Munksgaard Signe B, Jensen Rigmor H
Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
Headache. 2014 Jul-Aug;54(7):1251-7. doi: 10.1111/head.12408. Epub 2014 Jul 2.
Medication overuse headache (MOH) affects between 1% and 2% of the general population but is present in up to 50% of patients seen in headache centers. There are currently no internationally accepted guidelines for treatment of MOH.
A review of the current literature on MOH treatment and pathophysiology.
We conclude that headache frequency can be reduced to episodic headache in more than 50% of the patients by simple detoxification and information. Approximately half the patients will not have need for prophylactic medication after withdrawal. Pain perception is altered in patients with MOH but can be restored to a baseline pattern, indicating a reversible mechanism in the central sensitization leading to chronic pain. The great comorbidity with depression and anxiety could be a consequence of the altered serotonin metabolism indicating a reversible and potentially treatable condition.
Increased focus on MOH is extremely important, as MOH both can and should be treated and prevented. MOH is thus a diagnosis that should be considered in all chronic headache patients as the very first step in their management strategy. In the general population, prevention campaigns against MOH are essential to minimize chronic pain disability.
药物过量使用性头痛（MOH）在普通人群中的发病率为1%至2%，但在头痛中心就诊的患者中，这一比例高达50%。目前尚无国际公认的MOH治疗指南。
对当前有关MOH治疗和病理生理学的文献进行综述。
我们得出结论，通过简单的排毒和信息告知，超过50%的患者头痛频率可降至发作性头痛。约一半患者在停药后无需预防性用药。MOH患者的疼痛感知发生改变，但可恢复至基线模式，这表明导致慢性疼痛的中枢敏化存在可逆机制。与抑郁和焦虑的高度共病可能是血清素代谢改变的结果，提示这是一种可逆且可能可治疗的状况。
更加关注MOH极为重要，因为MOH既可以也应该得到治疗和预防。因此，MOH是所有慢性头痛患者管理策略中第一步就应考虑的诊断。在普通人群中，开展针对MOH的预防运动对于将慢性疼痛残疾降至最低至关重要。
