目的:确定美国头痛协会(AHS)成员如何管理门诊患者中的偏头痛状态(SM)。
背景:SM被定义为持续72小时以上的衰弱性偏头痛发作。SM没有标准的护理,包括在攻击可以被视为SM之前是否需要72小时的持续时间。
方法:来自AHS的难治性头痛特别兴趣小组开发了一项由四个问题组成的调查,分发给AHS成员,询问(1)他们是否治疗严重的难治性偏头痛发作与SM相同,无论持续时间如何,(2)他们在SM管理中的第一步是什么,(3)他们用于SM的前三种药物是什么,和(4)他们是否获得了联合神经亚专科理事会(UCNS)认证。该调查于2022年1月进行。进行描述性统计分析。
结果:收到了来自1859名AHS成员中的196名(10.5%)的回应;64.3%的人在头痛管理方面获得了UCNS认证。在72小时过去之前,受访者将69.4%(136/196)的重度难治性偏头痛发作患者视为SM。大多数(76.0%,149/196)选择“在家远程使用门诊药物治疗”作为第一步,11.2%(22/196)首选程序,6.1%(12/196)支持输液中心,6.1%(12/196)将患者送往急诊科(ED)或紧急护理,0.5%(1/196)首选直接入院。前五名的首选药物如下:(1)皮质类固醇(71.4%,140/196),(2)非甾体抗炎药(NSAIDs)(50.1%,99/196),(3)抗精神病药(46.9%,92/196),(4)曲坦(30.6%,60/196),和(5)双氢麦角胺(DHE)(21.4%,42/196)。
结论:具有头痛医学专长的医疗保健专业人员通常在早期治疗严重的偏头痛发作,并且不需要等待72小时才能达到SM的诊断标准。大多数受访者更喜欢使用一种或多种家庭使用药物的门诊管理;很少有人选择ED转诊。最后,皮质类固醇,NSAIDs,抗精神病药,Triptans,和DHE是家庭SM管理的前五名首选治疗方法。
OBJECTIVE: Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients.
BACKGROUND: SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72-h duration is required before the attack can be treated as SM.
METHODS: The Refractory Headache Special Interest Group from AHS developed a four-question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed.
RESULTS: Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72-h period had elapsed. Most (76.0%, 149/196) chose \"treat remotely using outpatient medications at home\" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti-inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196).
CONCLUSIONS: Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management.