Migraine Preventive Treatment Failure: A Cross-Sectional Study in a Tertiary Center in Brazil
DOI:
https://doi.org/10.48208/HeadacheMed.2023.39Palavras-chave:
Migraine, Preventive Therapy, Treatment Failure, Healthcare Resources, Disease BurdenResumo
Introdução: No Brasil, há escassez de evidências sobre o impacto da migrânea em pacientes que experimentaram falha em tratamento preventivo prévio (FTPP). Objetivo: Avaliar as associações entre ≥ 3 FTPP e dados clínicos, psiquiátricos e histórico médico. Métodos: Em um estudo retrospectivo e seccional, os prontuários de pacientes pela primeira vez consultando um especialista em cefaleia foram examinados. Selecionamos adultos de ambos os sexos com idade ≥ 18 anos que fizeram consulta entre Março e Julho de 2017. Modelos de regressão logística ordinal estimaram as associações entre o número de FTPP (nenhum tratamento anterior, 1 FTPP, 2 e ≥ 3 FTPP) e migrânea crônica, o número de exames diagnósticos realizados, classes de medicamentos abortivos utilizados e tratamentos não farmacológicos tentados (todos categorizados como nenhum, 1-3 e ≥ 4), e depressão grave (PHQ-9 ≥ 15) e ansiedade (GAD-7 ≥ 15), ajustados por sexo, idade e anos com a doença. Resultados: Dados de 440 pacientes (72,1% do sexo feminino) com uma média (DP) de idade de 37,3 (13,0) anos foram analisados. A frequência de nenhum tratamento anterior foi de 37,7% (166/440), enquanto 31,8% (140/440) apresentaram ≥ 3 FTPP. Entre esses, 35,7% (50/140) tinham migrânea episódica, e 64,3% (90/140) tinham migrânea crônica. Comparados ao grupo sem tratamento anterior, os pacientes com ≥ 3 FTPP mostraram maior probabilidade (intervalo de confiança de 95%) de migrânea crônica [2,10 (1,47, 2,98)], ≥4 exames diagnósticos [6,59 (3,38, 12,84)], ≥4 classes de medicamentos abortivos [16,03 (9,53, 26,94)], ≥4 tratamentos não farmacológicos [5,91 (3,07, 11,35)], e depressão grave [1,75 (1,07, 2,88)] e ansiedade grave [1,73 (1,05, 2,85)]. Conclusão: Pacientes que consultaram pela primeira vez um especialista tiveram uma alta frequência de não resposta ao tratamento, associada a um elevado impacto em termos de cronificação, comorbidade psiquiátrica, ineficácia de medicamentos agudos e tratamento não farmacológico, e exames desnecessários.
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Copyright (c) 2023 Arão Belitardo Oliveira, Eduardo Almeida Guimarães Nogueira, Mario Fernando Prieto Peres (Author)
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
