Headache Disorders, Secondary

WEDNESDAY, Dec. 11, 2024 -- Adults receiving chiropractic spinal manipulative therapy (SMT) for tension-type headache have a significantly lower likelihood of butalbital prescription, according to a study published online Nov. 29 in Health Science Reports . Robert J. Trager, D.C., from the Case Western Reserve University School of Medicine in Cleveland, and colleagues assessed whether receiving chiropractic SMT for tension-type headache impacts receipt of butalbital prescription. The analysis included 3,116 matched patients with tension-type headache receiving and not receiving SMT. The researchers found that the incidence of butalbital prescription was lower in the SMT cohort versus the non-SMT cohort (SMT: 1.7 percent; non-SMT: 3.8 percent; risk ratio, 0.46). The SMT cohort also had a lower incidence of medication overuse headache versus the non-SMT cohort (SMT: 0.5 percent; non-SMT: 1.2 percent; risk ratio, 0.44). "Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, medication overuse headache compared to matched controls not receiving SMTs," the authors write. "These findings reinforce clinical practice guidelines already recommending SMT for tension-type headache. However, additional research is needed to corroborate our results and examine the association between a broader variety of nonpharmacologic interventions and butalbital prescription and medication overuse headache." Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

临床在治疗头晕、偏头痛、耳鸣耳聋等疾病时，经常会联合使用氟桂利嗪和倍他司汀，这属于重复用药吗？本文通过对比两种药物的药理作用、适应证及用法用量等方面来进行分析解答。 1 氟桂利嗪 1）药理作用： 氟桂利嗪为桂利嗪的二氟化衍生物，同样为选择性 Ca2+ 拮抗剂，可阻止过量 Ca2+ 进入血管平滑肌细胞，引起血管扩张，对脑血管的选择性较好，而对心肌血管作用较差，因此对血压、心率的影响小。 对血管收缩物质引起的血管痉挛有持久的抑制作用，对基底动脉和颈内动脉作用更明显；增加耳蜗内辐射小动脉血流量从而改善前庭器官微循环、抑制眼球震颤和眩晕；可抑制缺血缺氧引起的钙超载，进而保护脑组织、维持血管内皮的完整性；可阻断神经细胞的病理性钙超载而防止阵发性去极化，细胞放电，从而避免癫痫发作；抗组胺和镇静作用。 2）适应证： 典型（有先兆）或非典型（无先兆）偏头痛的预防性治疗；前庭障碍，如眩晕、耳鸣、眼震、梅尼埃综合征、恶心、呕吐；脑循环障碍，如脑供血不足、头昏、血管性头痛、睡眠障碍、烦躁，脑血栓形成后姿势不稳；动脉循环障碍，如椎动脉缺血、四肢发冷、间歇性跛行、手脚麻木；静脉循环障碍，如下肢静脉曲张、足踝水肿；末梢循环障碍，如肢体末端水肿、皮肤苍白；癫痫的辅助治疗。 注：以下人群禁用氟桂利嗪：对本药或桂利嗪过敏者、脑出血性疾病急性期、帕金森氏病及锥体外系疾病、有抑郁病史者、妊娠期及哺乳期妇女禁用。 2 倍他司汀 1）药理作用： 倍他司汀是组胺 H1 受体弱激动剂、H3 受体强拮抗剂，能增加组胺的周转和释放，具有扩张血管作用，有促进脑干、内耳血液循环，缓解血管痉挛并减轻膜迷路积水的作用。 另外，倍他司汀能抵抗儿茶酚胺的缩血管作用及降低动脉压，并由抑制血液凝固及 ADP 诱导的血小板凝集作用，能延长大鼠的体外血栓形成时间，还有轻微的利尿作用。 2）适应证： 用于内耳眩晕症，亦可用于脑动脉硬化、缺血性脑血管疾病及高血压所致体位性眩晕、耳鸣。 注：对本药过敏者、嗜铬细胞瘤患者、儿童禁用。 3 氟桂利嗪、倍他司汀能否联用？如何使用？ 通过上述药理机制我们可知，二者通过不同的作用机制达到扩张血管、增加内耳血流量从而改善前庭微循环的作用，可以联合应用，同时可能增强疗效。 一些临床研究表明，相较氟桂利嗪或倍他司汀单药治疗，二者联合治疗眩晕症、耳鸣等疾病时疗效更佳，且安全性良好。 现整理二者的用法用量总结如下： 氟桂利嗪的用法用量： 倍他司汀的用法用量： 4 关于倍他司汀，还要注意以下几点 1）口服 or 静脉？ 应遵循能口服，不肌注，能肌注，不静脉的原则。因为口服用药方便且更安全，所以建议首选倍他司汀口服剂型使用，降低静脉输液使用率。 2）甲磺酸倍他司汀 or 盐酸倍他司汀？ 甲磺酸倍他司汀与盐酸倍他司汀在临床用药适应证、安全性及不良反应等方面均相似。 相比盐酸倍他司汀，甲磺酸倍他司汀与受体（H1、H3）的结合率相对更高，且餐后用药的胃内溶解度更高，生物利用度更好。甲磺酸倍他司汀比盐酸倍他司汀的达峰时间更短、药物半衰期更长。医师可根据实际情况酌情选用。 5 总结 在治疗眩晕症、耳鸣这些疾病时，氟桂利嗪联合倍他司汀有时可能较单药治疗效果更佳，医师在应用时应结合患者情况灵活科学应用。 专家精彩点评 神经内科头痛、头晕的患者众多，氟桂利嗪和倍他司汀是常用的两个药物。氟桂利嗪作为钙通道拮抗剂，主要用于偏头痛的预防治疗和眩晕的治疗。氟桂利嗪用于偏头痛预防治疗证据级别较强，耐受性良好，最常见的不良反应是镇静和体重增加。需注意 65 岁以上老年患者需减半服用，且用药期间注意监测抑郁、锥体外系反应等不良反应，推荐疗程不超过 6 个月。 倍他司汀具有组胺样作用，主要用于内耳眩晕症，需注意有消化道溃疡史或活动性消化道溃疡的患者、支气管哮喘的患者慎用，肾上腺髓质瘤患者禁用。两者通过不同作用机理，对眩晕症、耳鸣等疾病可联合使用，可根据患者情况灵活应用。 本文首发于丁香园旗下专业平台：丁香园神经时间策划 | 时间胶囊  投稿 | wangyue5@dxy.cn 题图 | 站酷海洛 参考文献：（上下滑动查看） 1. 梁富前, 梁祖贤, 骆勇, 谢绍维. 耳鸣患者采用倍他司汀联合盐酸氟桂利嗪治疗的临床疗效分析 [J]. 中国医学文摘（耳鼻咽喉科学）,2022,37(2):79-80,83. 2. 鲁秀荣. 倍他司汀联合氟桂利嗪治疗眩晕症中的应用效果观察 [J]. 黑龙江医药科学,2022,45(2):159-160. 3. 张铨成, 叶松福, 蓝秀梅. 盐酸氟桂利嗪胶囊联合甲磺酸倍他司汀片治疗良性眩晕症临床效果观察 [J]. 北方药学,2022,19(12):72-74. 4. 武俊波, 张基伟, 张丽荣, 赵明枝, 刘利娟. 盐酸氟桂利嗪联合盐酸倍他司汀治疗椎-基底动脉供血不足性眩晕症的临床效果观察 [J]. 内科,2022,05:523-526. 5. CHEN X Y, ZHONG D F, DUAN J L, et al. LC-MS-MS analysis of 2-pyridylacetic acid，a major metabolite of betahistine：application to a pharmacokinetic study in healthy volunteers[J]. Xenobiotica，2003, 33(12): 1261-1271. 6. LI S F，WONG S，SETHIA S，et al. Investigation of solubility and dissolution of a free base and two different salt forms as a function of pH [J]. Pharm Res, 2005, 22(4): 628-635.

