Takeshima Takao
Department of Neurology, Headache Center, Tominaga Hospital.
Rinsho Shinkeigaku. 2010 Nov;50(11):990-3. doi: 10.5692/clinicalneurol.50.990.
Chronification of migraine headaches is one of the most urgent issues. Chronic migraine (CM) and medication overuse headache (MOH) are defined in international classification of headache disorders II (ICHD-II). Appendix criteria of CM and MOH were submitted and will take over the original criteria. I described a case of CM and a case of MOH. Here I pointed out some practical issues in diagnosis of CM or MOH. 1) It is not easy to define the association of headache worsening and the beginning of medication overuse in many cases. 2) Some patients cannot discontinue the overused drugs; therefore, the diagnosis of CM nor MOH cannot be completed. 3) Some patients are not released from their headache even after the discontinuation of drug. In these cases, there are two possibilities. As a result of CM, the patient had simply overused the ineffective medications. From another point of view, MOH caused irreversible brain changes and MOH do not disappear after the detoxification. 4) In a practical management, we often prescribe preventive medications simultaneously at the beginning of detoxification. In these cases, it is unclear which one of the detoxification or the preventive medication contributes the improvement of headache. The chronification of migraine is regarded as chronification of acute mechanism of migraine, i.e., inflammation of the trigeminovascular system and sensitization of the brain. Apart from medication overuse, there have been reported some new risk factors for migraine chronification, including frequent headache, female sex, obesity, low income, low education, stress by life events, depression, snoring, sleep disorders, and past history of neck or head injury. Chronification of migraine severely disturbs the quality of patient's life. More attention should be paid and the further and extensive studies are urgently necessary.
偏头痛的慢性化是最紧迫的问题之一。慢性偏头痛（CM）和药物过量使用性头痛（MOH）在《国际头痛疾病分类第二版》（ICHD-II）中有定义。CM和MOH的附录标准已提交，并将取代原来的标准。我描述了一例CM病例和一例MOH病例。在此我指出了CM或MOH诊断中的一些实际问题。1）在许多情况下，很难确定头痛加重与药物过量使用开始之间的关联。2）一些患者无法停用过量使用的药物，因此无法完成CM或MOH的诊断。3）一些患者即使在停药后头痛仍未缓解。在这些情况下，有两种可能性。由于CM，患者只是过量使用了无效药物。从另一个角度来看，MOH导致了不可逆的脑部变化，且在排毒后MOH不会消失。4）在实际治疗中，我们常常在排毒开始时同时开具预防性药物。在这些情况下，不清楚是排毒还是预防性药物对头痛的改善有作用。偏头痛的慢性化被认为是偏头痛急性机制的慢性化，即三叉神经血管系统的炎症和大脑的敏化。除了药物过量使用外，还报道了一些偏头痛慢性化的新危险因素，包括频繁头痛、女性、肥胖、低收入、低教育水平、生活事件压力、抑郁、打鼾、睡眠障碍以及颈部或头部受伤史。偏头痛的慢性化严重干扰了患者的生活质量。应给予更多关注，迫切需要进一步广泛的研究。
