medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-080medsovet-7414Research ArticleГОЛОВНАЯ БОЛЬ И ГОЛОВОКРУЖЕНИЕHEADACHE AND VERTIGOЛечение хронической мигрени и инсомнии с помощью когнитивно-поведенческой терапииTreatment of chronic migraine and insomnia with cognitive behavioral therapyhttps://orcid.org/0000-0002-2752-4109ГоловачеваВ. А.GolovachevaV. A.

Головачева Вероника Александровна - кандидат медицинских наук, доцент кафедры нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Veronika A. Golovacheva - Cand. Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

xoxo.veronicka@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202311042023036876Copyright © Головачева В.А., 20232023Головачева В.А.Golovacheva V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7414Введение

Введение. Хроническая мигрень (ХМ) – неврологическое заболевание, которое часто сочетается с хронической инсомнией (ХИ). Для лечения пациентов с ХМ в сочетании с ХИ рекомендуется междисциплинарный подход, включающий когнитивно-поведенческую терапию (КПТ).

Цель

Цель. Оценить эффективность междисциплинарной программы лечения, включающей КПТ, в лечении пациентов с ХМ и ХИ. Материалы и методы. В исследование включены 54 пациента с ХМ и ХИ (19 мужчин и 35 женщин), средний возраст 34,1 ± 8,5 года. Оценка клинико-психологических показателей проводилась до и после лечения (на 3-м, 6-м, 12-м месяце наблюдения) с помощью беседы, тестирований, дневников головной боли и сна. Всем пациентам проводилось междисциплинарное лечение, включающее фармакотерапию, отмену обезболивающих препаратов при наличии лекарственно-индуцированной головной боли (ЛИГБ), КПТ головной боли и инсомнии.

Результаты

Результаты. Через 3 мес. после лечения наблюдалось статистически значимое снижение средних показателей по частоте головной боли, частоте приема обезболивающих, индексу тяжести инсомнии, шкале личностной и ситуативной тревоги Спилбергера – Ханина, шкале депрессии Бека, шкале оценки влияния мигрени на повседневную активность (p < 0,05). На 6-м и 12-м месяце наблюдения достигнутые улучшения сохранялись. На 3-м месяце наблюдения 35 (65%) пациентов достигли клинического эффекта в лечении ХМ: частота головной боли снизилась на 50% и более, 41 (76%) пациент достиг клинического эффекта в лечении ХИ: индекс тяжести инсомнии уменьшился на 8 баллов и более. К 6-му месяцу у 42 (77,8%) пациентов был клинический эффект в терапии ХМ, у 44 (81,5%) пациентов – в терапии ХИ. К 12-му месяцу наблюдения достигнутые клинические эффекты сохранялись.

Заключение

Заключение. Междисциплинарная программа, включающая КПТ, эффективна в лечении пациентов с ХМ и ХИ в краткосрочной и долгосрочной перспективе.

Introduction

Introduction. Chronic migraine (CM) is a neurological disease which is often comorbid with chronic insomnia (CI). The interdisciplinary approach including the cognitive behavioural therapy (CBT) is recommended for the treatment of patients with CM and comorbid CI.

Aim

Aim. To evaluate the effectiveness of the interdisciplinary treatment program including CBT in the treatment of patients with CM and CI. Materials and methods. A total of 54 patients with CM and CI (19 men and 35 women, mean age 34.1 ± 8.5 years), were enrolled in the study. The clinical and psychological characteristics were assessed before and after treatment (at Month 3, 6, 12) using interviewing, testing, headache and sleep diaries. All patients received the interdisciplinary treatment, including pharmacotherapy, discontinuation of pain medications in the presence of drug-induced headache (DIHA), CBT for headache and insomnia.

Results

Results. Three months after treatment, there was a statistically significant decrease in mean scores for headache frequency, pain drugs dosing interval, insomnia severity index, as well as according to the Spielberger Khanin's Reactive and Personal Anxiety Scale, Beck Depression Scale, Impact of Migraine on Daily Activities Scale (p < 0.05). The achieved improvements were maintained at Months 6 and 12 of the follow-up period. At Month 3, 35 (65%) patients achieved a clinical effect in the treatment of CM: the frequency of headache decreased by 50% or more, 41 (76%) patients achieved a clinical effect in the treatment of CI: the insomnia severity index decreased by 8 scores and more. At Month 6, 42 (77.8%) patients had a clinical effect in CM therapy, and 44 (81.5%) patients in CI therapy. The achieved clinical effects have been shown to be maintained by Month 12 of the follow-up period.

Conclusion

Conclusion. The interdisciplinary program including CBT is effective in the treatment of patients with CM and CI over the shortand long-term horizon.

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The authors declare that there are no conflicts of interest present.