WEDNESDAY, Sept. 18, 2024 -- Monthly use of erenumab injections (140 mg) is safe and effective in achieving medication overuse headache (MOH) remission in patients with nonopioid chronic migraine (CM) and MOH, according to a study published online Sept. 16 in JAMA Neurology . Stewart J. Tepper, M.D., from the New England Institute for Neurology and Headache in Stamford, Connecticut, and colleagues assessed the safety and efficacy of erenumab in patients with nonopioid CM-MOH. The analysis included 584 participants randomly assigned to erenumab (70 mg or 140 mg) or placebo, once monthly for 24 weeks. The researchers found that at month 6, 69.1 percent of participants in the erenumab 140-mg group (odds ratio, 2.01; 95 percent confidence interval, 1.33 to 3.05; P < 0.001 versus placebo) and 60.3 percent in the erenumab 70-mg group (odds ratio, 1.37; 95 percent confidence interval, 0.92 to 2.05; P = 0.13 versus placebo) achieved MOH remission versus 52.6 percent of participants in the placebo group. From baseline, least squares mean change in average monthly acute headache medication days was –9.4 days in the erenumab 140-mg group (difference from placebo, –2.7) and –7.8 days in the erenumab 70-mg group (difference from placebo, –1.2). Throughout the treatment period, MOH remission was sustained in 61.3 percent of participants in the erenumab 140-mg group, 49.5 percent of participants in the 70-mg group, and 37.6 percent in the placebo group. The safety profile was similar to that seen in previous trials, with treatment-emergent adverse event incidence in the combined erenumab group of 66.8 percent, including most commonly constipation (15.2 percent) and COVID-19 (13.9 percent). "This study is the first controlled trial to provide American Academy of Neurology class I evidence of beneficial effects of a migraine preventive treatment in patients with CM-MOH (nonopioid)," the authors write. Several authors disclosed ties to pharmaceutical companies, including Amgen, which manufactures erenumab and funded the study. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.