Department of Neurology, University of Münster, Münster, Germany.
Eur J Neurol. 2011 Sep;18(9):1115-21. doi: 10.1111/j.1468-1331.2011.03497.x.
Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache.
This guideline aims to give treatment recommendations for this headache.
Evaluation of the scientific literature.
Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200mg. Corticosteroids (at least 60mg prednisone or prednisolone) and amitriptyline (up to 50mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse.
Medication overuse headache can be treated according to evidence-based recommendations.
药物过度使用性头痛是一种常见病症，其人群患病率超过 1-2%。治疗方法基于教育、停药治疗（解毒）和预防治疗。还包括对停药头痛的管理。
本指南旨在为这种头痛提供治疗建议。
评估科学文献。
建议突然停止或逐渐减少过度使用的药物，停药治疗的类型可能与患者的治疗结果无关。然而，对于过度使用阿片类药物、苯二氮䓬类药物或巴比妥类药物的患者，建议采用住院治疗。此外，建议在开始停药治疗的第一天甚至之前就开始个体化的预防性药物治疗。唯一有中度证据表明对慢性偏头痛和药物过度使用患者预防性治疗有效的药物是托吡酯，剂量高达 200mg。皮质类固醇（至少 60mg 泼尼松或泼尼松龙）和阿米替林（高达 50mg）可能对治疗停药症状有效。停药治疗后，应定期对患者进行随访，以预防药物过度使用的复发。
可以根据循证建议治疗药物过度使用性头痛。
