在集群头痛中探索药物过量使用和药物过量使用头痛
Nunu Lund1, Marie-Louise Kulas Søborg1, Louise Ninett Carlsen1,2
1Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet - Glostrup, Glostrup, Denmark.
Cephalalgia : an international journal of headache
|August 29, 2025
概括
药物过度使用头痛 (MOH) 影响16%的群头痛 (CH) 患者,过度使用简单的止痛药,三药和阿片类药物很常见. 慢性心血管疾病和偏头痛是相关的因素,影响治疗的有效性.
科学领域:
- 神经学
- 头痛的药物
背景情况:
- 药物过度使用头痛 (MOH) 的患病率和集群头痛 (CH) 的诊断标准尚不清楚.
- 对于了解MOH对疾病管理和患者结果的影响至关重要.
研究的目的:
- 为了确定药物过量使用和可能的MOH在一个良好的CH队列.
- 确定与CH中MOH相关的因素,并评估其临床影响.
- 评估现有的MOH诊断标准的适用性.
主要方法:
- 根据ICHD-3标准对433名被诊断为CH患者进行了半结构面试.
- 使用ICHD-3标准评估过度使用药物和可能的MOH,并采用保守的定义 (每日双侧头痛).
- 分析了相关因素和临床影响,包括治疗的有效性.
主要成果:
- 在21%的CH患者中,药物过度使用,其中16%符合可能的MOH标准 (12%不包括单独的类药物过度使用).
- 过度使用的药物包括简单止痛药 (52.2%),三 (37.3%),阿片类药物 (29.9%) 和组合疗法 (20.9%).
- 慢性CH (OR=11. 4) 和并发性偏头痛 (OR=2. 35) 是相关的因素. 可能的MOH与更长的发作持续时间和治疗效率的降低有关.
结论:
- 在约16%的CH患者中,可能存在MOH,在保守的定义下,患病率较低 (4%).
- 现有的MOH标准可能需要针对CH进行调整,特别是考虑到每日发作和间歇性疼痛.
- 在CH中,MOH与急性和预防性治疗的有效性降低有关,因此需要进一步研究其作为加重因素的作用.
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