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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">r-n-j</journal-id><journal-title-group><journal-title xml:lang="ru">Российский неврологический журнал</journal-title><trans-title-group xml:lang="en"><trans-title>Russian neurological journal</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2658-7947</issn><issn pub-type="epub">2686-7192</issn><publisher><publisher-name>МИА</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.30629/2658-7947-2024-29-6-35-43</article-id><article-id custom-type="elpub" pub-id-type="custom">r-n-j-636</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CLINICAL RESEARCHES AND CASE REPORTS</subject></subj-group></article-categories><title-group><article-title>Оптимизация ведения пациентов с хронической мигренью и цервикалгией с использованием когнитивно-поведенческой терапии: проспективное двухлетнее рандомизированное исследование</article-title><trans-title-group xml:lang="en"><trans-title>Optimizing the management of patients with chronic migraine and neck pain: a prospective randomized trial with long-term follow-up</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2752-4109</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Головачева</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Golovacheva</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Москва</p></bio><bio xml:lang="en"><p>Moscow</p></bio><email xlink:type="simple">xoxo.veronicka@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2845-7323</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Головачева</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Golovacheva</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Москва</p></bio><bio xml:lang="en"><p>Moscow</p></bio><email xlink:type="simple">angelika.golovacheva@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1992-7960</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Парфенов</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Parfenov</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Москва</p></bio><bio xml:lang="en"><p>Moscow</p></bio><email xlink:type="simple">vladimirparfenov@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru">Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)<country>Россия</country></aff><aff xml:lang="en">I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia<country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>31</day><month>01</month><year>2025</year></pub-date><volume>29</volume><issue>6</issue><fpage>35</fpage><lpage>43</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Головачева В.А., Головачева А.А., Парфенов В.А., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Головачева В.А., Головачева А.А., Парфенов В.А.</copyright-holder><copyright-holder xml:lang="en">Golovacheva V.A., Golovacheva A.A., Parfenov V.A.</copyright-holder><license license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.r-n-j.com/jour/article/view/636">https://www.r-n-j.com/jour/article/view/636</self-uri><abstract><p>У большинства пациентов с хронической мигренью (ХМ) выявляется скелетно-мышечная цервикалгия, которая поддерживает хроническое течение мигрени и затрудняет лечение. Когнитивно-поведенческая терапия (КПТ) перспективна в комплексном лечении пациентов с ХМ и цервикалгией, однако ее эффективность недостаточно изучена в рандомизированных исследованиях.Цель исследования — оценить эффективность терапевтической программы, включающей КПТ, в лечении пациентов с ХМ и цервикалгией. Материал и методы. В исследование включено 120 пациентов с ХМ и цервикалгией (41 мужчина и 79 женщин), средний возраст 35,7 ± 9,2 лет. Проводились клиническая беседа, неврологический осмотр и тестирование. Пациенты были рандомизированы в две группы: группа 1 получала стандартную терапию ХМ (фармакотерапию профилактическую и для купирования приступов мигрени, информирование о заболевании и рекомендации по образу жизни), стандартную нелекарственную терапию цервикалгии (рекомендации по физической активности и лечебную гимнастику), при наличии лекарственно индуцированной головной боли (ЛИГБ) — стандартную терапию ЛИГБ (отмену обезболивающих препаратов (ОП), принимаемых ранее пациентом в избыточном количестве, терапию для облегчения симптомов отмены ОП, а при избыточном приеме рецептурных ОП или в случаях рецидива ЛИГБ проводилась терапия дексаметазоном) и КПТ; группа 2 получала стандартную терапию ХМ, стандартную нелекарственную терапию цервикалгии, стандартную терапию ЛИГБ (при наличии у пациента ЛИГБ). У всех пациентов оценивались клинические и психологические показатели до лечения и на 3, 6, 12 и 24 месяц после начала лечения.