Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD 20814, USA.
Cephalalgia. 2010 Mar;30(3):321-8. doi: 10.1111/j.1468-2982.2009.01913.x. Epub 2010 Feb 1.
Though symptomatic medication overuse is believed to play a role in progression from episodic headaches (EH) to chronic daily headaches (CDH), population-based data on this topic are limited. Our objective was to describe patterns of medication use among CDH and EH sufferers in a general population sample. We compared medications used to treat headache in CDH cases and EH controls identified from a large population-based computer-assisted telephone interview survey. CDH began within 5 years of the computer-assisted telephone interview. Questions on medication use focused on treatment prior to the onset of CDH for cases and on an equivalent period in the past for controls. We asked about the likelihood of treating, time waiting to treat, number of different medications used, first, second and third most frequently used headache pain medication, and total treatment days. Questions were also asked about the use of medication for non-headache pain. Current treatment patterns and past treatment patterns were assessed. Likelihood of use of specific medications was compared between CDH cases and EH controls after adjusting for age, sex, primary headache type and number of medications taken to treat pain. Our sample consists of 206 CDH cases and 507 EH controls. CDH subjects were more likely than EH controls to use over-the-counter/caffeine combination products, triptans, opioid compounds and 'other' prescription pain medications. Use of aspirin was protective. After adjustment, aspirin and ibuprofen were (negatively) associated with CDH [OR = 0.5 (0.3-0.9), OR = 0.7 (0.5-1.0)] and opioids remained positively associated with CDH [OR = 2.3 (1.3-3.9)]. For past use, CDH was positively associated with over-the-counter/caffeine combination products and opioid compounds and was negatively associated with use of aspirin. Only ibuprofen remained (negatively) associated with CDH after adjustment [OR = 0.6 (0.4-0.9)]. After adjusting for demographic factors, primary headache type and number of medications taken, CDH sufferers are more likely to use opioid-combination analgesics, and less likely to use aspirin or ibuprofen, than EH sufferers.
尽管人们认为症状性药物滥用在从发作性头痛（EH）向慢性每日头痛（CDH）的进展中起作用，但关于这一主题的基于人群的数据有限。我们的目的是描述一般人群样本中 CDH 和 EH 患者的药物使用模式。我们比较了从一项大型基于人群的计算机辅助电话访谈调查中确定的 CDH 病例和 EH 对照者使用的治疗头痛的药物。CDH 在计算机辅助电话访谈后 5 年内开始。关于药物使用的问题侧重于病例的 CDH 发作前和对照者过去的等效时期。我们询问了治疗的可能性、治疗等待时间、使用的不同药物数量、首选的第二和第三种头痛止痛药，以及总治疗天数。还询问了用于非头痛疼痛的药物使用情况。评估了当前的治疗模式和过去的治疗模式。在调整年龄、性别、主要头痛类型和用于治疗疼痛的药物数量后，比较了 CDH 病例和 EH 对照者使用特定药物的可能性。我们的样本包括 206 例 CDH 病例和 507 例 EH 对照者。与 EH 对照者相比，CDH 患者更有可能使用非处方/咖啡因组合产品、曲坦类药物、阿片类化合物和“其他”处方止痛药。使用阿司匹林具有保护作用。调整后，阿司匹林和布洛芬与 CDH 呈负相关[OR=0.5（0.3-0.9），OR=0.7（0.5-1.0）]，而阿片类药物与 CDH 呈正相关[OR=2.3（1.3-3.9）]。对于过去的使用，CDH 与非处方/咖啡因组合产品和阿片类化合物呈正相关，与阿司匹林的使用呈负相关。调整后，只有布洛芬仍与 CDH 呈负相关[OR=0.6（0.4-0.9）]。在调整人口因素、主要头痛类型和使用的药物数量后，CDH 患者比 EH 患者更有可能使用阿片类复合镇痛药，而不太可能使用阿司匹林或布洛芬。
