肉毒素對偏頭痛和日常性慢性頭痛行之有效

能夠降低發病率和治療的費用

  2002年6月19日─昨天在西雅圖召開的美國頭痛協會的年會上有一報告報導了用肉毒素治療偏頭痛或日常性慢性頭痛大約90%的病人症狀有明顯的改善。

  由於肉毒素比許多預防偏頭痛的藥物價格更便宜且副作用更小,所以這種方法能夠顯著的降低發病率和治療慢性頭痛的費用。

  「肉毒素將成為頭痛預防性治療的主要藥物之一。」來自Winston-Salem, N.C.的Wake Forest大學Baptist醫學中心的報告人B. Todd Troost在新聞發表會上說,「當它有效時,日常性治療藥物和治療偏頭痛急性發作的藥物將大大的減少甚至被消除。」

  Troost對134位偏頭痛、緊張性頭痛和每個月發作超過15次的日常性慢性頭痛進行了4次肉毒素治療,每次間隔3個月。他們中101位是男性,33位是女性,大部分患有已用三次傳統的頭痛藥物治療的頑固性頭痛。

  每次治療後對治療效果進行打分,從1分(代表治療無效)到5分(代表效果非常好)。總的情況,84%的病人有效,經過4次的病人治療效果得分平均為4.3分。研究顯示沒有新的差異,也沒有明顯的副作用出現。

  「此項治療具有遞增的效果或累計的效應,」Troost說,「當病人第一次用藥時出現輕微的藥物反應時,我叫病人不要放棄。第二次或第三次就好多了。」

  治療時,肉毒素分別注射於眶週,前額,顳肌,有時注射於下頜肌肉。對於全頭痛的病人,在頸部和肩部肌肉額外注射肉毒素。這次研究肉毒素的日常性的慢性頭痛用量為30—200U,偏頭痛的用量為15-240U。

  「80%的日常性慢性頭痛病人在治療衰弱性頭痛時藥物使用過度。」Troost說,「這些病人應考慮使用預防性的治療方案。」

Migraine, Chronic Daily Headache Respond to Botox

Could Reduce Morbidity, Cost of Treatment

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 19, 2002 -- About 90% of patients with migraine or chronic daily headache had significant improvement in symptoms after four treatments of botulinum toxin A (Botox), according to a presentation on June 18 at the American Headache Society annual meeting held in Seattle.

Since Botox can be less expensive and have fewer side effects than many medications used for headache prevention, this approach could substantially reduce both the morbidity and the cost of managing chronic headache.

"Botox is becoming one of the main preventive therapies for headache," presenter B. Todd Troost, MD, from Wake Forest University Baptist Medical Center in Winston-Salem, N.C., says in a news release. "When it is effective, the need for daily medications or acute medicines for severe attacks is significantly reduced or eliminated."

Troost gave one to four Botox treatments at three-month intervals to 134 patients with migraine headaches, tension headaches, or chronic daily headaches occurring more than 15 days each month. The patients were 101 men and 33 women, most refractory to at least three conventional headache medications.

After each treatment, patients quantified the results using a five-point scale ranging from 1 for no improvement to 5 for excellent effect. Overall, 84% of patients reported improvement, as did 92% of patients who had four treatments, with a mean score of 4.3. There were no gender differences or adverse events noted.

"There were significant improvements that appear to be progressive and may also be cumulative," Troost says. "I tell patients that it is important not [to] give up if it has only a mild effect the first time. The second or third time it really seems to work better."

For headache treatment, Botox is injected into periorbital, frontalis, temporalis, and sometimes jaw muscles. For patients with global headaches, additional injections are given in cervical and shoulder muscles. Doses in this study ranged from 30-200 U for chronic daily headache and 15-240 U for migraine.

"Overuse of medications for debilitating headaches has been observed in up to 80% of chronic daily headache patients," Troost says. "These patients should be considered for preventive therapy."

© 2002 WebMD Inc. All rights reserved.

    
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