Analysis of the current status and influencing factors of standardized migraine drug treatment:a cross⁃sectional study based on 2 028 patients
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Department of Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 ,China
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摘要:
目的：调查偏头痛患者预防性药物治疗的指南遵从性现状，量化评估治疗不足与潜在过度治疗的规模，并分析其相关影响因素。方法：采用横断面研究设计，纳入2020年1月—2025年8月于南京医科大学第一附属医院头痛专病门诊就诊，且符合国际头痛疾病分类第3版诊断标准的2 028例偏头痛患者。依据《中国偏头痛诊断与治疗指南（2023版）》及国际头痛学会偏头痛预防药物治疗全球实践建议，以每月偏头痛天数≥4 d作为预防性治疗指征，并结合实际用药情况分为符合指征组（A组）、 潜在过度治疗组（B组）、规范急性期治疗组（C组）、用药不当组（D组），比较各组临床特征及用药模式差异，并以多因素Logistic 回归分析A组治疗不足的影响因素。结果：2 028例患者中，A组685例（33.8%），其中21.2%（145/685）存在治疗不足；B组、C组和D组分别为446例（22.0%）、619例（30.5%）和278例（13.7%）。A、B组预防性用药以钙离子拮抗剂和抗癫痫药为主，B组钙离子拮抗剂使用率高于 A 组（71.3% vs. 40.6%，P ＜ 0.001）；急性期药物中，曲普坦类、对乙酰氨基酚、非甾体抗炎药和降钙素基因相关肽受体拮抗剂在C组使用率最高。多因素Logistic回归分析显示，急性期特异性药物使用（调整的OR=1.90，95%CI： 1.27~2.82，P=0.002）和每月偏头痛天数增加（调整的OR=1.02，95%CI：1.00~1.03，P=0.036）与A组治疗不足显著相关。结论：偏头痛预防性治疗存在明显的“双向不规范”现象，即符合指征患者治疗不足，而不符合指征患者存在潜在过度治疗。临床实践中应严格把握预防性治疗指征，强化对急性期特异性药物使用者的预防治疗评估，并规范药物选择与头痛分型诊断，以提高指南遵从性。
Abstract:
Objective：To investigate guideline adherence to preventive pharmacotherapy in patients with migraine，quantify the extent of undertreatment and potential overtreatment，and analyze the associated influencing factors. Methods：In this cross-sectional study，2 028 patients with migraine who attended the specialized headache clinic of the First Affiliated Hospital of Nanjing Medical University between January 2020 and August 2025 and fulfilled the diagnostic criteria of the International Classification of Headache Disorders，3rd edition（ICHD-3）were enrolled. According to the Chinese Guidelines for the Diagnosis and Treatment of Migraine（2023 edition）and the International Headache Society’s global practice recommendations for preventive pharmacological treatment of migraine，≥4 monthly migraine days was defined as the indication for preventive treatment. Based on treatment indications and actual medication use，patients were categorized into four groups：indication - comforming group（Group A），potential overtreatment group （Group B），appropriate acute treatment group（Group C），and inappropriate medication use group（Group D）. Clinical characteristics and medication patterns were compared among the groups. Multivariable logistic regression was performed to identify factors associated with undertreatment in Group A. Results：Among the 2 028 patients，685（33.8%）were assigned to Group A，of whom 21.2%（145/685） were undertreated. Groups B，C，and D comprised 446（22.0%），619（30.5%），and 278（13.7%）patients，respectively. Preventive medications in Groups A and B were mainly calcium channel blockers and antiepileptic drugs，with a significantly higher use of calcium channel blockers in Group B than in Group A（71.3% vs. 40.6%，P ＜ 0.001）. For acute medications，triptans，acetaminophen， nonsteroidal anti-inflammatory drugs，and calcitonin gene-related peptide receptor antagonists were used most frequently in Group C. Multivariable logistic regression showed that the use of acute migraine-specific medications（adjusted OR=1.90，95%CI：1.27-2.82，P= 0.002）and a greater number of monthly migraine days（adjusted OR=1.02，95%CI：1.00-1.03，P=0.036）were significantly associated with undertreatment in Group A. Conclusion：Preventive treatment of migraine demonstrated a clear pattern of bidirectional nonadherence，characterized by undertreatment among patients with indications for preventive therapy and potential overtreatment among those without such indications. In clinical practice，stricter adherence to indications for preventive treatment is needed，along with strengthened evaluation of preventive therapy among users of migraine - specific acute medications and more standardized drug selection and headache subtype diagnosis，in order to improve guideline adherence.
