背 景：偏頭痛為一常見的神經性疾病，除了頭痛症狀外，也有充份的流行病學證據支持偏頭痛與憂鬱症、泛焦慮症、失眠等精神疾病之共病性，經常性的發作可引起病患嚴重失能，影響到日常的工作以及降低生活品質。因此本研究藉由使用三種不同偏頭痛預防藥物：propranolol、valproic acid、topiramate，比較其臨床療效及副作用。
方法：共收納75名符合IHS偏頭痛診斷標準之病人，隨機分配給予propranolol、valproic acid、topiramate共三個月的時間，以頭痛的頻次(次/周)、強度(VAS)、每次頭痛發作時間(小時)以及作為指標來進行評估，利用匹斯堡睡眠品質量表與醫院焦慮與憂鬱量表分析藥物對偏頭痛之精神症狀的影響，並記錄用藥期間任何與藥物相關的副作用。
結果：病患的平均年齡為47.4歲，偏頭痛發作病史平均為18.5年。三種使用的藥物皆能有效的減少患者之頭痛頻次、強度、時間；另外，valproic acid對於患者的睡眠品質、焦慮以及憂鬱量表的分數，也有顯著的改善。安全性方面，propranolol以發生胸悶的報告為多，尤其容易發生在增加劑量的調整區間，valproic acid耐受性良好，topiramate的不良反應常使病患無法耐受，因此而退出用藥的比率最高。
結論：本研究使用的藥物皆為台灣偏頭痛學會推薦的第一線慢性偏頭痛預防用藥，結果顯示三者的臨床療效相當，但對於睡眠品質、或精神共病症狀的改善程度不一，因此針對預防頭痛的效果上，可考慮患者合併之精神共病症狀、各藥物禁忌症來選擇，若病患無法耐受副作用，則可換成另外一種藥物。
Background: Migraine headache is a common neurological disorder with a prevalence rate around 10~20% in general population. Besides headache, migraine also associates to varied psychiatric symptoms such as anxiety, depression and insomnia. Migraine often causes impaired quality of life, loss of work hours, and decreases productivity. The aim of this study was to evaluate the clinical effects and safety of propranolol, valproic acid, and topiramate.
Methods: A total of 75 patients with migraine defined to IHS criteria were included, and assigned to receive propranolol, valproic acid, or topiramate for 3 months. Frequency, duration, severity of migraine attacks, and side effects were evaluated. Co-morbidity of psychiatric symptoms was also assessed with PSQI and HADS questionnaires.
Results: The 54 patients who completed treatment had a mean age of 47.4 years, and mean duration of migraine for 18.5 years. All the three drugs significantly decreased the headache frequency, intensity, and duration (p<0.05). Compared to baseline, there were significant improvements in PSQI and HADS scores of valproic acid. The major side effect of propranolol was chest tightness; discontinuation rate due to adverse events was higher with topiramate.
Conclusion: The results of this study indicated that propranolol, valproic acid, and topiramate had similar benefits in migraine prophylaxis. Although these drugs had different profiles of adverse effects and contraindications, in the event of failure of or intolerance for one treatment, the patient may be switched to the other.
