Zeeberg P, Olesen J, Jensen R
Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
Cephalalgia. 2009 Feb;29(2):214-20. doi: 10.1111/j.1468-2982.2008.01710.x. Epub 2008 Sep 24.
The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre and compared the results with those using the current criteria. For CM we also tested two alternative criteria, one requiring > or = 4 migraine days/month and > or = 15 headache days/month, the second requiring > or = 15 headache days/month and > or = 50% migraine days. We included 969 patients with migraine or tension-type headache (TTH) among 1326 patients treated and dismissed in a 2-year period. Two hundred and eighty-five patients (30%) had TTH, 265 (27%) had migraine and 419 (43%) had mixed migraine and TTH. The current criteria for MOH classified 86 patients (9%) as MOH, 98 (10%) as probable MOH and 785 (81%) as not having MOH after a 2-month drug-free period. Using the appendix criteria, 284 patients (29%) were now classified as MOH, no patients as probable MOH and 685 (71%) as not having MOH. For CM only 16 patients (3%) fulfilled the current diagnostic criteria. This increased to 42 patients (7%) when we applied the appendix criteria. Using the less restrictive criteria of > or = 4 migraine days and > or = 15 headache days, 88 patients (14%) had CM, whereas the more restrictive criteria of > or = 15 headache days and > or = 50% migraine days resulted in 24 patients (4%) with CM. Our data suggest that the IHS has succeeded in choosing new criteria for CM which are neither too strict, nor too loose. For MOH, a shift to the appendix criteria will increase the number of MOH patients, but take into account the possibility of permanent changes in pain perception due to medication overuse and the possibility of a renewed effect of prophylactic drugs due to medication withdrawal. We therefore recommend the implementation of the appendix criteria for both MOH and CM into the main body of the International Classification of Headache Disorders.
国际头痛协会（IHS）分类小组委员会最近提出了药物过量使用性头痛（MOH）和慢性偏头痛（CM）的修订标准。我们将这些修订标准应用于丹麦头痛中心的头痛患者群体进行实地测试，并将结果与使用现行标准的结果进行比较。对于CM，我们还测试了两个替代标准，一个要求每月偏头痛天数≥4天且每月头痛天数≥15天，另一个要求每月头痛天数≥15天且偏头痛天数≥50%。在两年内接受治疗并出院的1326例患者中，我们纳入了969例偏头痛或紧张型头痛（TTH）患者。285例患者（30%）患有TTH，265例（27%）患有偏头痛，419例（43%）患有偏头痛和TTH混合型。现行的MOH标准在经过2个月的药物洗脱期后，将86例患者（9%）分类为MOH，98例（10%）分类为可能的MOH，785例（81%）分类为无MOH。使用附录标准时，现在有284例患者（29%）被分类为MOH，无患者被分类为可能的MOH，685例（71%）被分类为无MOH。对于CM，只有16例患者（3%）符合现行诊断标准。当我们应用附录标准时，这一数字增加到42例患者（7%）。使用每月偏头痛天数≥4天且每月头痛天数≥15天这种限制较少的标准时，88例患者（14%）患有CM，而使用每月头痛天数≥15天且偏头痛天数≥50%这种限制较多的标准时，有24例患者（4%）患有CM。我们的数据表明，IHS成功地为CM选择了既不过于严格也不过于宽松的新标准。对于MOH，转向附录标准会增加MOH患者的数量，但要考虑到药物过量使用导致疼痛感知永久性改变的可能性以及药物戒断后预防性药物重新起效的可能性。因此，我们建议将MOH和CM的附录标准纳入《国际头痛疾病分类》的主体内容。
