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目的评估成人慢性紧张性头痛(TTH)预防用药的有效性和耐受性。方法从起点到2009年8月对几个数据库进行了检索,选择相关的随机试验。这些试验报告了TTH病人预防用药的效果,以疼痛测量(强度、频率、持续时间、改善或指数)作为结果测量。2位作者就原始报告偏倚和提取数据的风险进行了独立评估。根据药物类型进行数据整合。结果本研究共涵括44个试验(3 399例病人),其中15个试验(34.1%)有偏倚低风险。研究药物主要包括抗抑郁药、肌肉松弛药、地西泮和血管扩张剂。整体上,抗抑郁药不比安慰剂更有效,不同抗抑郁药间无明显差异。与安慰剂比较,地西泮和血管扩张剂的有效证据不一致。此外,与安慰剂或生物反馈疗法比较,普萘洛尔对TTH病人的抑郁有负性影响。与安慰剂相比,未发现单用肌肉松弛剂或5-HT受体促效剂使用证据。结论总之,对减轻头痛严重度或减少发生频率,用抗抑郁药和止痛剂不比安慰剂更有效。与安慰剂或生物反馈相比,普萘洛尔似乎对TTH病人的抑郁有负性影响。未发现单用肌肉松弛药或5-HT受体促效剂的证据。
Objective To evaluate the efficacy and tolerability of preventive prophylaxis for chronic tension-induced headache (TTH) in adults. Methods From the beginning to August 2009, several databases were searched and the relevant randomized trials were selected. These trials report the effect of prophylaxis in TTH patients measured as a result of pain measurements (intensity, frequency, duration, improvement or exponential). Two authors independently assessed the risk of bias and data extraction from the original report. Data integration based on drug type. Results A total of 44 trials (3 399 patients) were included in this study, of which 15 trials (34.1%) were biased at low risk. Research drugs include antidepressants, muscle relaxants, diazepam and vasodilators. Overall, antidepressants were not more effective than placebo and no significant difference was found between different antidepressants. Valid evidence for diazepam and vasodilators was inconsistent with placebo. In addition, propranolol had a negative effect on depression in TTH patients compared with placebo or biofeedback. No evidence of single-use muscle relaxant or 5-HT receptor agonist use was found compared with placebo. Conclusions In conclusion, antidepressants and analgesics are no more effective than placebo in reducing headache severity or reducing the frequency of occurrence. Propranolol appears to have a negative effect on depression in TTH patients compared to placebo or biofeedback. No evidence of single muscle relaxant or 5-HT receptor agonist was found.