[Psychophysiological features of analgesics abuse headache]

Sixty patients with abuse headache (AHA) (58 women and 2 men, mean age 44.5 years) and 10 age- and sex-matched controls have been studied. AHA diagnostic criteria were as follows: daily or almost daily headache, daily or every other day use of analgesics, primary headache (migraine or headache of tension--HAT) in anamnesis, uneffectiveness of medication. Clinico-neurological analysis, headache diary, Beck depression scale, Spilberger Trait/State Inventory, "Pain lifetime anamnesis", autonomic dystonia questionnaire, evaluation of night-time sleep score subjective characteristics and nociceptive flexor reflex (R-111) (NFR) determination were used. The results obtained confirmed the literature data that analgesics abuse in migraine resulted in AHA 2 times more often than in HAT. The causes were mainly psychogenic: mood improvement, night-time sleep normalization and post-stress cephalgia intensification. An influence of such factors as age and menopause was not found. Headache was of mixed character with features of both migraine and HAT and was not dependent on cephalgia type in anamnesis. Quantity of analgesics taken by the patients ranged from 40 to 120 tablets a month and influenced, in general, a speed of primary HA to AHA transformation. For AHA formation, systematic analgesics intake was more significant comparing to its absolute quantity. Pronounced psycho-autonomic disorders and night-time sleep disturbances in AHA were revealed. In analgesics abuse, pain and NFR thresholds were significantly higher as compared to controls. However, pain to reflex thresholds ratio proved to be reduced that indicated a relative deficiency of antinociceptive system which is necessary for pain syndrome reduction.