【原】药物过度使用头痛（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Wakerley BR. Medication-overuse headache. Pract Neurol. 2019,19(5):399-403.本次学习由谢珺田副主任医师主讲。

Abstract

Medication-overuse headache is defined as headache occurring on more than 15days in a month in people with pre-existing primary headache, and developing as a consequence of regular overuse of acute headache treatments. Medication-overuse headache is common in general neurology clinics and can be difficult to manage. Most patients have a background of migraine, which has slowly transformed over months and years from the episodic to chronic form; with this comes an increased use of acute migraine treatment. This paper identifies who is at risk of developing medication-overuse headache, and reviews preventive measures and current treatment strategies.

Keywords: chronic migraine; daily headache; medication-overuse headache; migraine; rebound headache.

摘要

药物过度使用头痛是指原发性头痛患者因经常过度使用急性头痛治疗药物而产生的，一个月内发作15天以上的头痛。药物过度使用头痛在神经内科门诊很常见，而治疗较为困难。大多数患者都有偏头痛的背景，偏头痛经过数月和数年的时间慢慢从急性发作型转变为慢性型；随之而来的是急性偏头痛治疗药物的使用增加。本文确立了哪些患者有发生药物过度使用头痛的风险，并综述了现行的预防措施和治疗方法。

关键词：慢性偏头痛;慢性每日头痛;药物过度使用头痛;偏头痛;反跳性头痛。

Introduction

The observation that the analgesics used to treat headache can themselves cause headache is a paradox that over the years has led to significant confusion and frustration among both doctors and patients. Furthermore, so-called medication-overuse headache does not occur in everyone who overuses medication, and may occur in people taking analgesics for other conditions associated with chronic pain. The latest International Classification of Headache Disorders (ICHD-3),3 an expert consensus view, defines medication-overuse headache (also known as drug-induced headache, medication-misuse headache and rebound headache) as: 'headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months’ (box 1). Medication-overuse headache is therefore considered a secondary headache disorder. It most frequently occurs in the context of chronic migraine and less with commonly chronic tension-type headache. It is a major global health problem with significant morbidity. This paper identifies who is at risk of developing medication-overuse headache, and reviews preventive measures and current treatment strategies (figure 1).

引文

用于治疗头痛的止痛剂本身会导致头痛，这一发现本身似乎就是一个悖论，多年来一直困扰着医生和患者。此外，所谓的药物过度使用头痛并非发生于所有过度使用药物的人群，只是可能发生于因各种与慢性疼痛相关的病症而服用止痛药的患者。依据最新版的头痛疾病国际分类（ICHD-3），学者一致认为，将药物过度使用头痛（也称为药物诱发头痛、药物滥用头痛和反跳性头痛）定义为：“原发性头痛患者由于经常过度使用急性或症状性头痛药物（每月10天或以上或15天或以上，取决于药物）超过3个月以上引起的每月发作15天或以上的头痛”（表1）。因此药物过度使用头痛应被认为是继发性头痛疾病。它最常发生于慢性偏头痛患者，较少发生于慢性紧张型头痛患者。这是一个严重的全球健康问题，发病率很高。本文明确了哪些患者有发生药物过度使用头痛的风险，并综述了现行的预防措施和治疗方法（图1）。

How common is medication-overuse headache?

Epidemiological studies indicate that up to 4% of the population overuse analgesics and 1% have medication-overuse headache. One study estimated that up to 70% of people with chronic daily headache have medication-overuse headache.

药物过度使用头痛发生率如何？

流行病学研究表明，高达4%的人群过度使用止痛药，1%的人有药物过度使用头痛。一项研究估计，高达70%的慢性每日头痛患者有药物过度使用头痛。