Diener H-C, Dodick D W, Goadsby P J, Bigal M E, Bussone G, Silberstein S D, Mathew N, Ascher S, Morein J, Hulihan J F, Biondi D M, Greenberg S J
Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, Essen 45122, Germany.
Cephalalgia. 2009 Oct;29(10):1021-7. doi: 10.1111/j.1468-2982.2009.01859.x. Epub 2009 Apr 23.
Chronic migraine has been linked to the excessive use of acute headache medications. Medication overuse (MO) is commonly considered the most significant risk factor for the progression of migraine from an episodic to a chronic condition. Managing MO is a challenge. Discontinuation of the acute medication can result in withdrawal headache, nausea, vomiting and sleep disturbances. This review summarizes the results from two similarly designed, randomized, placebo-controlled, multicentre studies of chronic migraine conducted in the USA and European Union. Both studies demonstrate the efficacy and safety of the migraine preventive medication, topiramate, for the treatment of chronic migraine in patient populations both with and without MO. These studies may have important implications for the future of chronic migraine management, suggesting that detoxification prior to initiating prophylactic therapy may not be required in all patients if MO is present.
慢性偏头痛与过度使用急性头痛药物有关。药物过度使用（MO）通常被认为是偏头痛从发作性转变为慢性疾病的最重要风险因素。管理药物过度使用是一项挑战。停用急性药物可能会导致撤药头痛、恶心、呕吐和睡眠障碍。本综述总结了在美国和欧盟进行的两项设计相似、随机、安慰剂对照、多中心慢性偏头痛研究的结果。两项研究均证明了偏头痛预防性药物托吡酯在治疗伴有或不伴有药物过度使用的患者群体中的慢性偏头痛时的有效性和安全性。这些研究可能对慢性偏头痛管理的未来具有重要意义，表明如果存在药物过度使用，在启动预防性治疗之前可能并非所有患者都需要排毒。
