非甾体抗炎药治疗偏头痛时发生药物过度使用性头痛的风险：一项严格评价的主题

Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: a critically appraised topic.

作者信息

Starling Amaal J, Hoffman-Snyder Charlene, Halker Rashmi B, Wellik Kay E, Vargas Bert B, Dodick David W, Demaerschalk Bart M, Wingerchuk Dean M

机构信息

Department of Neurology and Library Services, Mayo Clinic, Scottsdale, AZ 85255, USA.

出版信息

Neurologist. 2011 Sep;17(5):297-9. doi: 10.1097/NRL.0b013e31822d109c.

DOI:10.1097/NRL.0b013e31822d109c

PMID:21881477

Abstract

BACKGROUND

The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine.

OBJECTIVE

To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine.

METHODS

The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts.

RESULTS

The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06).

CONCLUSIONS

Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

摘要

背景

药物过度使用性头痛（MOH）的发生与频繁使用镇痛药，尤其是阿片类药物治疗原发性头痛疾病，特别是偏头痛有关。非甾体抗炎药（NSAIDs）常用于治疗偏头痛。

目的

严格评估关于偏头痛患者中与NSAID治疗相关的MOH风险的证据。

方法

通过构建一个结构化的、经过严格评估的主题来实现该目的。这包括一个临床场景、结构化问题、文献检索策略、严格评估、结果、证据总结、评论和最终结论。参与者包括顾问和住院神经科医生、医学图书馆员、临床流行病学家和头痛神经学内容专家。

结果

MOH的1年发病率为2.5%。在基线头痛频率低（每月0至4天）至中度（每月5至9天）的患者中，NSAIDs与进展为MOH无关，可能具有保护作用（优势比=0.31；95%置信区间，0.27 - 0.34）。然而，在基线头痛频率高（每月10至14天）的患者中，NSAIDs与进展为MOH有关（优势比=1.93；95%置信区间，1.82 - 2.06）。