Ghiotto N, Sances G, Galli F, Tassorelli C, Guaschino E, Sandrini G, Nappi G
Headache Unit & University Centre for Adaptive Disorders and Headache, Mondino Institute of Neurology Foundation, Pavia, Italy.
Cephalalgia. 2009 Feb;29(2):233-43. doi: 10.1111/j.1468-2982.2008.01712.x. Epub 2008 Nov 18.
Medication overuse headache (MOH) is a growing problem worldwide and a challenge for clinicians and investigators. This study aims to contribute to the ongoing debate surrounding the classification of MOH. Applying the revised diagnostic criteria for MOH contained in the updated International Classification of Headache Disorders (ICHD-II), we enrolled 140 probable MOH (p-MOH) patients. They were submitted to an in-patient detoxification protocol and re-examined 2, 6 and 12 months later to confirm, or otherwise, the diagnosis of MOH and to observe the evolution of their headache. MOH diagnosis was confirmed 2 months after detoxification in 71% of patients, who reverted to an episodic headache pattern and stopped their drug overuse The overall clinical situation at 2 months closely reflected the 1-year trend. The 2-month period after drug withdrawal should be retained as a diagnostic criterion in the ICHD-II because it is useful not only as a diagnostic parameter, but also as predictor of a good outcome of 1-year drug withdrawal. In addition, the present findings point to the need for a more objective criterion to quantify headache frequency after drug withdrawal.
药物过量使用性头痛（MOH）在全球范围内是一个日益严重的问题，对临床医生和研究人员来说也是一项挑战。本研究旨在为围绕MOH分类的持续争论做出贡献。应用更新后的《国际头痛疾病分类》（ICHD-II）中包含的MOH修订诊断标准，我们招募了140例可能患有MOH（p-MOH）的患者。他们接受了住院戒毒方案，并在2个月、6个月和12个月后再次接受检查，以确认或排除MOH诊断，并观察其头痛的演变情况。71%的患者在戒毒2个月后确诊为MOH，这些患者恢复为发作性头痛模式并停止了药物过量使用。2个月时的总体临床情况密切反映了1年的趋势。停药后2个月的时间段应保留为ICHD-II中的诊断标准，因为它不仅作为诊断参数有用，而且作为1年停药良好结局的预测指标也有用。此外，目前的研究结果表明需要一个更客观的标准来量化停药后的头痛频率。
