素分析

Factors associated with recurrent headache caused by drug overuse

  • 摘要:
      背景  药物过度使用性头痛(medication overuse headache,MOH)的发生率和复发率高,造成了较大的经济和社会负担,目前缺少其复发因素的大样本研究。
      目的  探索与MOH复发相关的危险因素。
      方法  收集2015年9月 - 2022年1月就诊于解放军总医院第一医学中心的MOH患者386例,并随访至少1年,使用非条件Logistic回归分析探索MOH复发相关的独立危险因素。
      结果  386例患者中,男性80例,女性306例,其中101例(26.2%)患者复发。与未复发组相比,复发组受教育程度更低(P=0.001),体质量指数更大(P=0.001),原发性头痛病程更长(P=0.048),头痛频率更高(P=0.001),头痛部位为双侧者占比更高(P<0.001),药物过度使用的病程更长(P=0.004),服用镇痛药的频率更高(P<0.001),预防治疗时间更短(P<0.001),合并焦虑(P=0.037)和睡眠障碍(P=0.024)的比例更高,差异均有统计学意义。多元Logistic回归结果显示,受教育年限≤9年(OR=2.52,95% CI:1.24 ~ 5.16,P=0.011),药物过度使用的病程长(OR=1.09, 95% CI:1.00 ~ 1.18,P=0.043)及预防治疗时间<12个月(OR=6.84,95% CI:3.82 ~ 12.22,P<0.001)与MOH复发独立关联。
      结论  受教育程度低、药物过度使用的病程长和针对原发性头痛的预防治疗时间短可能是MOH复发的危险因素。

     

    Abstract:
      Background  Medication overuse headache (MOH) has high incidence and relapse rate, imposing a heavy social and economic burden. MOH is influenced by multiple factors and a large sample size study is needed to explore more risk factors.
      Objective  To further assess the risk factors for relapse in medication overuse headache patients in China.
      Methods  This retrospective cohort study included MOH patients in the First Medical Center of Chinese PLA General Hospital from September 2015 to January 2022 who were followed up for at least 1 year. The nonconditional Logistic regression analysis was used to explore the independent risk factors of relapse in MOH patients.
      Results  In total, 386 patients data were analyzed in this retrospective study, including 80 males and 306 females, of whom 101 (26.2%) cases had relapse. Patients in the relapse group had lower education level (P<0.001), higher BMI (P<0.001), longer duration couse of disease (P<0.001), higher frequency of headache onset (P=0.001), higher proportion of bilateral headache (P<0.001), longer duration of drug overuse (P=0.004), higher frequency of analgesic use (P<0.001), shorter duration of preventive medicine (P<0.001), higher percentage of anxiety (P=0.037) and sleep disorders (P=0.024) when compared to the patients without relapse. In Logistic regression analysis, educational level ≤9 years (OR=2.52, 95% CI: 1.24-5.16, P=0.011), duration of medication overuse (OR=1.09, 95% CI: 1.00-1.18, P=0.043) and duration of preventive therapy <12 months (OR=6.84, 95% CI: 3.82-12.22, P<0.001) were independently associated with MOH relapse.
      Conclusion  Lower education level, longer duration of medication overuse and shorted duration of preventive therapy may be independent risk factors for MOH relapse.

     

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