目的:评估曲唑酮联合托吡酯疗法治疗药物过度使用性头痛的疗效和安全性.方法:采用前瞻性研究,将105例药物过度使用性头痛(medication overuse headache,MOH)病人随机分为两组:对照组52例,服用托吡酯治疗,观察组53例,在托吡酯治疗的同时加用曲唑酮,疗程均为3个月.所有受试者接受治疗期间撤去急性期止痛药及其他药物.采用汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)评估戒断性焦虑,评估两组治疗效果及不良反应发生率.结果:接受治疗后第7天、15天、30天、90天,观察组HAMA评分明显低于对照组,差异有统计学意义(P<0.05).观察组治疗总有效率94.3%,高于对照组的65.4%,差异有统计学意义(P<0.05).针对不良反应发生率,观察组(16.98%)与对照组(15.38%)的差异无统计学意义.结论:曲唑酮联合托吡酯治疗药物过度使用所致的戒断性焦虑、头痛有良好疗效,耐受性好,可用于MOH的治疗.%Objective: To evaluate the safety and efficacy of trazodone combined topiramate in treatment of medication overuse headache (MOH). Methods: Prospectively, 105 patients with MOH were randomly divided into two groups. The control group with 52 cases received topiramate, while the observation group with another 53 cases further received trazodone. A course of treatment was three months. All MOH patients were recommended to withdraw from overused analgesics and other drugs. The withdrawal anxiety was evaluated with Hamilton Anxiety Scale. The outcome of therapy and incidence of adverse events were compared between these two groups. Results:After 7,15,30 , and 90 days treatment, the Hamilton Anxiety Scale score of the observation group was significantly higher than that of the control group (P < 0.05). The total efficiency rate of the observation group was 94.3% , significantly higher than that of the control group (65.4%, P < 0.05). In addition, the incidence of adverse reaction in observation groups was 16.98% and in control group was 15.38%,there was no statistically significant difference. Conclusion: Trazodone combined topiramate can improve withdrawal anxiety and the symptoms of headache, and has good tolerance, that can be recommend in treatment of medication overuse headache.
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