关键词: 偏头痛, 焦虑, 托吡酯, 文拉法辛, 治疗结果

Abstract: Background　Chronic migraine is prone to be combined with anxiety and depression disorder.But Chinese guidelines for the prevention and treatment of migraine do not specify the treatments for chronic migraine with generalized anxiety disorder.Neurologists or general practitioners choose the treatments of chronic migraine with generalized anxiety disorder according to personal experience or existing drugs in our hospital，and there is no large sample study report in China.Objective　To explore the efficacy and safety of topiramate titration combined with venlafaxine in the treatment of chronic migraine with generalized anxiety disorder.Methods　158 patients with chronic migraine were selected in  the Second Affiliated Hospital of Guangxi Medical University from June 2018 to February 2020.We divided into two groups according to the random number table，one was topiramate group and the other was topiramate combined with venlafaxine group，all of them were treated for 6 months.The attack days，visual analogue scale（VAS），migraine specific quality of life questionnaire（MSQ v2.1），HIT-6，PSQI，HAMA and adverse drug reactions were evaluated before treatment and 3 and 6 months after treatment between two groups.Results　125 patients completed 6 months of treatments and follow-ups，65 cases in topiramate group and 60 cases in topiramate combined with venlafaxine group.There was no interaction between treatment time and treatment method（P>0.05）.Treatment time and treatment method had significant effect on headache attack days，VAS，HIT-6 and PSQI（P<0.05）.After 3 months of treatment，the headache attack days，VAS，HIT-6，PSQI and MSQ V2.1 total scores of the two groups decreased compared with those before treatment（P<0.05）.After 6 months of treatment，the attack days and PSQI in topiramate group were less than those in the same group for 3 months，while the attack days，VAS，HIT-6 and PSQI in the topiramate combined with venlafaxine group were less than those in the same group for 3 months（P<0.05）.After 6 months of treatment，the headache attack days，VAS，HIT-6 of topiramate combined with venlafaxine group were less than those of topiramate group（P<0.05）.There was no interaction between treatment time and treatment method（P>0.05）.Treatment time and treatment method had significant effect on MSQ v2.1 function limitation，function loss，emotional function and total score was significant（P<0.05）.MSQ v2.1 function limitation，function loss，emotional function and total score of the two groups were lower than those before treatment after 3 months of treatment（P<0.05）.After 6 months of treatment，the function limitation，function loss，emotional function and total score of topiramate combined with venlafaxine group were lower than those of the same group for 3 months（P<0.05）.After 6 months of treatment，the function limitation，function loss，emotional function and total score of topiramate combined with venlafaxine group were lower than those of topiramate group（P<0.05）.The effective rate of topiramate combined with venlafaxine group was higher than that of topiramate group at 3 and 6 months（P<0.05）.There were 114 patients with oral topiramate dose of 100 mg/D，accounting for 79.78%（71/89） of the total effective number；18 patients with 150 mg / D accounted for 20.22%（18/89）.There was no significant difference in the incidence of adverse drug reactions between the two groups（χ2=0.170，P=0.680）.Conclusion　Topiramate combined with venlafaxine is safe and effective in the treatment of chronic migraine with generalized anxiety disorder.

Key words: Migraine disorders, Anxiety, Topiramate, Venlafaxine, Treatment outcome