Lake Alvin E
Michigan Head Pain and Neurological Institute, Ann Arbor, MI 48104, USA.
Headache. 2008 Jan;48(1):26-31. doi: 10.1111/j.1526-4610.2007.00971.x.
The new appendix criteria for a broader concept of chronic migraine from the International Headache Society no longer require headache resolution or return to the previous headache pattern to confirm the diagnosis of medication overuse headache (MOH). MOH can be subdivided into simple (Type I) and complex (Type II). Complex cases may involve long-term use of daily opioids or combination analgesics, multisourcing, multiple psychiatric comorbidities, and/or a history of relapse. Daily use of opioids for other medical conditions, psychiatric comorbidity including borderline personality disorder, prior history of other substance dependence or abuse, and family history of substance disorders are risk factors for MOH. Relapse for analgesic overusers can be as high as 71% at 4-year follow-up. A case illustration spans 20 years from initial presentation through multiple periods of recovery and relapse to illustrate issues in the screening and management of complex MOH patients.
国际头痛协会对慢性偏头痛更广泛概念的新附录标准不再要求头痛缓解或恢复到先前的头痛模式来确诊药物过度使用性头痛（MOH）。MOH可细分为单纯型（I型）和复合型（II型）。复杂病例可能涉及长期每日使用阿片类药物或复方镇痛药、多药合用、多种精神疾病共病和/或复发史。因其他医疗状况每日使用阿片类药物、包括边缘性人格障碍在内的精神疾病共病、既往其他物质依赖或滥用史以及物质障碍家族史是MOH的危险因素。在4年随访中，镇痛药过度使用者的复发率可高达71%。一个病例说明从初次就诊开始历经多个康复和复发阶段，跨度达20年，以阐述复杂MOH患者筛查和管理中的问题。