Результаты. Через 3 месяца лечения в группе 1 наблюдалось статистически значимое (p &lt; 0,05) улучшение: снижение частоты ГБ, частоты и кратности приема ОП, интенсивности цервикалгии по Визуальной аналоговой шкале (ВАШ), общего балла перикраниальной болезненности (ОБПБ), показателей по шкале оценки влияния мигрени на повседневную активность (ШОВМПА), по индексу ограничения жизнедеятельности из-за боли в шее (ИОЖБШ), шкале катастрофизации боли, шкале личностной и ситуативной тревоги Спилбергера-Ханина, шкале депрессии центра эпидемиологических исследований. Через 6, 12 и 24 месяца от начала лечения достигнутые улучшения сохранились. В группе 2 через 3 месяца лечения отмечалось статистически значимое (p &lt; 0,05) улучшение только шести показателей — частоты ГБ, частоты и кратности приема ОП, интенсивности цервикалгии по ВАШ, показателей по ШОВМПА и ИОЖБШ. Однако через 6, 12 и 24 месяца наблюдения в группе 2 достигнутые улучшения не сохранились. Через 3 месяца лечения клинический эффект (КЭ) по ХМ (уменьшение частоты ГБ на 50% и более) и КЭ по цервикалгии (снижение интенсивности боли по ВАШ и показателя по ИОЖБШ на 30% и более) в группе 1 достигли 75% пациентов, в группе 2 — 45% (p &lt; 0,001). Через 24 месяца наблюдения КЭ по ХМ и цервикалгии в группе 1 имели 80% пациентов, в группе 2 — 30% (p &lt; 0,001).Заключение. Добавление КПТ к стандартной терапии ХМ и цервикалгии повышает эффективность лечения пациентов в краткосрочной и долгосрочной перспективе.</p></abstract><trans-abstract xml:lang="en"><p>Most patients with chronic migraine (CM) have musculoskeletal neck pain, which maintains the chronic course of migraine and complicates treatment. Cognitive behavioral therapy (CBT) is promising in the complex treatment of patients with CM and cervicalgia. However, few randomized trials have been conducted to evaluate the effectiveness of CBT in CM.The aim of the study was to evaluate the effectiveness of an multidisciplinary program including CBT in the treatment of patients with CM and neck pain.Material and methods. The study included 120 patients with CM and neck pain (41 men and 79 women), average age 35.7 ± 9.2 years. All patients underwent a clinical interview, neurological examination and testing using clinical and psychological methods. Patients were randomized into two groups: group 1 received standard treatment and CBT, group 2 — only standard treatment. All patients were assessed for clinical and psychological indicators before treatment and at 3, 6, 12 and 24 months follow-up.Results. At 3 months follow-up, statistically significant (p &lt; 0.05) improvement was observed in group 1: decrease in headache frequency, frequency and doses of taking painkillers (PK), neck pain intensity by the Visual Analogue Scale (VAS), the Total pericranial pain score, in the Migraine Disability Assessment (MIDAS), in the Neck Disability Index (NDI), in the Pain catastrophizing scale, the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale. At 6, 12 and 24 months follow-up, the achieved improvements were maintained. In group 2, at 3 months follow-up, statistically significant improvement was observed in only six indicators — headache frequency, frequency and doses of taking PK, neck pain intensity by VAS, MIDAS and NDI. However, at 6, 12 and 24 months of follow-up the achieved improvements were not maintained in group 2. At 3 months of follow-upin group 1 was clinical efficacy (CE) for CM (decrease in headache frequency by 50% or more) and CE for neck pain (decrease in pain intensity by VAS and the NDI by 30% or more) achieved by 75% of patients, in group 2 — 45% (p &lt; 0.001). At 24 months follow-up in group 1 CE for CM and neck pain was achieved by 80% of patients, in group 2 — 30%.Conclusion. An multidisciplinary program including CBT is significantly more effective than standard treatment for chronic migraine and neck in the short and long term.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>хроническая мигрень</kwd><kwd>цервикалгия</kwd><kwd>боль в шее</kwd><kwd>лекарственно-индуцированная головная боль</kwd><kwd>коморбидные нарушения</kwd><kwd>лечение</kwd><kwd>междисциплинарный подход</kwd><kwd>когнитивно-поведенческая терапия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>chronic migraine</kwd><kwd>neck pain</kwd><kwd>medication overused headache</kwd><kwd>comorbid disorders</kwd><kwd>treatment</kwd><kwd>multidisciplinary approach</kwd><kwd>cognitive behavioral therapy</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">The International Classification of Headache Disorders, 3 rd edition (ICHD-3). 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