背景:自从第一次描述nummular头痛(NH)以来,已经描述了500多例,描绘其临床表型和对治疗的反应。然而,目前尚无长期随访期间NH自然史和结局的数据.本研究旨在描述大量NH患者的长期结局和随访。
方法:对一系列病例进行描述性观察性综合研究。研究人群包括患有原发性NH的成年患者和至少12个月的随访。人口统计变量,既往病史,临床表型,NH的诊断和治疗,时间模式,并对长期演变进行了分析。
结果:总计,168例患者入选,随访中位数[四分位距(IQR)]为80.5(55-118.5)个月。NH发病后的时间模式是慢性的,占67.9%,在诊断时,每月疼痛天数中位数(IQR)为20[10-30]天,其中138例(82.1%)患者每月疼痛天数≥8天.112例(66.7%)患者需要预防性治疗。最常用的药物是加巴喷丁(69/112;61.6%)。单甲毒素A(38/112;33.9%),阿米替林(31/112;27.7%)和拉莫三嗪(21/112;18.7%)。91/112(81.3%)患者对预防性治疗的反应至少部分。在后续行动结束时,81例(48.2%)患者的NH不活跃。活动性NH患者,每月头痛天数中位数(IQR)为3(1~12)天,35例(20.8%)患者疼痛≥8天.
结论:大多数患者的NH长期结局为阳性。经过6.7年的平均随访,48%的病例不活跃。三分之二的患者需要预防性治疗,其中80%对治疗有反应。在仍有症状的NH病例中,头痛频率较低,慢性NH患者的比例从68%下降到11%。
Since the first description of nummular headache (NH), more than 500 cases have been described, delineating its clinical phenotype and response to treatment. However, data on the natural history of NH and outcomes during long-term follow-up are not currently available. The present study aimed to describe the long-term outcomes and follow-up of a large series of patients with NH.
A descriptive observational ambisective study with a series of cases was conducted. The study population included adult patients with primary NH and a minimum of 12 months of follow-up. Demographic variables, previous medical history, clinical phenotype, diagnosis and treatment of NH, temporal pattern, and long-term evolution were analysed.
In total, 168 patients were enrolled and followed for a median [interquartile range (IQR)] of 80.5 (55-118.5) months. The temporal pattern after NH onset was chronic in 67.9% and, at diagnosis, the median (IQR) number of pain days per month was 20 [10-30] days with 138 (82.1%) patients with ≥8 days of pain per month. Preventive treatment was needed by 112 (66.7%) patients. The most frequently used drugs were gabapentin (69/112; 61.6%), onabotulinumtoxinA (38/112; 33.9%), amitriptyline (31/112; 27.7%) and lamotrigine (21/112; 18.7%). Response to preventive treatment was at least partial in 91/112 (81.3%) patients. At the end of follow-up, 81 (48.2%) patients had inactive NH. Of patients with active NH, the median (IQR) number of headache days per month was 3 (1-12) days and patients had ≥8 days of pain in 35 (20.8%) cases.
Long-term outcomes of NH were positive in most patients. After a median of 6.7 years of follow-up, 48% of cases were inactive. Two-thirds of patients required preventive treatment, and 80% of them were treatment-responsive. In NH cases that remained symptomatic, the headache frequency was lower, and the proportion of patients with chronic NH decreased from 68% to 11%.