Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Headache. 2016 Nov;56(10):1675-1684. doi: 10.1111/head.12881. Epub 2016 Aug 23.
Chronic daily headache (CDH) affects 2% to 4% of the North American and European population. Various pathways lead to this condition, although chronification of migraine and the occurrence of central sensitization in tension headache are the 2 most common. Medication overuse headaches complicate a substantial portion of other primary headaches that have become chronic and often make their treatment more complex and less successful.
METHODS/RESULTS: A 10-step process to help primary care providers evaluate and treat CDH patients begins with excluding secondary headache disorders, then moves on to classification of the primary underlying headache disorder. Next, the exacerbating factors, as well as relevant comorbid conditions, are identified. The patient's current acute therapy is examined, and attempts are made to identify and resolve medication overuse if present. Past preventive therapies are reviewed, allowing for thoughtful design of a headache action plan with preventive, acute, and lifestyle components. Patients are asked to keep a headache diary, used to initiate a cycle of continuous improvement in a patient's response to acute and preventive therapeutic approaches.
A systematic approach and partnership with patients often make it possible to convert CDH to episodic headache that is responsive to both acute and preventive therapies.
慢性每日头痛（CDH）影响北美和欧洲人口的 2%至 4%。尽管偏头痛的慢性化和紧张性头痛中的中枢敏化的发生是最常见的两种，但导致这种情况的各种途径。药物过度使用头痛使许多已经变为慢性的其他原发性头痛变得更加复杂，并且常常使治疗效果更差。
方法/结果：帮助初级保健提供者评估和治疗 CDH 患者的 10 步流程从排除继发性头痛障碍开始，然后继续对原发性潜在头痛障碍进行分类。接下来，确定加重因素以及相关的合并症。检查患者目前的急性治疗方法，并尝试确定和解决药物过度使用的问题（如果存在）。回顾过去的预防性治疗方法，以便可以精心设计头痛行动计划，其中包括预防，急性和生活方式的组成部分。要求患者记录头痛日记，用于启动患者对急性和预防性治疗方法的反应的持续改进循环。
系统的方法和与患者的合作通常可以将 CDH 转变为对急性和预防性治疗均有反应的发作性头痛。
