Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period
Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period
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DOI：
10.1111/j.1526-4610.2006.00442.x
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发表时间：
2006-05-01
期刊：
影响因子：
5
通讯作者：
Bigal, ME
中科院分区：
文献类型：
--
作者：
Meskunas, CA;Tepper, SJ;Bigal, ME
目标。目的：评估过去15年来某头痛中心与药物过度使用性头痛（MOH）相关的物质。在过去的15年里，偏头痛的急性治疗方法发生了很大的变化，因此，与MOH相关的物质也可能发生了变化。我们随机回顾了2005年、2000年、1995年和1990年受试者的图表，以确定与MOH相关的物质。由于《国际头痛疾病分类》第二版提出的标准要求通过停药后的改善来证明因果归因（本研究未对此进行评估），因此我们在此提到可能的MOH （PMOH）。我们对比了研究期间与PMOH相关的物质。-我们的样本由1200人组成，每年300人感兴趣。诊断为PMOH的受试者比例多年来保持稳定，从1990年占该中心所有病例的64%到2005年的59.3%不等。我们发现，可能的麦角胺过度使用头痛的相对频率显著下降（从18.6%降至0%，P < 0.0001），可能的联合止痛药过度使用头痛的相对频率显著下降（从42.2%降至13.6%,P < 0.0001）。阿片类药物过度使用头痛的差异不显著。曲坦类药物（从0%增加到21.6%,P < 0.0001）、单纯镇痛药（从8.8%增加到31.8%,P < 0.05）和急性联合用药（从9.8%增加到22.7%,P = 0.01）的相对频率显著增加。虽然过度使用急性药物仍然是三级保健领域的一个重要问题，但与过度使用相关的物质在过去15年中发生了巨大变化。教育活动应强调新的特定急性偏头痛药物（曲坦类药物）也可能与PMOH有关。
Objectives.-To evaluate the substances associated with medication overuse headache (MOH) in a headache center, over the course of the past 15 years.Background.-The acute treatment of migraine has substantially changed over the past 15 years, and therefore, the substances associated with MOH may have changed as well.Methods.-We randomly reviewed charts of subjects seen during the years of 2005, 2000, 1995, and 1990, to identify substances associated with MOH. Since the criteria proposed by the second edition of the International Classification of Headache Disorders require causal attribution, demonstrated by improvement after withdrawal (and this was not assessed in this study), herein we refer to probable MOH (PMOH). We contrasted the substances associated with PMOH over the studied years.Results.-Our sample consists of 1200 individuals, 300 per year of interest. The proportions of subjects with a diagnosis of PMOH remained stable over the years, varying from 64% of all cases seen in the center in 1990, to 59.3% in 2005. We found a significant decrease in the relative frequency of probable ergotamine overuse headache (from 18.6% to 0%, P < .0001), and in probable combination analgesic overuse headache (from 42.2% to 13.6%, P < .0001). The differences were not significant for opioid overuse headache. The relative frequency increased significantly for the triptans (from 0% to 21.6%, P < .0001), simple analgesics (from 8.8% to 31.8%, P < .05), and for combinations of acute medications (from 9.8% to 22.7%, P = .01).Conclusion.-While overuse of acute medications remains an important problem in the tertiary care arena, the substances associated with the overuse have dramatically changed over the past 15 years. Educational initiatives should emphasize that the newer specific acute migraine medications (triptans) may also be associated with PMOH.