Department of Medical and Molecular Sciences, Internal Medicine and Regional Referral Headache Centre, School of Health Sciences, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2011 Dec;15(12):1401-20.
Migraine is an episodic painful disorder occasionally developing into a chronic form. Such disorder represents one of the most common neurological diseases in clinical practice. Chronicization is often accompanied by the appearance of acute drugs overuse. Chronic migraine (CM) constitutes migraine's natural evolution in its chronic form and involves headache frequency of 15 days/month, with features similar to those of migraine attacks. Medication Overuse Headache (MOH) has been defined as a headache present on > or = 15 days/month, with regular overuse for > 3 months of one or more drugs used for acute and/or symptomatic headache management. Subtypes of MOH attributed to different medications were delineated. Misuse of ergots, triptans, opioids or combination analgesics on > or = 10 days/month was required to make the diagnosis of MOH, while > or = 15 days/month were needed for simple analgesic-overuse headache. CM's low prevalence produces an extremely high disability grade. Therefore, special attention should be paid to both control and reduction of risk factors which might favour the migraine chronicization process and/or the outbreak of MOH. In MOH sufferers, the only treatment of choice is represented by drug withdrawal. Successful detoxification is necessary to ensure improvement in the headache status when treating patients who overuse acute medications. Different procedures have been suggested for withdrawal namely at home, at the hospital, with or without the use of steroids, with re-prophylaxis performed immediately or at the end of the washout period. At the moment we have not a total agreement whether prophylactic treatment should be started before, during, or after discontinuation of the overuse drug. Both drugs have been approved for CM treatment in view of their well-defined resistance to previous prophylaxis drugs. Recently, the PREEMPT clinical program has confirmed onabotulinumtoxinA as an effective, safe, and well-tolerated prophylactic treatment for adults with CM.
偏头痛是一种间歇性疼痛障碍，偶尔会发展为慢性形式。这种疾病是临床实践中最常见的神经疾病之一。慢性化通常伴随着急性药物过度使用的出现。慢性偏头痛（CM）构成偏头痛在慢性形式下的自然演变，涉及头痛频率为 15 天/月，其特征与偏头痛发作相似。药物过度使用性头痛（MOH）已被定义为头痛存在于>或= 15 天/月，且> 3 个月内定期过度使用一种或多种用于急性和/或对症头痛管理的药物。已划定归因于不同药物的 MOH 亚型。需要>或= 10 天/月的麦角生物碱、曲坦类、阿片类药物或组合镇痛药的滥用，才能诊断为 MOH，而简单镇痛药过度使用性头痛则需要>或= 15 天/月。CM 的低患病率导致极高的残疾等级。因此，应特别注意控制和减少可能有利于偏头痛慢性化过程和/或 MOH 爆发的危险因素。在 MOH 患者中，唯一的治疗选择是停药。成功戒毒对于治疗过度使用急性药物的患者改善头痛状况是必要的。已经提出了不同的戒毒程序，即在家中、在医院中、使用或不使用类固醇、立即或在冲洗期结束时进行重新预防。目前，我们尚未就预防性治疗应在停药前、期间还是之后开始达成完全一致。鉴于对以前预防药物的耐药性，这两种药物都已被批准用于 CM 的治疗。最近，PREEMPT 临床项目证实了 onabotulinumtoxinA 作为成人 CM 的有效、安全且耐受良好的预防性治疗。
