Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Norwegian National Headache Centre, St. Olavs University Hospital, Trondheim, Norway Department of Neuroscience, Imperial College London, London, England, UK Department of Neurology, Oslo University Hospital, and University of Oslo, Oslo, Norway.
Pain. 2012 Jan;153(1):56-61. doi: 10.1016/j.pain.2011.08.018. Epub 2011 Oct 22.
Medication-overuse headache (MOH) is relatively common, but its incidence has not been calculated and there are no prospective population-based studies that have evaluated risk factors for developing MOH. The aim of this study was to estimate incidences of and identify risk factors for developing chronic daily headache (CDH) and MOH. This longitudinal population-based cohort study used data from the Nord-Trøndelag Health Surveys performed in 1995-1997 and 2006-2008. Among the 51,383 participants at baseline, 41,766 were eligible approximately 11 years later. There were 26,197 participants (responder rate 63%), among whom 25,596 did not report CDH at baseline in 1995-1997. Of these, 201 (0.8%) had MOH and 246 (1.0%) had CDH without medication overuse (CDHwoO) 11 years later. The incidence of MOH was 0.72 per 1000 person-years (95% confidence interval 0.62-0.81). In the multivariate analyses, a 5-fold risk for developing MOH was found among individuals who at baseline reported regular use of tranquilizers [odds ratio 5.2 (3.0-9.0)] or who had a combination of chronic musculoskeletal complaints, gastrointestinal complaints, and Hospital Anxiety and Depression Scale score ≥ 11 [odds ratio 4.7 (2.4-9.0)]. Smoking and physical inactivity more than doubled the risk of MOH. In contrast, these factors did not increase the risk of CDHwoO. In this large population-based 11-year follow-up study, several risk factors for MOH did not increase the risk for CDHwoO, suggesting these are pathogenetically distinct. If the noted associations are causal, more focus on comorbid condition, physical activity, and use of tobacco and tranquilizers may limit the development of MOH.
药物过度使用性头痛（MOH）较为常见，但目前尚未计算其发病率，也没有前瞻性的基于人群的研究评估其发病的危险因素。本研究旨在评估慢性每日头痛（CDH）和 MOH 的发病率并识别其发病危险因素。本研究为一项基于人群的纵向队列研究，数据来源于 1995-1997 年和 2006-2008 年进行的挪威特隆赫姆健康调查。在基线时的 51383 名参与者中，约 11 年后有 41766 名符合条件。其中 26197 名参与者（应答率为 63%），其中 25596 名在 1995-1997 年基线时未报告 CDH。其中，201 名（0.8%）患有 MOH，246 名（1.0%）患有 CDH 但未滥用药物（CDHwoO），11 年后有 201 名（0.8%）患有 MOH，246 名（1.0%）患有 CDH 但未滥用药物（CDHwoO）。MOH 的发病率为 0.72/1000 人年（95%置信区间 0.62-0.81）。在多变量分析中，基线时报告经常使用镇静剂的个体（比值比 5.2 [3.0-9.0]）或具有慢性肌肉骨骼投诉、胃肠道投诉和医院焦虑和抑郁量表评分≥11 的组合的个体发生 MOH 的风险增加 5 倍[比值比 4.7（2.4-9.0）]。吸烟和身体活动不足会使 MOH 的风险增加一倍以上。相比之下，这些因素并未增加 CDHwoO 的风险。在这项大规模的基于人群的 11 年随访研究中，MOH 的一些危险因素并未增加 CDHwoO 的风险，这表明它们在发病机制上是不同的。如果注意到的关联是因果关系的，更多地关注共病、身体活动以及烟草和镇静剂的使用可能会限制 MOH 的发展。
