Katsarava Z, Fritsche G, Muessig M, Diener H C, Limmroth V
Department of Neurology, University Hospital Essen, Germany.
Neurology. 2001 Nov 13;57(9):1694-8. doi: 10.1212/wnl.57.9.1694.
Complete withdrawal from headache medication is the treatment of choice for medication-overuse headache. Discontinuation of the overused headache medication, however, results in the development of withdrawal headache, often associated with nausea, vomiting, and sleep disturbances.
In a prospective study of 95 patients, the authors investigated the duration and severity of withdrawal headache after overuse of various headache drugs, including single and combination analgesics, ergots, and triptans. All patients underwent standard inpatient withdrawal therapy for 14 days.
The duration of withdrawal headache was shorter in patients overusing triptans (4.1 days) than in patients overusing ergots (6.7 days) or analgesics (9.5 days; p < 0.002). The mean headache intensity on the first day of withdrawal did not differ between the groups (p = 0.821). By day 14, however, it was lower in patients overusing triptans (0.08) than in patients overusing ergots (0.4) or analgesics (0.9; p < 0.005). Rescue medication was requested less by patients undergoing triptan withdrawal (0.25 requests) than by patients undergoing ergot withdrawal (1.25) or analgesic withdrawal (1.85; p < 0.05). Similar to findings in the entire patient population, withdrawal headache was shorter and less severe in migraineurs overusing triptans than in those overusing ergots or analgesics. Because only patients with migraine, but no patient with tension-type headache, overused triptans, withdrawal headache was shorter in the group of patients with migraine alone (6.7 days versus 9.6 days for patients with tension-type headache and 8.5 days for patients with combination headache, p < 0.02).
The duration and severity of withdrawal clearly depend on the type of overused headache drug only.
完全停用头痛药物是药物过量使用性头痛的首选治疗方法。然而，停用过量使用的头痛药物会导致戒断性头痛的发生，常伴有恶心、呕吐和睡眠障碍。
在一项对95例患者的前瞻性研究中，作者调查了过量使用各种头痛药物（包括单一和复合镇痛药、麦角类药物和曲坦类药物）后戒断性头痛的持续时间和严重程度。所有患者均接受了为期14天的标准住院戒断治疗。
过量使用曲坦类药物的患者戒断性头痛持续时间（4.1天）比过量使用麦角类药物的患者（6.7天）或镇痛药的患者（9.5天）短（p<0.002）。戒断第一天的平均头痛强度在各组之间无差异（p=0.821）。然而，到第14天时，过量使用曲坦类药物的患者的头痛强度（0.08）低于过量使用麦角类药物的患者（0.4）或镇痛药的患者（0.9；p<0.005）。与麦角类药物戒断的患者（1.25次）或镇痛药戒断的患者（1.85次）相比，曲坦类药物戒断的患者请求使用急救药物的次数更少（0.25次；p<0.05）。与整个患者群体的研究结果相似，过量使用曲坦类药物的偏头痛患者的戒断性头痛比过量使用麦角类药物或镇痛药的患者更短、更轻。由于只有偏头痛患者，而没有紧张型头痛患者过量使用曲坦类药物，因此仅偏头痛患者组的戒断性头痛持续时间较短（6.7天，而紧张型头痛患者为9.6天，混合性头痛患者为8.5天，p<0.02）。
戒断的持续时间和严重程度显然仅取决于过量使用的头痛药物类型。
