Rapoport Alan M
Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
CNS Drugs. 2008;22(12):995-1004. doi: 10.2165/0023210-200822120-00003.
Episodic migraine is a disabling painful disease that can affect the normal function of daily routine activities such as performance at work and school, and home and social relationships. In addition to the physical disability during migraine, between attacks many patients experience a condition referred to as interictal burden, which can present as pre-event worry about future attacks and can result in the anticipatory use and/or overuse of acute care medications. The overuse of medication can often lead to medication overuse headaches (MOHs) and chronic migraine. Unfortunately, patients, and even some physicians, are often unaware of this phenomenon. Therefore, it is important for knowledgeable physicians to raise awareness and to address the risks of medication overuse with their patients through effective communication. Future management of medication overuse should include detoxification and a comprehensive programme that includes the use of preventive medications such as sodium valproate (divalproex sodium) and topiramate in order to reduce dependency on acute care medication. Also, MOHs may be most effectively managed with the initiation of preventive treatment prior to detoxification, in addition to the decreased use of acute care medication. A long-term treatment plan, including behavioural therapy, migraine preventive medication and appropriate acute care therapy, may be optimal in treating patients with MOHs.
发作性偏头痛是一种致残性疼痛疾病，会影响日常活动的正常功能，如工作、学习表现以及家庭和社会关系。除了偏头痛发作时的身体残疾外，在发作间期，许多患者还会经历一种称为发作间期负担的情况，表现为对未来发作的事前担忧，并可能导致急性护理药物的预期使用和/或过度使用。药物过度使用往往会导致药物过量使用性头痛（MOHs）和慢性偏头痛。不幸的是，患者甚至一些医生常常没有意识到这种现象。因此，知识渊博的医生通过有效的沟通提高患者的认识并解决药物过度使用的风险非常重要。药物过度使用的未来管理应包括排毒和一个综合方案，该方案包括使用预防性药物，如丙戊酸钠（双丙戊酸钠）和托吡酯，以减少对急性护理药物的依赖。此外，除了减少急性护理药物的使用外，在排毒前开始预防性治疗可能是管理MOHs最有效的方法。一个长期治疗计划，包括行为疗法、偏头痛预防性药物和适当的急性护理疗法，可能是治疗MOHs患者的最佳方法。
