預防性偏頭痛治療後偏頭痛急性用藥比較之研究

偏頭痛被世界衛生組織（WHO）列為世界前二十大令人失能疾病之一。當嚴重的偏頭痛發作的時候，它所造成的失能程度就如同四肢癱瘓一樣。而根據過去的研究指出，當偏頭痛病人之頭痛發作的頻率較高時，使用預防性藥物可以改善頭痛發作的頻率、因頭痛造成的失能程度、頭痛的嚴重度。因此，本研究運用台北榮總神經內科醫師所提供之全民健康保險研究資料庫中的2005年承保抽樣歸人檔，針對2005至2009年這段期間，偏頭痛之病人在投予預防性藥物治療之後，其前後一年偏頭痛與頭痛急性藥物的月定義每日劑量、月費用以及累計處方門診數之比較研究。本研究之偏頭痛病人共32,544人，利用台灣頭痛學會推薦的偏頭痛預防性藥物將病人分群，然後用變異數分析探討族群間急性藥物的差異，且用配對樣本t檢定探討族群自身急性藥物的改變。研究的結果發現，偏頭痛病人的人數，女性約為男性的3倍，病人平均年齡的變異程度不一，族群自身急性藥物的月定義每日劑量與累計處方門診數有顯著的改善，月費用的改善則程度不一。另一方面，本研究的貢獻在於，若是無法進行臨床實驗以及比較其臨床療效時，提供了利用全民健康保險研究資料庫進行偏頭痛治療藥物間比較之另一種研究方法。

關鍵字

全民健保資料庫；偏頭痛；急性藥物

並列摘要

Migraine has been listed as one of the top twenty disabling diseases by WHO. When severe migraine onsets, it may cause various degrees of disabling in ability, as if paralysis of four limbs. According to past studies, when a patient experienced frequent migraine onset, the use of preventive medication could improve the frequency, the degree of disability, and the severity of disease. Therefore, the study used the Longitudinal Health Insurance Database 2005 (LHID2005) of the National Health Insurance Research Database from the Internal Neuroscience Department of the Taipei Veterans General Hospital. It was a contrast research to compare the monthly defined daily dose, the monthly expense, and the accumulative outpatient prescription of patients one year before and after the preventive medication, as well as the patients of acute onset between 2005 and 2009. The study included 32,544 individuals with migraine. By following the recommended list of preventive medication by the Taiwan Headache Society, patients were grouped and analyzed for intergroup variation using the ANOVA. With paired t-test, the change in each individual within the group after administration for acute onset would be investigated. The research result showed that the female population had 3 times more than males. The average age of onset varied. Significant improvement in the monthly defined daily dose and the accumulative outpatient prescription was seen after administration for acute onset. As for the monthly expense, the degree of improvement varied. On the other hand, the study result contributed an alternative method of research to compare various medication modes for migraine using the National Health Insurance Research Database, if it was impossible to conduct a clinical trial to assess the therapeutic effect.