Relja Giuliano, Granato Antonio, Maria Antonello Rodolfo, Zorzon Marino
Headache Center, Department of Clinical Medicine and Neurology, University of Trieste, Italy.
Headache. 2004 Feb;44(2):148-53. doi: 10.1111/j.1526-4610.2004.04031.x.
The International Headache Society has defined the diagnostic criteria for headache induced by substance use. Recently, a revision to these criteria has been proposed.
To consider whether the International Headache Society criteria for headache induced by substance use and the proposed revisions for the classification of daily and near-daily headache with medication abuse permit classification of patients commonly seen in a headache center.
One hundred fourteen consecutive patients (96 women [84.2%] and 18 men [15.8%]; mean age, 54.2 years [SD, 14]) with headache and chronic overuse of medications, admitted for detoxification to the inpatient unit of a headache center, participated in the study. The initial headache, medications and doses used, duration of daily medication use, and means of medication administration were studied.
Eighty-one patients (71%) had an initial headache of migraine without aura, 13 patients (11.4%) had migraine without aura and coexistent tension-type headache, 11 (9.7%) patients had migraine with and without aura, and 9 patients (7.9%) had episodic tension-type headache. Medications overused by patients included analgesics combined with barbiturates or other nonnarcotic substances in 39.5%, simple analgesics in 38.6%, triptans in 11.4%, and ergotamine in 10.5%. Using the International Headache Society diagnostic criteria, we were able to classify only 28.1% of our patients; the proposed revised criteria for daily and near-daily headaches with medication abuse permitted the classification of 46.4% of patients.
The minimum dose of medication required to induce chronic headache should be revised because a high proportion of patients are not classifiable using either the International Headache Society diagnostic criteria or the revised criteria recently proposed. A more comprehensive definition for the required minimum dose might be used. Triptan abuse can cause chronic headache and should be included in the International Headache Society classification.
国际头痛协会已明确了物质使用所致头痛的诊断标准。最近，有人提议对这些标准进行修订。
探讨国际头痛协会关于物质使用所致头痛的标准以及针对药物滥用导致的每日及近每日头痛分类的提议修订版，是否能对头痛中心常见患者进行分类。
114例因头痛且长期药物滥用而入住头痛中心住院部进行戒毒治疗的连续患者（96名女性[84.2%]和18名男性[15.8%]；平均年龄54.2岁[标准差14]）参与了本研究。对初始头痛情况、使用的药物及剂量、每日用药持续时间和用药方式进行了研究。
81例患者（71%）初始头痛为无先兆偏头痛，13例患者（11.4%）有无先兆偏头痛并伴有紧张型头痛，11例患者（9.7%）有或无先兆偏头痛，9例患者（7.9%）有发作性紧张型头痛。患者过度使用的药物包括：39.5%为镇痛药联合巴比妥类药物或其他非麻醉性物质，38.6%为单纯镇痛药，11.4%为曲坦类药物，10.5%为麦角胺。使用国际头痛协会诊断标准，我们仅能对28.1%的患者进行分类；针对药物滥用导致的每日及近每日头痛的提议修订标准能对46.4%的患者进行分类。
应修订诱发慢性头痛所需的最小药物剂量，因为使用国际头痛协会诊断标准或最近提议的修订标准，有很大比例的患者无法进行分类。或许可采用更全面的所需最小剂量定义。曲坦类药物滥用可导致慢性头痛，应纳入国际头痛协会分类中。
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